The urinary bacterial flora in patients with three types of urinary tract diversion

Abstract

SUMMARY.There is known to be a high risk of malignancy at uretero-colic anastomoses and it has been postulated that bacteria catalyse both the local formation and the activation of carcinogens such as N-nitrosamines. If this theory is correct, then the risk of malignancy should be greatest when the prevalence of mixed urinary tract infection is greatest.Bacterial culture was performed on samples of urine obtained from 56 patients with three forms of urinary tract diversion: ureterosigmoidostomy, isolated ileal and colon conduits. As expected, the rectal urine of all patients with a ureterosigmoidostomy had a rich bacterial flora. However, 1 1 of the 15 patients with ileal conduits (73%) had significant mixed growths of bacteria in the loop urine, whereas only six out of 16 colon loop urines (37.5%) were infected, all being monobacterial infections. The implications of these bacteriological findings for carcinogenesis associated with urinary diversion are discussed.

Perioperative antibiotics in radical cystectomy with ileal conduit urinary diversion: Efficacy and risk of antimicrobial prophylaxis on the operation day alone

“…SSI in radical surgery with urinary diversion for invasive bladder cancer may depend on two biological and two technical factors. The former involve the patient's underlying condition and extent of the primary disease, and the latter are associated with the surgical technique and urinary diversion 1,13 , 16 . We discuss the present results concerning these factors.…”

“…The present study showed that most SSI accompanied by diversion can be prevented by AMP on the operative day. Although conduit urine is bacteriuric in most cases, 16 its contribution to SSI is thought to be small. Our results may be useful also in cases requiring urinary diversion for congenital malformations, neurological disorders and incurable inflammatory disease of the urinary tract.…”

Management of urolithiasis in patients after urinary diversions

“…Most patients with urinary diversions become colonized with a multitude of bacteria regardless of the type of diversion. Colonization rates range from 14 to 96%[9–13]. Nonetheless, most of these patients ultimately remain asymptomatic, despite colonization with known uropathogens.…”

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“…Subsequently, Farshi has confirmed the presence of bacterial colonies on the surface of 68% of ureteral stents, although in only 30% of patients was the urine culture was positive [28,29,45]. This author has also shown the correlation between the urinary tract infection and the duration of ureteral stenting [46][47][48][49]. Lifshitz [9] has confirmed the presence of bacterial colonies on the surface of 28-90% of ureteral stents and significant bacteriuria in only 7-34% of patients.…”