Clinical Significance of Bacteriuria in Patients with Orthotopic Sigmoid Neobladder after Radical Cystectomy

Objectives: To evaluate the incidence and clinical significance of bacteriuria in patients who underwent sigmoid neobladder substitution after radical cystectomy. Patients and Methods: The study included 149 patients with invasive bladder carcinoma who underwent radical cystectomy and orthotopic sigmoid bladder substitution. Diagnosis of bacteriuria was made by freshly collected midstream urine culture at 3, 6 and 12 months postoperatively. Positive urinary culture was defined as >100 000 colony forming units (CFU)/ml. The data collected were evaluated in correlation to the clinical status of the patients. Results: Overall 466 urine samples from 149 patients were cultured during the follow-up period. Out of these 149 patients, 18 were lost to follow-up and 11 patients developed new stone formation in the neobladder with an incidence of bacteriuria of 91%. These 29 patients were excluded from the study. Among the remaining 120 patients, positive urine culture with significant growth of uropathogens was seen in 64%, 47% and 33% at 3, 6 and 12 months, respectively. Two thirds of patients with positive urine cultures were asymptomatic. The commonest uropathogen encountered was E Coli (72%) followed by Klebsiella (12%). Conclusion: Sigmoid neobladder substitution is associated with a high incidence of bacteriuria. Despite, the spontaneous clearance of bacteriuria over time without antimicrobial manipulation, antimicrobial therapy was needed in some patients, particularly those with a large post-void residual (PVR) urine volume, persistent urosepsis and stone formation in the neobladder.