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Related Concept Videos

Disorders of the Urinary System01:20

Disorders of the Urinary System

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The urinary system is responsible for eliminating waste and excess fluids from the body. However, disorders of the urinary system can arise due to various reasons like infections, stress, age, congenital abnormalities, and lifestyle.
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Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma
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Post-Operative Urinary Tract Infections After Radical Cystectomy: Incidence, Pathogens, and Risk Factors.

Maxwell Sandberg1, Rachel Vancavage2, Justin M Refugia1

  • 1Department of Urology, Wake Forest University School of Medicine, Winston Salem, NC 27101, USA.

Journal of Clinical Medicine
|November 27, 2024
PubMed
Summary

Urinary tract infections (UTIs) after radical cystectomy (RC) with urinary diversion (UD) occur in 14% of patients. Risk factors vary by time post-surgery, including female sex early on and specific diversion types later.

Keywords:
antibioticsbacteriabladder cancerradical cystectomyurinary tract infection

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Area of Science:

  • Urology
  • Oncology
  • Infectious Diseases

Background:

  • Urinary tract infections (UTIs) are a common complication following radical cystectomy (RC) with urinary diversion (UD).
  • Limited data exists on the incidence, causative pathogens, and patient risk factors for post-operative UTIs after RC.
  • This study aims to elucidate these aspects in a large patient cohort.

Purpose of the Study:

  • To determine the incidence of UTIs after radical cystectomy (RC) with urinary diversion (UD).
  • To identify common pathogens responsible for post-operative UTIs.
  • To assess patient-specific risk factors associated with UTI development at different post-operative time points.

Main Methods:

  • Retrospective analysis of 386 patients undergoing RC with UD between 2012 and 2024.
  • UTI incidence defined by urine culture results (>10^5 CFU/hpf) from post-operative day 0 up to 90 days post-discharge.
  • Statistical assessment of risk factors, including patient demographics and type of urinary diversion.

Main Results:

  • Cumulative UTI incidence was 14%, with 2% in the immediate post-op period, 8% within 30 days, and 7% between 31-90 days.
  • Common pathogens included Escherichia coli (26%), Enterococcus faecalis (24%), Klebsiella pneumoniae (21%), and Pseudomonas species (21%).
  • Female sex was a risk factor in the immediate post-op period; cutaneous ureterostomy and Wallace anastomosis in ileal conduit patients were risk factors at 31-90 days.

Conclusions:

  • Post-operative UTI incidence and pathogen profiles after RC with UD vary significantly based on the time elapsed since surgery.
  • Specific urinary diversion techniques and patient characteristics are associated with increased UTI risk at different post-operative intervals.
  • Understanding these temporal and risk factor variations is crucial for managing UTIs in this patient population.