Bacterial adherence in the human ileal conduit: a morphological and bacteriological study.

A retrospective study of 50 patients with urinary diversion was undertaken to determine the incidence of bacteriuria and upper tract infection. Eighty-four per cent of these patients developed bacteriuria caused by a variety of pathogenic organisms and 14 per cent had clinical evidence of pyelonephritis. A phased morphological and bacteriological study was then carried out in a further 17 patients with ileal conduits. Electron microscopy examination of cup biopsy specimens from superficial and deep segments of the conduit showed virtually no bacteria adhering to the columnar cells of the conduit, although Gram positive cocci were seen adhering to the keratinized cells from the muco-cutaneous junction. However, the conduit mucus was heavily colonized, initially with yeasts, then sequentially with microcolonies of Gram-positive and Gram-negative bacteria, up to 16 years after urinary diversion had been performed. Bacteriological examination of conduit and stomal mucus and urine specimens of these 17 patients confirmed the presence of large numbers of uropathogens . Of 23 conduit isolates, 9 possessed hemagglutinins, 18 of 18 attached to uroepithelial cells in vitro and 6 of 6 attached to ureteral transitional cells in vitro, indicating their adhesive and pathogenic capabilities.