Sakai Y, Fujisawa M, Nakano Y, Miyazaki S, Arakawa S, Kamidono S
Department of Urology, Kobe University School of Medicine, Kobe, Japan.
J Urol. 2000 Dec;164(6):2104-7.
Various intestinal segments are used to reconstruct the urinary tract. For unclear reasons asymptomatic chronic bacteriuria is common in patients treated with reconstruction. We compared bacterial adherence in ileum, colon and bladder in rats with ileal and colonic bladder augmentation.
Bladder augmentation using ileum or colon was performed in 8-week-old rats. After 3 months urinary pH was measured and urine was cultured. Urovirulence factors of Escherichia coli aspirated from the augmented bladders were detected by polymerase chain reaction. In rats with negative urine culture after augmentation experimental cystitis was induced by the transurethral inoculation of E. coli C5, with type I pili and aerobactin or E. coli C92 with type I pili, P fimbriae and aerobactin at a concentration of 10(5) colony forming units per 0.3 ml. After 14 days we counted the colony forming units per cm.(2) of bladder and cm.(2) of intestinal augmentation tissue.
When cultures were negative, mean urinary pH plus or minus standard deviation for ileocystoplasty (7.35 +/- 0.33) was significantly higher than that for colocystoplasty (6.80 +/- 0.45) or in controls (6.67 +/- 0.30). Bacterial colonization occurred in 60 of 96 ileocystoplasties (62.5%) and 36 of 68 colocystoplasties (52.9%). All 32 E. coli strains aspirated from ileocystoplasties had type I pili. In colocystoplasties 14 strains had type I pili, 4 had P fimbriae and type I pili, and 1 had no virulence factor. In experimental cystitis in the ileal patch and bladder there were 10(3.2) to 10(6.2) (log mean 4.9) and 10(1.1) to 10(5.1) (log mean 3.5) colony forming units of E. coli C5, respectively. In the colonic patch and bladder there were 10(2.2) to 10(6.2) (log mean 3.9) and 10(2.1) to 10(5.1) (log mean 3.7) colony forming units of E. coli C5, respectively. In the ileal patch and bladder versus the colonic patch and bladder there were 10(3.2) to 10(6.2) (log mean 5.0) and 10(3.1) to 10(6.1) (log mean 4.5) versus 10(3.2) to 10(6.2) (log mean 4.3) and 10(2.1) to 10(6.1) (log mean 3.8) colony forming units of E. coli C92, respectively. E. coli C5 adhered to more ileum than bladder, while bacterial adherence did not differ for colon and bladder. Adherence of E. coli C92 did not differ significantly in bladder and implanted ileum or colon.
The colonic segment offers more resistance to E. coli than the ileal segment in urinary diversion.
使用各种肠段重建尿路。原因不明的是，无症状慢性菌尿在接受重建治疗的患者中很常见。我们比较了回肠、结肠和膀胱在大鼠回肠和结肠膀胱扩大术中的细菌黏附情况。
对8周龄大鼠进行回肠或结肠膀胱扩大术。3个月后测量尿pH值并进行尿液培养。通过聚合酶链反应检测从扩大膀胱中吸出的大肠杆菌的尿路致病因子。在扩大术后尿培养阴性的大鼠中，经尿道接种浓度为每0.3 ml 10(5) 菌落形成单位的带有I型菌毛和气杆菌素的大肠杆菌C5或带有I型菌毛、P菌毛和气杆菌素的大肠杆菌C92诱导实验性膀胱炎。14天后，我们计算每平方厘米膀胱和每平方厘米肠道扩大组织中的菌落形成单位数。
当培养结果为阴性时，回肠膀胱扩大术的平均尿pH值加减标准差（7.35±0.33）显著高于结肠膀胱扩大术（6.80±0.45）或对照组（6.67±0.30）。96例回肠膀胱扩大术中60例（62.5%）发生细菌定植，68例结肠膀胱扩大术中36例（52.9%）发生细菌定植。从回肠膀胱扩大术中吸出的所有32株大肠杆菌均有I型菌毛。在结肠膀胱扩大术中，14株有I型菌毛，4株有P菌毛和I型菌毛，1株无致病因子。在回肠补片和膀胱的实验性膀胱炎中，大肠杆菌C5的菌落形成单位分别为10(3.2)至10(6.
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