PD11-12 URINARY TRACT INFECTION AFTER URINARY DIVERSION – DIFFERENT PATTERNS OF OCCURRENCE IN PATIENTS WITH ILEAL CONDUIT AND ORTHOTOPIC NEOBLADDER (2015)

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion II1 Apr 2015PD11-12 URINARY TRACT INFECTION AFTER URINARY DIVERSION – DIFFERENT PATTERNS OF OCCURRENCE IN PATIENTS WITH ILEAL CONDUIT AND ORTHOTOPIC NEOBLADDER Roy Mano, Hanan Goldberg, Yariv Stabholz, Danny Hazan, Daniel Kedar, Jack Baniel, and Ofer Yossepowitch Roy ManoRoy Mano More articles by this author , Hanan GoldbergHanan Goldberg More articles by this author , Yariv StabholzYariv Stabholz More articles by this author , Danny HazanDanny Hazan More articles by this author , Daniel KedarDaniel Kedar More articles by this author , Jack BanielJack Baniel More articles by this author , and Ofer YossepowitchOfer Yossepowitch More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1101AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ileal conduit (IC) urinary diversion has been associated with a lower rate of postoperative urinary tract infections (UTI) compared to orthotopic neobladder (ONB) diversion; however, the pattern of UTI episodes after surgery has not been well defined. We aimed to compare the pattern of UTI episodes and associated pathogens in patients with IC and ONB. METHODS Our institutional radical cystectomy database was queried to retrieve the medical records of 179 patients treated between 2006 - 2011. Data pertaining to febrile UTI after surgery were collected. Estimated probability of UTI was calculated using the Kaplan Meier method. The number of UTI episodes at 3 months intervals was reported as the percentage of patients available for followup during the specific interval. Rates of UTI were compared between the IC and ONB groups using the Fisher exact test. RESULTS The study cohort consisted of 130 IC and 49 ONB patients. Patients with ONB were younger than IC patients (median age 60 years vs. 72 years, p<0.001). Median followup was 38 months (IQR 11-63). The rate of UTI events stratified by diversion type during the first 3 years after surgery is illustrated in the figure. Median time from surgery to first infection was 1.5 months (IQR, 1 – 12.5) for ONB patients and 11 months (IQR, 2.5 – 27) for IC patients (p=0.04, log-rank test). During the first 3 months after surgery 14/48 ONB patients (29%) had at least one UTI episode compared to 10/120 IC patients (8%), p=0.001. Rates of UTI did not differ significantly between the groups during subsequent follow-up. Associated comorbidities, presence of diabetes and a positive preoperative urine culture had no impact on rates of UTI. Most infections in IC patients (31/52, 60%) were caused by E. Coli. Common pathogen in ONB patients were Klebsiella (12/41, 29%), E. Coli (10/41, 24%), and P. Aeruginosa (9/41, 22%). CONCLUSIONS The risk of febrile UTI during the initial 3 months after surgery is significantly higher in patients with ONB compared to IC urinary diversion, however, appears to be comparable during subsequent followup. Common causative pathogens and antibiotic susceptibilities differ between the two groups. These findings may facilitate preoperative counseling regarding the expected risk and pattern of UTI episodes after urinary diversion. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e255 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roy Mano More articles by this author Hanan Goldberg More articles by this author Yariv Stabholz More articles by this author Danny Hazan More articles by this author Daniel Kedar More articles by this author Jack Baniel More articles by this author Ofer Yossepowitch More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...