Mano Roy, Goldberg Hanan, Stabholz Yariv, Hazan Danny, Margel David, Kedar Daniel, Baniel Jack, Yossepowitch Ofer
Department of Urology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Urology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Urology. 2018 Jun;116:87-92. doi: 10.1016/j.urology.2018.03.042. Epub 2018 Apr 4.
To compare the incidence rate of urinary tract infections (UTIs) and associated pathogens between patients with ileal conduit and patients with orthotopic neobladder urinary diversion.
The medical records of 179 patients treated with radical cystectomy between 2006 and 2011 were reviewed and data pertaining to postoperative UTI were collected. UTI incidence was reported at 3 months' intervals and compared by diversion type. Preoperative predictors of UTI were evaluated with Cox regression analyses.
The study cohort included 130 patients with ileal conduit and 49 patients with orthotopic neobladder. Patients with a neobladder were younger (P <.001). Median follow-up was 38 months (IQR [interquartile range], 11-63). Median time from surgery to first infection was 1.5 months (IQR, 1-12.5) for patients with a neobladder and 11 months (IQR, 2.5-27) for patients with a conduit (P = .04). During the first 3 months after surgery, 29% of the patients with a neobladder and 8% of the patients with ileal conduit had a UTI episode (P = .001). Rates of UTI did not differ during subsequent follow-up. Diversion type was not associated with UTI on multivariable analysis. Escherichia coli was the most common pathogen in patients with a conduit (58%), and Klebsiella spp. in patients with a neobladder (29%).
The risk of UTI is significantly higher in patients with a neobladder during the first 3 months after surgery and comparable to patients with ileal conduit during subsequent follow-up. These findings may facilitate preoperative counseling regarding the expected risk of UTI after urinary diversion.
比较回肠膀胱术患者与原位新膀胱尿流改道术患者的尿路感染（UTI）发生率及相关病原体。
回顾性分析2006年至2011年间接受根治性膀胱切除术的179例患者的病历，并收集术后UTI相关数据。每隔3个月报告UTI发生率，并按尿流改道类型进行比较。采用Cox回归分析评估UTI的术前预测因素。
研究队列包括130例回肠膀胱术患者和49例原位新膀胱患者。新膀胱患者更年轻（P <0.001）。中位随访时间为38个月（四分位间距[IQR]，11 - 63）。新膀胱患者从手术到首次感染的中位时间为1.5个月（IQR，1 - 12.5），回肠膀胱术患者为11个月（IQR，2.5 - 27）（P =0.04）。术后前3个月，29%的新膀胱患者和8%的回肠膀胱术患者发生UTI发作（P =0.001）。后续随访期间UTI发生率无差异。多变量分析显示尿流改道类型与UTI无关。大肠埃希菌是回肠膀胱术患者中最常见的病原体（58%），肺炎克雷伯菌是新膀胱患者中最常见的病原体（29%）。
新膀胱患者术后前3个月UTI风险显著高于回肠膀胱术患者，后续随访期间两者相当。这些发现可能有助于术前就尿流改道后UTI的预期风险进行咨询。
