Asymptomatic bacteriuria in men with orthotopic ileal neobladders: possible relationship to nocturnal enuresis

• Published in: BJU international 2005-08, Vol.96 (3), p.391-396
• Main Authors: Abdel‐Latif, Mohamed, Mosbah, Ahmed, Bahnasawy, Magdy S. El, Elsawy, Essam, Shaaban, Atallah A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anti-Bacterial Agents - therapeutic use; Bacterial Infections - drug therapy; Bacterial Infections - urine; bacteriuria; Bacteriuria - etiology; Biological and medical sciences; Enuresis - microbiology; Enuresis - urine; Humans; Male; Medical sciences; Middle Aged; neobladders; Nephrology. Urinary tract diseases; nocturnal enuresis; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Treatment Outcome; Urinary Diversion - adverse effects; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urine - microbiology
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2005.05637.x

The role of asymptomatic bacteriuria in patients with urinary diversion in general has been reported as having a significant role prognostically in several published studies. Authors from Mansoura, with considerable experience in the constructing the orthotopic ileal neobladder, have evaluated the incidence of asymptomatic bacteriuria in such patients prospectively, and have assessed its possible effect on neobladder function. OBJECTIVE To assess prospectively the incidence with time of asymptomatic bacteriuria in patients with orthotopic ileal neobladders, and the possible effect on neobladder function. PATIENTS AND METHODS In all, 47 patients (mean age 52.7 years, sd 8.7, range 31–68) with uncomplicated orthotopic ileal neobladders were prospectively evaluated. With no antibiotic manipulation, consecutive urine cultures were assessed monthly. Continence was assessed by direct information from the patients at each follow‐up visit. RESULTS Overall, 797 samples were cultured from the 47 patients (mean 17.6, sd 7.1). There was a steady decrease in the incidence of positive cultures, from 74.5%, to 35.6% and 6.7% at 1, 6 and 18 months, respectively. While there was persistently sterile urine in only eight patients (17%), 32 had occasional and seven had persistent bacteriuria. Escherichia coli was the commonest organism (76.6%) followed by Klebsiella pneumonia (15.7%); 54% of E. coli and 38% of K. pneumonia infections were sensitive to nitrofurantoin. Diurnal continence was achieved in 98% of the patients at 6 months after surgery. There was a gradual decrease in the frequency of nocturnal enuresis (NE) with time, from 87%, to 42%, 28% and 27% at 1, 6, 12 and 18 months, respectively. There was a significant correlation between the presence of bacteriuria and NE during the first 6 months, but it was not sustained after that. The age of the patients was also related significantly to the incidence of NE; at 6 months, only one of 18 men aged ≤ 50 years had NE, while 19 of 29 aged > 50 years had (P  50 years had NE (P = 0.001). CONCLUSIONS Ileal neobladders are associated with a high incidence of asymptomatic bacteriuria during the first year after surgery. There was spontaneous clearance of bacteriuria with time, with no antimicrobial manipulation. Soon after surgery there was a significant association between bacteriuria and NE. The effect of antimicrobials on p