title: Febrile Urinary Tract Infection after Radical Cystectomy and Ileal Neobladder in Patients with Bladder Cancer.
abstract: Urinary tract infection (UTI) is one of the most common complications after radical cystectomy and orthotopic neobladder reconstruction. This study investigated the incidence and implicated pathogen of febrile UTI after ileal neobladder reconstruction and identify clinical and urodynamic parameters associated with febrile UTI. From January 2001 to May 2015, 236 patients who underwent radical cystectomy and ileal neobladder were included in this study. Fifty-five episodes of febrile UTI were identified in 46 patients (19.4%). The probability of febrile UTI was 17.6% and 19.8% at 6 months and 24 months after surgery, respectively. While, Escherichia coli was the most common implicated pathogen (22/55, 40.0%), Enterococcus spp. were the most common pathogen during the first month after surgery (18/33, 54.5%). In multivariate logistic regression analysis, ureteral stricture was an independent risk factor associated with febrile UTI (OR 5.93, P = 0.023). However, ureteral stricture accounted for only 6 episodes (10.9%, 6/55) of febrile UTI. Most episodes of febrile UTI occurred within 6 months after surgery. Thus, to identify risk factors associated with febrile UTI in the initial postoperative period, we assessed videourodynamics within 6 months after surgery in 38 patients. On videourodyamic examination, vesicoureteral reflux (VUR) was identified in 16 patients (42.1%). The rate of VUR presence in patients who had febrile UTI was not significantly different from those in patients without febrile UTI (50% vs. 39.3%, P = 0.556). Patients with febrile UTI had significantly larger residual urine volume (212.0 ± 193.7 vs. 90.5 ± 148.2, P = 0.048) than those without. E. coli and Enterococcus spp. are common pathogens and ureteral stricture and residual urine are risk factors for UTI after ileal neobladder reconstruction.
authors.affiliation: Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea .
authors.forename: Kwang Hyun
authors.identifier: 0000-0002-6264-5109
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea .
authors.forename: Hyun Suk
authors.identifier: 0000-0003-1806-3539
authors.initials: HS
authors.lastname: Yoon
authors.affiliation: Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea .
authors.forename: Hana
authors.identifier: 0000-0002-8553-0152
authors.initials: H
authors.lastname: Yoon
authors.affiliation: Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea .
authors.forename: Woo Sik
authors.identifier: 0000-0001-6413-8779
authors.initials: WS
authors.lastname: Chung
authors.affiliation: Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea .
authors.forename: Bong Suk
authors.identifier: 0000-0002-2352-1680
authors.initials: BS
authors.lastname: Sim
authors.affiliation: Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea .
authors.forename: Dong Hyeon
authors.identifier: 0000-0002-1215-0028
authors.initials: DH
authors.lastname: Lee
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015653:Cystectomy / Q000009:adverse effects; D016983:Enterococcus / Q000302:isolation & purification; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D014563:Urodynamics
chemical_list: D000900:Anti-Bacterial Agents
keywords: Urinary Bladder Neoplasm; Urinary Diversion; Urinary Tract Infection; Urodynamics