Limited value of the Fairley test in urologic infections in patients with neuropathic bladders.

In an attempt to localize sites of urinary tract infection, a combined Fairley washout test and prostatic localization was performed on 110 spinal cord injured (SCI) patients with neurogenic bladder dysfunction and a history of recurrent bacteriuria. Analysis of 100 patients demonstrated both single and double site of localization. Single sites of localization involved: upper tract 21 of 92 (23%), bladder 15 of 92 (16%), prostate eight of 92 (9%), and 48 of 92 (52%) undetermined. In eight cases, double site of localization was documented: prostate and upper tract six of eight (75%), prostate and bladder one of eight (12%), and prostate and undetermined one of eight (12%). Eighty-seven patients were followed post localization with urine cultures on the fourth or tenth day post procedure; 27 patients (31%) became sterile post localization, 55 patients (63%) stayed infected (greater than or equal to 10(4) colonies/ml), and five patients (6%) had less than 10(4) colonies/ml. Limitation of the Fairley washout may be attributed to the following: difficulty in sterilizing large atonic and trabeculated bladders, TUR sphincterotomy with widely open bladder neck, and heavy urethral colonization from use of external urinary collecting devices. Our modification of Fairley's test included irrigation of the urethra in seven patients. The final bladder irrigant specimen was positive in only one patient compared to 16 of 37 patients without urethral irrigation. We conclude that the ability of the modified Fairley washout and prostatic localization to diagnose the site of urinary tract infection in an SCI population is limited. However, as a mechanical washout for asymptomatic bacteriuria, the Fairley test was found to be beneficial in 31% of the patients as a therapeutic modality.