Wood David P, Bianco Fernando J, Pontes J Edson, Heath Martha A, DaJusta Daniel
Department of Urology, Wayne State University, Detroit, Michigan 48109-0330, USA.
J Urol. 2003 Jun;169(6):2196-9. doi: 10.1097/01.ju.0000067909.98836.91.
With an intact normal bladder bacterial colonization is uncommon unless intermittent catheterization is instituted. Because intestine, which is normally colonized with bacteria, is used to form an orthotopic neobladder, we determined whether patients with orthotopic urinary diversion are at increased risk for urinary tract infection and urosepsis.
A total of 66 patients who received an orthotopic neobladder after radical cystectomy were prospectively evaluated with urinalysis and culture 2 months to 4 years postoperatively. No patient was on suppressive antibiotics unless they had recurrent urinary tract infections.
A total of 55 voided normally and 11 performed intermittent catheterization at least once daily due to high post-void residual urine. Of the patients who voided normally 78% had at least 1 positive urinalysis. If a patient had a positive urinalysis, bacteria was identified on culture in 50%. Overall 26 (39%) and 8 (12%) patients had a urinary tract infection and urosepsis, respectively. The estimated 5-year probability of urinary tract infection and urosepsis for patients who voided independently were 58% and 18%, respectively. Urine culture with greater than 100,000 cfu bacteria and female gender were the only factors predictive of urinary tract infection on multivariate analysis. Recurrent urinary tract infection was the only predictor for urosepsis. Intermittent catheterization or hydronephrosis was not related to urinary tract infection or urosepsis.
The presence of small bowel intestine appears to promote asymptomatic bacterial colonization but urosepsis rarely occurs unless the patient has recurrent urinary tract infections. Prophylactic antibiotics are recommended only for patients with recurring urinary tract infections but treating a positive urinary culture in the absence of specific voiding symptoms is not advocated in this patient population.
在膀胱功能正常且未进行间歇性导尿的情况下，膀胱细菌定植并不常见。由于通常有细菌定植的肠道被用于构建原位新膀胱，我们确定接受原位尿流改道的患者是否有更高的尿路感染和尿脓毒症风险。
对66例行根治性膀胱切除术后接受原位新膀胱的患者进行前瞻性评估，术后2个月至4年进行尿液分析和培养。除非有复发性尿路感染，否则患者不使用预防性抗生素。
共有55例患者排尿正常，11例因排尿后残余尿量多而至少每日进行一次间歇性导尿。在排尿正常的患者中，78%的患者至少有1次尿液分析呈阳性。如果患者尿液分析呈阳性，培养发现细菌的比例为50%。总体而言，分别有26例（39%）和8例（12%）患者发生尿路感染和尿脓毒症。独立排尿患者尿路感染和尿脓毒症的估计5年发生率分别为58%和18%。多因素分析显示，尿液培养细菌菌落数大于100,000 cfu和女性是尿路感染的唯一预测因素。复发性尿路感染是尿脓毒症的唯一预测因素。间歇性导尿或肾积水与尿路感染或尿脓毒症无关。
小肠的存在似乎促进了无症状细菌定植，但除非患者有复发性尿路感染，否则很少发生尿脓毒症。仅建议对复发性尿路感染患者使用预防性抗生素，但不主张在该患者群体中对无特定排尿症状的阳性尿培养进行治疗。
