Complications of enterocystoplasty.

Bladder reconstruction, either by augmentation or substitution enterocystoplasty, is a safe alternative to supravesical urinary diversion providing careful attention to preoperative selection, surgical technique, and postoperative review is observed. However, under the most optimal conditions an untoward outcome may occur. We reviewed our series of 100 intestinocystoplasties to categorize the types of complications encountered, and to identify preoperative risk factors that could potentially develop into an unfavorable sequela. Twenty-seven patients required either early or late surgical intervention, while 30 were managed nonoperatively. In our review we identified two groups, those with myelodysplasia and those with a solitary functioning kidney, who are at a higher risk for an unfavorable outcome to develop.     

Candida urinary tract infection with special reference to ascending pyelonephritis]

The pathogenesis of Candida urinary tract infection (UTI) has been investigated clinically and experimentally with special reference to ascending pyelonephritis in rats. Among the Candida species, Candida albicans was most frequently isolated from clinical specimens including urine in two medical centers, one in Japan and the other in the United States. The isolates of C. albicans serotype B showed a significantly lower susceptibility to 5-fluorocytosine compared to those of serotype A (p less than 0.01). The distribution pattern of the serum antibody titers against C. albicans in 20 candiduria patients (C. albicans 19 and Candida tropicalis 1) was similar to that in 23 bacterial complicated UTI patients. All patients with candiduria had underlying diseases of the urinary tract, such as neurogenic bladder, bladder cancer or benign prostatic hyperplasia: indwelling urinary catheters were present in 15 patients and all had received antimicrobial agents before the study. Ascending Candida pyelonephritis has been investigated in female rats which were transurethrally inoculated into the bladder with C. albicans ATCC 10259 strain. The incidence of Candida pyelonephritis was approximately 80% in rats treated with cyclophosphamide and more than 70% in rats with partial ureteral obstruction. There was a significant relationship between renal and urinary Candida cell populations (p less than 0.01). Furthermore, a significant relationship was revealed between renal Candida cell populations and histological grades of pyelonephritis (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Urinary tract infection associated with urinary calculi. 1. The significance of urinary tract infection in urinary calculi

We investigated 158 cases of urinary stones (infection stones 56, metabolic stones 102) with special reference to pyuria, bacteriuria, stone culture and urease activities of isolated bacteria. Abacterial pyuria was noted in 9 out of 49 (18%) infection stones and in 53 of 77 (69%) metabolic stones. Bacteriuria was noted in 79% of the infection stones and 26% of the metabolic stones. Sixty-seven percent of the infection stones were infected with mainly urea splitting bacteria such as Proteus mirabilis and Staphylococcus. Twenty-three percent of metabolic stones were also infected. Though E. coli, a non-urea splitting bacteria, was isolated most frequently from metabolic stones, urease positive Staphylococcus and Pseudomonas were also isolated. Bacteria within stones could be predicted on the basis of urine culture results of only 20 of 41 infection stones and 8 of 24 metabolic stones. These facts are useful for selection of some antibiotics in the treatment of urinary tract infections associated with urinary calculi. Urinary infections of urea splitting bacteria in infection stones are thought to be initial factors of stone formation and those of non-urea splitting bacteria are to be superimposed. However, urea splitting bacteria in metabolic stones may convert them into infection stones in future.     

Mucosal morphology of ileal conduits with particular reference to urinary infections

Mucosal biopsies were obtained for histological and electron microscopical studies from 20 patients with ileal urinary conduits. Special interest was focused on problems of urinary tract infections and their possible role in the pathogenesis of these changes. Chronic inflammation with mild to total villous atrophy was found as well as reduction in the amount of mucosal glands. Ultrastructurally the main cellular elements of the ileal epithelium and mucosa were preserved. The age of the conduit did not seem to be decisive in the histological findings. Also recurrent infections could not be shown to be responsible for the changes in the conduit mucosa. In irradiated patients, fibrotic changes in the lamina propria of the conduit mucosa were apparent and the microvilli especially short and scanty.     

Complications of urinary tract reconstruction

Urinary tract reconstruction has benefited a vast number of patients with dysfunctional lower urinary tracts caused by congenital abnormalities, previous surgery, or both. Reconstructive efforts have been innovative and continue to evolve. With this evolution, new complications continue to appear, and in order to minimize the risk to the patient, we must recognize our previous lessons. Appropriate patient selection is essential in achieving a successful outcome in this group. The patient's neurologic status, urologic anatomy, renal function, and motivation are also important factors in choosing the appropriate patient and correct surgical approach. Close follow-up remains the single most important element in assuring long-term well-being for most of these patients.     

Complications of urinary tract undiversion

The complications of urinary tract undiversion can be divided into those associated with patient selection, choice of techniques, and early and late surgical difficulties. Patient selection must take into account the original reason for diversion (incontinence, hydronephrosis, reflux, or renal functional impairment), current renal function and bladder dynamics, upper urinary tract anatomy, and psychosocial considerations. Technical considerations require versatility and ingenuity on the part of the surgeon. Although direct uroepithelium-to-uroepithelium continuity is ideal, this often cannot be accomplished. A variety of techniques including transureteroureterostomy, psoas hitch of the bladder, bladder augmentation, ileocecal and colon interposition, and autotransplantation can be used to facilitate the refunctionalization of the urinary tract. One must monitor the patient postoperatively for potential early and late complications. Meticulous attention to surgical details will help minimize these. The ultimate goal is to achieve stable renal function and urinary continence.     

Results of reoperations after enterocystoplasty in patients with tuberculosis of the urinary tract

In 129 patients with tuberculosis of the urinary system subjected to enterocytoplasty repeated surgical interventions took place. Repeated operations were performed in 103 patients after sigmocytoplasty. Operations of the reconstructive-reparative character prevailed among the repeated operations (reimplantation of the ureter into the intestinal transplant, resection of the intestine-bladder anastomosis and combination of these two operations). Remote results were studied in 106 out of 129 patients after repeated operations. Good results were obtained in 55.6%, satisfactory--in 18.9%, bad--in 6.6% of cases. Twenty patients died from the increasing renal insifficiency.     

Localization of urinary tract infection.

Both the antibody-coating and LDH isoenzyme techniques theoretically fulfill the criteria for an ideal localization test. Both are noninvasive. They are relatively easy to perform and well within the capability of most clinical laboratories. Both can be done rapidly and the results can be in the clinician's hands in a matter of a few hours. The results of the antibody-coating technique do not appear to be valid for children. Since only one controlled study with comparison with other localization techniques has been done in adults, further evaluation needs to be done. The LDH isoenzyme pattern has not been studied in adults but appears to be accurate in children. A prospective comparison of both procedures in adults using either the Fairly bladder washout technique or the Stamey ureteral catheterization method to localize definitively the site of infection would be most helpful. Definitive noninvasive localization techniques could lead to therapy being initiated with the site of infection defined. This would facilitate earlier and more intensive antibiotic therapy in those patients at risk for renal parenchymal damage from upper tract infections.     

Mechanisms of urinary tract infection.

Most urinary tract infections begin as a cystitis secondary to decreased host resistance brought on by disruption of tissue integrity or a decrease in blood supply to the bladder. In the female, infrequent voiding and the uninhibited bladder are the most common causes of urinary tract infection and are best treated by healthy voiding regimens; while in the male, structural and functional obstructive uropathy are most often associated with urinary tract infection and are alleviated by lowering the high intravesical pressures via surgical or medical measures. The concept that host resistance is the determinant of infection rather than the organism has permitted the use of clean, intermittent self-catheterization; clean intermittent self-dilatation; and transurethral diverticulectomy in the therapy of a host of urologic disease syndromes.     

尿路结构异常儿童合并泌尿系感染的病原菌分析

目的探讨尿路结构异常儿童合并泌尿系感染（UTI）致病菌的分布及药物敏感及耐药情况。 方法收集2012年1月至2016年12月中山大学附属第三医院及汕头市中心医院符合UTI住院患儿476例,分为尿路正常组及尿路异常组,比较两组间病原菌构成比及对抗菌药物的敏感和耐药情况。 结果尿路异常者162例（肾积水最为常见,占43.83%）,尿路正常儿童314例。尿路异常儿童合并感染常见于男性（P<0.05）,共检出致病菌166株,革兰氏阴性菌（G^-）为主（71.08%）,大肠埃希菌占首位（40.36%）,肠球菌属居第2位（22.89%）,粪肠球菌在尿路异常组常见（χ²=4.59,P=0.032）。两组间常见病原菌耐药性差异无统计学意义。 结论尿路结构异常男性儿童易发生泌尿系感染,且肠球菌感染的发生率高于尿路结构正常儿童。     

Quantitation of urinary Tamm-Horsfall protein in children with urinary tract infection.

It has been suggested that urinary Tamm-Horsfall protein (THP) prevents colonization of the urinary tract by binding uropathogens. We tested the hypothesis that low urinary THP levels may predispose to urinary tract infection (UTI) by measuring THP levels in children. We studied a cohort of 35 girls with uncomplicated recurrent UTI (group 1) that was compared with 27 patients with myelomeningoceles undergoing clean intermittent catheterization (group 2) and 16 female controls (group 3). We measured urinary THP in both aggregated (aTHP) and disaggregated form (dTHP), leukocyte esterase activity, urine chemistries and culture. No significant differences in dTHP or aTHP levels were seen between groups 1 and 3, but group-1 patients had higher dTHP levels than group-2 patients (p < 0.008). History of reflux or the presence of bacteriuria or pyuria at the time of urine collection did not affect dTHP levels; in contrast, pyuria or bacteriuria at the time of sampling was associated with markedly lower aTHP levels when compared with sterile samples (p < 0.0001). For all groups, measured quantities of dTHP did not correlate with aTHP levels. We conclude that excretion of dTHP in children with history of recurrent UTI is not reduced. In contrast, concentrations of aTHP are profoundly depressed in children during times of UTI, suggesting a role for THP in the pathogenesis of UTI. Assaying THP in its aggregated form may prove valuable when studying its physiologic function and merits further investigation.     

Neonatal urinary tract infection with petechiae and thrombocytopenia.

Thrombocytopenia and petechiae were signs of urinary tract infection in 2 neonates. Both infants had significant anomalies of the urinary tract. In each case antimicrobial therapy eliminated the infection and thrombocytopenia, allowing the surgical correction to be performed when the infants were clinically well. The importance of urine cultures and excretory urography in such cases is emphasized.     

Non-invasive localization of urinary tract infection.

New methods to localize the source of bacteriuria were evaluated in monkeys with experimental urinary tract infection. A high level of diagnostic accuracy was obtained with the combined study of antibody-coated urinary bacteria by immunofluorescence, 131I hippuran scintiphotos in the hydropenic state and 67gallium citrate scintiphotos. Unique patterns were found, which differentiate cystitis, ureteritis, pyelonephritis and renal or perinephric abscesses.