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Original Research

Open Access

FEBRILE URINARY TRACT INFECTION AFTER RADICAL CYSTECTOMY WITH URINARY DIVERSION: DIFFERENT CHARACTERISTICS IN PATIENTS WITH ILEAL CONDUIT AND ORTHOTOPIC NEOBLADDER

  • Seungsoo Lee1
  • Seung Ryong Baek1
  • Won Hoon Song1
  • Tae Nam Kim2
  • Sung-Woo Park1
  • Jong Kil Nam1

1Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea

2Department of Urology, Pusan National University Hospital, Busan, Korea

DOI: 10.15586/jomh.v16i3.246 Vol.16,Issue 3,July 2020 pp.38-46

Published: 16 July 2020

*Corresponding Author(s): Jong Kil Nam E-mail: tuff-kil@hanmail.net

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Abstract

Background and Objective

To compare the incidence of febrile urinary tract infection (UTI) and bacterial identification between patients with orthotopic neobladder (ONB) and ileal conduit (IC).

Materials and Methods

Data of 164 patients who underwent radical cystectomy with ONB and IC for bladder cancer between January 2009 and January 2018 at our institution were analyzed. Febrile UTI observed was listed and subsequently compared. Incidence of febrile UTI, clinicopathological characteristics, and microorganisms identified were reported at 3 months interval; and preoperative predictors of febrile UTI were evaluated with Cox regression analysis. Patients were divided into ONB and IC.

Results

The study cohort included 52 patients with ONB and 112 patients with IC. Febrile UTI was diagnosed in 49 (29.9%) patients. Compared to IC group, ONB group had significantly higher incidence of young age (p=0.00), lower cancer stage (p=0.013), longer hospital stay (p=0.049), longer operation time (p=0.00), and higher incidence of febrile UTI within the first 3 months after surgery (p=0.006). On univariable and multivariable analysis, factors associated with significantly increased febrile UTI risk were diabetes (odds ratio [OR]: 4.52; p=0.002) and ONB diversion (OR: 1.27; p=0.031). Forty-four (89.8%) patients were culture positive. However, significant difference in microorganisms was not detected between patients who under-went ONB or IC diversion.

Conclusion

Diabetes and ONB diversion were associated with higher risk symptomatic UTI following radical cystectomy.

Keywords

urinary tract infections; urinary bladder neoplasms; urinary diversion

Cite and Share

Seungsoo Lee,Seung Ryong Baek,Won Hoon Song,Tae Nam Kim,Sung-Woo Park,Jong Kil Nam. FEBRILE URINARY TRACT INFECTION AFTER RADICAL CYSTECTOMY WITH URINARY DIVERSION: DIFFERENT CHARACTERISTICS IN PATIENTS WITH ILEAL CONDUIT AND ORTHOTOPIC NEOBLADDER. Journal of Men's Health. 2020. 16(3);38-46.

References

1. Meyer JP, Blick C, Arumainayagam N, et al. A three-centre experience of orthotopic neoblad-der reconstruction after radical cystectomy:Revisiting the initial experience, and results in 104 patients. BJU Int 2009;103:680–3. https://doi. org/10.1111/j.1464-410X.2008.08204.x

2. Cookson MS, Chang SS, Wells N, et al. Complications of radical cystectomy for nonmuscle invasive disease: Comparison with muscle inva-sive disease. J Urol 2003;169:101–4. https://doi. org/10.1016/S0022-5347(05)64045-1

3. Hautmann RE. Urinary diversion: Ileal conduit to neobladder. J Urol 2003;169:834–42. https://doi. org/10.1097/01.ju.0000029010.97686.eb

4. Lawrentschuk N, Colombo R, Hakenberg OW, et al. Prevention and management of complications fol-lowing radical cystectomy for bladder cancer. Eur Urol 2010;57:983–1001. https://doi.org/10.1016/j. eururo.2010.02.024

5. Lowrance WT, Rumohr JA, Chang SS, et al. Contemporary open radical cystectomy: Analysis of perioperative outcomes. J Urol 2008;179:1313–8. https://doi.org/10.1016/j.juro.2007.11.084

6. Nazmy M, Yuh B, Kawachi M, et al. Early and late complications of robot-assisted radical cystectomy: A standardized analysis by urinary diversion type. J Urol 2014;191:681–7. https://doi.org/10.1016/j. juro.2013.10.022

7. Pariser JJ, Anderson BB, Pearce SM, et al. The effect of broader, directed antimicrobial prophylaxis including fungal coverage on perioperative infec-tious complications after radical cystectomy. Urol Oncol 2016;34:121.e9–14. https://doi.org/10.1016/j. urolonc.2015.10.007

8. Kang J, Baek SE, Kim T, et al. Impact of fat obe-sity on laparoscopic total mesorectal excision: More reliable indicator than body mass index. Int J Colorectal Dis 2012;27:497–505. https://doi. org/10.1007/s00384-011-1333-2

9. Edge SB, Compton CC. The American Joint Committee on Cancer: The 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010;17:1471–4. https://doi.org/10.1245/s10434-010-0985-4

10. Ramakrishnan K, Scheid DC. Diagnosis and man-agement of acute pyelonephritis in adults. Am Fam Physician 2005;71:933–42.

11. Lavallée LT, Schramm D, Witiuk K, et al. Perioperative morbidity associated with radical cystectomy in a multicenter database of community andacademichospitals.PLoSOne2014;9:e111281. https://doi.org/10.1371/journal.pone.0111281

12. Shabsigh A, Korets R, Vora KC, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 2009;55:164–74. https://doi. org/10.1016/j.eururo.2008.07.031

13. Mano R, Baniel J, Goldberg H, et al. Urinary tract infections in patients with orthotopic neo-bladder. Urol Oncol 2014;32:50.e9–14. https://doi. org/10.1016/j.urolonc.2013.07.017

14. Daneshmand S, Ahmadi H, Schuckman AK, et al. Enhanced recovery protocol after radical cys-tectomy for bladder cancer. J Urol 2014;192: 50–5. https://doi.org/10.1016/j.juro.2014.01.097

15. Parker WP, Toussi A, Tollefson MK, et al. Risk factors and microbial distribution of urinary tract infections following radical cystectomy. Urology 2016;94:96–101. https://doi.org/10.1016/j. urology.2016.03.049

16. van Hemelrijck M, Thorstenson A, Smith P, et al. Risk of in-hospital complications after radical cys-tectomy for urinary bladder carcinoma: Population-based follow-up study of 7608 patients. BJU Int 2013;112:1113–20. https://doi.org/10.1111/bju.12239

17. Falagas ME, Vergidis PI. Urinary tract infections in patients with urinary diversion. Am J Kidney Dis 2005;46:1030–7. https://doi.org/10.1053/j. ajkd.2005.09.008

18. Mano R, Goldberg H, Stabholz Y, et al. Urinary tract infections after urinary diversion-different occurrence patterns in patients with ileal con-duit and orthotopic neobladder. Urology 2018;116: 87–92. https://doi.org/10.1016/j.urology.2018.03.042

19. Wang D, Li LJ, Liu J, et al. Long-term urodynamic eval-uation of laparoscopic radical cystectomy with orthot-opic ileal neobladder for bladder cancer. Oncol Lett 2014;8:1031–4. https://doi.org/10.3892/ol.2014.2281

20. Di Tonno F, Siracusano S, Ciciliato S, et al. Morphological changes on the intestinal mucosa in orthotopic neobladder. Urol Int 2012;89:67–70. https://doi.org/10.1159/000338168

21. Senkul T, Yildirim S, Iseri C, wtal. Histopathologic changes in the mucosa of ileal orthotopic neoblad-der-findings in 24 patients followed up for 5 years. Scand J Urol Nephrol 2003;37:202–4. https://doi. org/10.1080/00365590310008046

22. Chen SL, Jackson SL, Boyko EJ. Diabetes mellitus and urinary tract infection: Epidemiology, patho-genesis and proposed studies in animal models. J Urol 2009;182:S51–6. https://doi.org/10.1016/j. juro.2009.07.090

23. Wilke T, Boettger B, Berg B, et al. Epidemiology of urinary tract infections in type 2 diabetes mel-litus patients: An analysis based on a large sam-ple of 456,586 German T2DM patients. J Diabetes Complications 2015;29:1015–23. https://doi. org/10.1016/j.jdiacomp.2015.08.021

24. Keegan SJ, Graham C, Neal DE, et al. Characterization of Escherichia coli strains causing urinary tract infections in patients with transposed intestinal segments. J Urol 2003;169:2382–7. https://doi.org/10.1097/01.ju.0000067445.83715.7b

25. Suriano F, Gallucci M, Flammia GP, et al. Bacteriuria in patients with an orthotopic ileal neo-bladder: Urinary tract infection or asymptomatic bacteriuria? BJU Int 2008;101:1576–9. https://doi. org/10.1111/j.1464-410X.2007.07366.x

26. Bonadio M, Costarelli S, Morelli G, et al. The influence of diabetes mellitus on the spectrum of uropathogens and the antimicrobial resis-tance in elderly adult patients with urinary tract infection. BMC Infect Dis 2006;6:54. https://doi. org/10.1186/1471-2334-6-54

27. Papazafiropoulou A, Daniil I, Sotiropoulos A, et al. Urinary tract infection, uropathogens and anti-microbial resistance in diabetic and nondiabetic patients. Diabetes Res Clin Pract 2009;85:e12– 3. https://doi.org/10.1016/j.diabres.2009.04.020

28. Meiland R, Geerlings SE, De Neeling AJ, et al. Diabetes mellitus in itself is not a risk factor for anti-biotic resistance in Escherichia coli isolated from patients with bacteriuria. Diabet Med 2004;21:1032–

4. https://doi.org/10.1111/j.1464-5491.2004.01169.x

29. Hautmann RE, de Petriconi R, Gottfried HW, et al. The ileal neobladder: Complications and functional results in 363 patients after 11 years of followup. J Urol 1999;161:422–7. https://doi.org/10.1016/S0022-5347(01)61909-8

30. Elmajian DA, Stein JP, Esrig D, et al. The Kock ileal neobladder: Updated experience in 295 male patients. J Urol 1996;156:920–5. https://doi. org/10.1016/S0022-5347(01)65663-5

31.Arai Y, Taki Y, Kawase N, et al. Orthotopic ileal neobladder in male patients: Functional outcomes of 66 cases. Int J Urol 1999;6:388–92. https://doi.org/10.1046/j.1442-2042.1999.00084.x

32. Wullt B, Holst E, Steven K, et al. Microbial ora in ileal and colonic neobladders. Eur Urol 2004;45: 233–9. https://doi.org/10.1016/j.eururo.2003.09.002

33. Wood DP Jr, Bianco FJ Jr, Pontes JE, et al. Incidence and signi􆙩cance of positive urine cultures in patients with an orthotopic neobladder. J Urol 2003;169:2196–9. https://doi.org/10.1097/01. ju.0000067909.98836.91

34. Studer UE, Stenzl A, Mansson W, et al. Bladder replacement and urinary diversion. Eur Urol 2000;38:790–800. https://doi.org/10.1159/000020385

35. Ordorica RC, Masel J, Seigne J, et al. Evaluation and management of mechanical dysfunction in continent colonic urinary reservoirs. J Urol 2000;163:1679–84. https://doi.org/10.1016/S0022-5347(05)67519-2

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