Clinical Significance of Bacteriuria in Patients with Orthotopic Sigmoid Neobladder after Radical Cystectomy

ABSTRACT

Objectives: To evaluate the incidence and clinical significance of bacteriuria in patients who underwent sigmoid neobladder substitution after radical cystectomy. Patients and Methods: The study included 149 patients with invasive bladder carcinoma who underwent radical cystectomy and orthotopic sigmoid bladder substitution. Diagnosis of bacteriuria was made by freshly collected midstream urine culture at 3; 6 and 12 months postoperatively. Positive urinary culture was defined as 100 000 colony forming units (CFU)/ml. The data collected were evaluated in correlation to the clinical status of the patients. Results: Overall 466 urine samples from 149 patients were cultured during the follow-up period. Out of these 149 patients; 18 were lost to follow-up and 11 patients developed new stone formation in the neobladder with an incidence of bacteriuria of 91. These 29 patients were excluded from the study. Among the remaining 120 patients; positive urine culture with significant growth of uropathogens was seen in 64; 47and 33at 3; 6 and 12 months; respectively. Two thirds of patients with positive urine cultures were asymptomatic. The commonest uropathogen encountered was E Coli (72) followed by Klebsiella (12). Conclusion: Sigmoid neobladder substitution is associated with a high incidence of bacteriuria. Despite; the spontaneous clearance of bacteriuria over time without antimicrobial manipulation; antimicrobial therapy was needed in some patients; particularly those with a large post-void residual (PVR) urine volume; persistent urosepsis and stone formation in the neobladder