Studies on patients with ileal conduit diversion with special regard to renal infection.

Bergman, B. S tu d ie s on p a t ie n ts w ith i l e a l c o n d u it d iv e rs io n w ith s p e c ia l re g a rd to re n a l in f e c t io n . Scand J U ro l N e p h ro l, s u p p l. 47 ; Umeå U niv Med D is s , New S e r ie s 36, 32 pp. The c o n d it io n s fo r re tro g ra d e t r a n s p o r t o f u r in e and th e re b y b a c te r ia in th e u r in a r y svstem o f d iv e r te d p a t ie n ts (d e v ic e and u r in a r y t r a c t ) were s tu d ie d w ith roe n tg e n o ­ lo g ic a l te c h n ig u e . B a c k -f lo w from th e u r in a r y c o l le c t in g d e v ice in t o th e c o n d u it o c c u rre d in a f i f t h o f th o se p a t ie n ts who had a f l a t stom a. A n ip p le stoma o f a t le a s t 2 cm h e ig h t r e s is te d b a c k -f lo w b e t te r th a n any f l a t stom a. U re te ra l r e f lu x o c c u rre d to a p p ro x im a te ly 30 % o f th e u re te r s , b o th in th e su p in e and e re c t body p o s it io n s .T h e in t r a lu m in a l p re s s u re in th e c o n d u it was " lo w " ( ^ 1 2 cm H2 O) in a p p ro x im a te ly 30 % when r e f lu x o c c u rre d . The au topsy s tu d y showed a h ig h e r freq u e n cy o f r e n a l in f e c t io n s in d iv e r te d p a t ie n ts th a n in n o n -d iv e r te d c o n t r o ls . 5 o f 11 p a t ie n ts who d ie d more th a n 2 months a f t e r d iv e r s io n , and w ith o u t ca n ce r a t a u to p s y , were a t t r ib u t e d to dea th from re n a l i n f e c t io n . There was a r e la t io n s h ip between u ro g ra p h ic a l a b n o rm a lit ie s , re c o g n iz e d as a s s o c ia te d w ith p y e lo n e p h r i t is , and ra is e d serum a n tib o d y t i t e r s a g a in s t E . c o l i a n d /o r P .m i r a b i l i s . Most o f th e ” n o t no rm a l" re n a l u n i t s d e te r io ra te d a f t e r th e d iv e rs io n o p e ra t io n . The v a r ia b le "k id n e y a re a " was found to be " s m a ll" in a h ig h e r freq u e n cy a f t e r a lo n g p o s to p e ra t iv e p e r io d than a f t e r a s h o r t one. Raised -serum a n tib o d y t i t e r s o c c u rre d in 35 % o f th e p a t ie n ts and were c o r re la te d to g row th o f th e c o rre s p o n d in g b a c te r ia ( E . c o l i and P .m i r a b i l i s r e s p e c t iv e ly ) in th e c o n d u it u r in e . The fre q u e n cy o f ra is e d a n t ib o d y t i t e r s in c re a s e d w ith th e tim e a f t e r th e d iv e rs io n o p e ra t io n . A f te r t re a tm e n t w ith a n t ib io t i c s o f p a t ie n ts w ith b a c te r iu r ia and ra is e d serum a n tib o d y t i t e r s , th e t i t e r s were w i t h in norm al l im i t s («£ 5 1 2 ), o r decreased s i g n i f i c a n t l y , in 22 o f 25 p a t ie n ts . Serum a n tib o d y t i t e r d e te rm in a tio n s a g a in s t E . c o l i and P .m i r a b i l i s a re suggested as complement to u r in a r y c u ltu re s in th e fo l lo w -u p o f d iv e r te d p a t ie n ts . The r e s id u a l u r in e volume in th e c o n d u it was shown to be o f im p o rta n ce f o r b a c te r iu r ia and ra is e d t i t e r a g a in s t P .m i r a b i l i s . Some m easures, w h ich p o s s ib ly may reduce b a c te r iu r ia and th e re b y p y e lo n e p h r i t is , a re sugg es te d . A n ip p le stoma o f a t le a s t 2 cm h e ig h t ought to be c o n s tru c te d a t th e o p e ra t io n . To o b ta in a low r e s id u a l u r in e volume th e c o n d u it s h o u ld be s h o r t and u n o b s tru c te d . The u r in a r y c o l le c t in g d e v ic e s h o u ld be em ptied o f te n and connected to a u r ib a g d u r in g th e n ig h t . Scandinavian Journal of Urology and Nephrology Supplementum 47 From the Department of Urology, University of Umeå, Umeå, Sweden. Studies on Patients with ILEAL CONDUIT DIVERSION with special regard to Renal Infection