Urinary findings in 20 asymptomatic patients with an ileal conduit

Systematic review: bacterial colonisation of conduits and neobladders-when to test, watch, and treat

BACKGROUND

Urinary diversion procedures frequently result in bacterial colonisation. There is an increased incidence of developing urinary tract infections (UTIs) in this patient population. Current guidelines, however, recommend against treating this colonisation. This systematic review aimed to determine when and how to test, monitor, and treat bacteriuria in patients with urinary diversion.

METHODS

A systematic search strategy was conducted based on keywords "urinary diversion" and "bacteriuria", on MEDLINE, Embase, and Google Scholar. Articles were screened and included only if they reported on (i) testing methods for bacteriuria, (ii) surveillance of bacteriuria over time, or (iii) when and how to treat bacteriuria. Results were summarised and reported using a narrative synthesis.

RESULTS

Altogether, 26 studies were included in this review. Inconsistencies were noted in the definitions of bacteriuria, with most studies reporting bacteriuria as > 10⁴ cfu/mL (8/17 studies). Bacteriuria prevalence varied greatly (range 9.1-100%). Monitoring bacteriuria over time may help detect a reduction in bacteriuria, as demonstrated in three studies (follow-up range 5-18 months; sample size 18-56). The link between preceding bacteriuria and subsequent UTIs has not been fully explored yet. Short-term antimicrobial therapy may be useful in the immediate post-operative setting; however, long-term prophylactic treatment is ineffective in preventing bacteriuria.

CONCLUSIONS

We recommend consistent reporting of bacteriuria definitions, the benefits of monitoring bacteriuria over time, and use of short-term antimicrobial therapy; bacteriuria should not be treated with long-term therapy.

Bladder, bowel and bugs--bacteriuria in patients with intestinal urinary diversion

The incorporation of intestinal segments into the urinary tract favors bacterial growth of the skin flora, anaerobic bacteria, and uropathogenic strains. The route of infection is ascending; bacteria enter the urethra or the abdominal stoma, which is followed by colonization of the reconstructed lower urinary tract. Bacteriuria is common in all kind of reconstructions; however, urine from neobladder patients with complete emptying is reported to carry bacteria to a lesser extent. Clean intermittent catheterization and residual urine seem to increase the bacterial burden. Patients with augmentation cystoplasties constitute a distinct subgroup in which the remaining part of the bladder tissue is an important determinant of urinary tract susceptibility to infection. The increased rate of bacteriuria in the reconstructed patients indicates a lack of "antibacterial defenses", and the symptom free state of the patients suggests that only a restricted host response is triggered. The role of the specific and inflammatory antibacterial defenses in the reconstructed lower urinary tract remains largely unknown.