Risk Factors For Symptomatic Urinary Tract Infection After Radical Cystectomy And Its Impact For The Post-operative Renal Function

Purpose The aim of this article is to investigate the risk factors related with the urinary tract infection after radical cystectomy and its impact on the post-operative renal function in patients with bladder cancer.Materials and Methods:The clinical data of patients undergoing radical resection of laparoscopic bladder cancer performed by the same surgeon from the First Affiliated Hospital of Fujian Medical University from January 01,2014 to December 31,2017were retrospectively analyzed.The average age of the patients was 65.12±9.70 years.There were 87 males and 8 females.There were 46 patients in the in situ neobladder group,38 patients in the ileal bladder group,and 11 patients in the ureterocutaneous ostomy group.There were 29 cases of hypertension and 15 cases of diabetes.Patients were collected for age,gender,body mass index(BMI),diabetes,hypertension,preoperative albumin,preoperative hemoglobin,Charlesson comorbidity index(CCI),preoperative urinary tract infection,preoperative and postoperative eGFR,neoadjuvant Chemotherapy,operation time,perioperative blood transfusion,urinary diversion,postoperative hydronephrosis,pathological staging and other indicators.According to whether there was symptomatic urinary tract infection after removal of the catheter within 3 months after surgery,the patients were divided into urinary tract infection positive group and urinary tract infection negative group.At the same time,clinical data such as urine culture of patients were collected to compare the characteristics of urinary tract infections before and after surgery.Finally,the definition of mean eGFR decreased by more than 25%after 1 year was the occurrence of renal dysfunction,and the effect of postoperative urinary tract infection on long-term renal function after surgery was analyzed.Risk factors were analyzed by t test orχ2 test,and multivariate analysis was performed using logistic regression.RESULTS:All 95 patients were followed up for more than 1 year.There were 59 cases(62%)with urinary tract infection and 36 cases(38%)with negative urinary tract infection.Univariate analysis showed that The incidence of urinary tract infection was significantly lower in patients with preoperative albumin>40 g/l compared with patients with preoperative albumin<40 g/l(P=0.001).Patients with postoperative hydronephrosis had a significantly greater risk of developing urinary tract infections than those without hydronephrosis.The difference between the two groups was statistically significant(P=0.004).There were no significant differences in age,sex,BMI,diabetes mellitus,hypertension,hemoglobin,CCI,preoperative urinary tract infection,preoperative renal function,operation time,perioperative blood transfusion,pathological stage,neoadjuvant chemotherapy and urinary diversion(P>0.05).Multivariate analysis showed that preoperative albumin(OR=0.230,95%CI 0.008-0.658,P=0.006)and postoperative hydronephrosis(OR=5.034,95%CI 1.373-18.452,P=0.015)were independent risk predictors of urinary tract infection.The mean eGFR decreased from 83.4±19.1 ml/min/1.73 m~2 to 79.7±23.6 ml/min/1.73 m~2,a total of 19(20%)cases of renal dysfunction.Logistic regression analysis showed that postoperative urinary tract infection(OR=5.277,95%CI 1.296-21.493,P=0.02)was a risk factor for long-term renal impairment.The common preoperative urinary tract infections were E.coli(31.8%),Staphylococcus(18.2%)and Enterococcus(13.6%).The most common bacterial groups after surgery were Enterococcus(28.6%),Escherichia coli(22.2%),Klebsiella(9.5%),Staphylococcus(9.5%),Pseudomonas aeruginosa(7.9%).Conclusions Urinary tract infection after radical cystectomy is a common complication.Low preoperative albumin levels and postoperative hydronephrosis may increase the risk of postoperative urinary tract infections.The coverage of pathogenic microorganisms in urinary tract infections before and after surgery is similar,and Gram-negative bacilli are the most common pathogenic microorganisms.Postoperative urinary tract infections are more likely to cause renal impairment.