title: Complications of clam enterocystoplasty with particular reference to urinary tract infection.
abstract: A study was carried out on 112 patients who had undergone a clam procedure. Follow-up extended from 15 months to 8 years. The efficacy of the operation in achieving and maintaining continence in patients with instability and hyper-reflexia was confirmed (93% in the neuropathic group, 91% in the congenital instability group and 78% in the idiopathic group). Complications were common and included inability to void (requiring self-catheterisation), haematuria, mucus production and recurrent urinary tract infection. Complete bacteriological data were obtained on 80 patients; 30% were infected pre-operatively (all but 4 in the neuropathic group) but 66% had bacteriuria at the time of assessment after surgery. Subjectively, 17 patients (24%) who "never" got infected had bacteriuria, as did 29 (63%) of those who were "occasionally" infected. Objectively, 84% of patients on intermittent self-catheterisation (ISC) had positive cultures, but even in those voiding spontaneously bacteriuria was present in 60%. Careful follow-up of these patients is mandatory and a more rigorous approach to eradication of infection and subsequent prophylaxis has been instituted.
authors.affiliation: Department of Urology, Royal Infirmary, Cardiff.
authors.forename: N
authors.initials: N
authors.lastname: Fenn
authors.forename: I G
authors.initials: IG
authors.lastname: Conn
authors.forename: K A
authors.initials: KA
authors.lastname: German
authors.forename: T P
authors.initials: TP
authors.lastname: Stephenson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001437:Bacteriuria / Q000209:etiology; D002648:Child; D004926:Escherichia coli / Q000302:isolation & purification; D006417:Hematuria / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000150:complications; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*; D014552:Urinary Tract Infections / Q000209:etiology*; D014572:Urology / Q000379:methods