Advertisement

Pediatric Surgery International

, Volume 34, Issue 9, pp 983–989 | Cite as

Impact of positive preoperative urine cultures before pediatric lower urinary tract reconstructive surgery

  • Alexander C. Small
  • Alejandra Perez
  • Jayant Radhakrishnan
  • Stanley Desire
  • Philip Zachariah
  • Lisa C. Creelman
  • Shumyle AlamEmail author
Original Article

Abstract

Purpose

Children who undergo lower urinary tract reconstruction (LUTR) often have asymptomatic bacteriuria or recurrent urinary tract infections (UTI). We aimed to determine the prevalence of positive preoperative urine cultures (PPUC) before LUTR and to analyze any impact on postoperative outcomes.

Methods

This retrospective review included all pediatric LUTR procedures utilizing bowel segments performed by one surgeon over 2 years. Preoperative cultures were obtained 1–2 days before surgery. Baseline characteristics and 90-day infection/readmission rates between patients with and without PPUC were compared using descriptive statistics, Fisher’s exact, and Mann–Whitney tests with significance p < 0.05.

Results

54 patients with mean age 10.1 ± 5.6 years underwent LUTR procedures using bowel including continent catheterizable channel (85%), enterocystoplasty (81%), and/or urinary diversion (9%). PPUC was present in 28 patients (52%). Postoperatively, 20% had inpatient infections, including eight UTI, four surgical site infections, and two bloodstream infections with no difference between those with or without PPUC. Within 90 days of discharge, 28% of patients were readmitted to the hospital, and there was no difference between groups. Postoperative urine cultures were positive in 83% of patients within 90 days.

Conclusions

Half of the patients undergoing LUTR have PPUC, but it does not increase the risk of postoperative infections or hospital readmissions. We believe complex LUTR can be safely performed in patients with PPUC.

Keywords

Pediatric Urology Reconstruction Urinary tract Bladder Microbiome 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Research involving human participants

Study protocol received approval from the Columbia University institutional review board. All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

A waiver of informed consent was obtained due to the retrospective nature of the study.

References

  1. 1.
    Pokrzywa CJ, Papageorge CM, Kennedy GD (2016) Preoperative urinary tract infection increases postoperative morbidity. J Surg Res 205:213–220.  https://doi.org/10.1016/j.jss.2016.06.025 CrossRefPubMedGoogle Scholar
  2. 2.
    Fok CS, McKinley K, Mueller ER et al (2013) Day of surgery urine cultures identify urogynecologic patients at increased risk for postoperative urinary tract infection. J Urol 189:1721–1724.  https://doi.org/10.1016/j.juro.2012.11.167 CrossRefPubMedGoogle Scholar
  3. 3.
    Patel N, Shi W, Liss M et al (2015) Multidrug resistant bacteriuria before percutaneous nephrolithotomy predicts for postoperative infectious complications. J Endourol 29:531–536.  https://doi.org/10.1089/end.2014.0776 CrossRefPubMedGoogle Scholar
  4. 4.
    Koulouvaris P, Sculco P, Finerty E et al (2009) Relationship between perioperative urinary tract infection and deep infection after joint arthroplasty. Clin Orthop Relat Res 467:1859–1867.  https://doi.org/10.1007/s11999-008-0614-8 CrossRefPubMedGoogle Scholar
  5. 5.
    Rizvi SJ, Chauhan R, Gupta R, Modi P (2008) Significance of pretransplant urinary tract infection in short-term renal allograft function and survival. Transplant Proc 40:1117–1118.  https://doi.org/10.1016/j.transproceed.2008.03.075 CrossRefPubMedGoogle Scholar
  6. 6.
    Cai T, Verze P, Palmieri A et al (2017) Is preoperative assessment and treatment of asymptomatic bacteriuria necessary for reducing the risk of postoperative symptomatic urinary tract infections after urologic surgical procedures? Urology 99:100–105.  https://doi.org/10.1016/j.urology.2016.10.016 CrossRefPubMedGoogle Scholar
  7. 7.
    Vigil HR, Hickling DR (2016) Urinary tract infection in the neurogenic bladder. Transl Androl Urol 5:72–87.  https://doi.org/10.3978/j.issn.2223-4683.2016.01.06 PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    McLeod DJ, Asti L, Mahida JB et al (2016) Preoperative risk assessment in children undergoing major urologic surgery. J Pediatr Urol 12:26.e1–26.e7.  https://doi.org/10.1016/j.jpurol.2015.04.044 CrossRefGoogle Scholar
  9. 9.
    Cohen S, Palazzi K, Marietti S et al (2014) Lack of improvement: a national assessment of readmission rates after pediatric bladder reconstruction. Nephrourol Mon 6:e20263.  https://doi.org/10.5812/numonthly.20263 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Bilimoria KY, Liu Y, Paruch JL et al (2013) Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 217:833–842.  https://doi.org/10.1016/j.jamcollsurg.2013.07.385 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Korets R, Graversen JA, Kates M et al (2011) Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol 186:1899–1903.  https://doi.org/10.1016/j.juro.2011.06.064 CrossRefPubMedGoogle Scholar
  13. 13.
    Novak TE, Salmasi AH, Mathews RI et al (2008) Complications of complex lower urinary tract reconstruction in patients with neurogenic versus nonneurogenic bladder—is there a difference? J Urol 180:2629–2634.  https://doi.org/10.1016/j.juro.2008.08.056 CrossRefPubMedGoogle Scholar
  14. 14.
    Du K, Mulroy EE, Wallis MC et al (2015) Enterocystoplasty 30-day outcomes from National Surgical Quality Improvement Program Pediatric 2012. J Pediatr Surg 50:1535–1539.  https://doi.org/10.1016/j.jpedsurg.2015.04.009 CrossRefPubMedGoogle Scholar
  15. 15.
    McNamara ER, Kurtz MP, Schaeffer AJ et al (2015) 30-Day morbidity after augmentation enterocystoplasty and appendicovesicostomy: a NSQIP pediatric analysis. J Pediatr Urol 11:209.e1–209.e6.  https://doi.org/10.1016/j.jpurol.2015.04.016 CrossRefGoogle Scholar
  16. 16.
    Regenbogen SE, Read TE, Roberts PL et al (2011) Urinary tract infection after colon and rectal resections: more common than predicted by risk-adjustment models. J Am Coll Surg 213:784–792.  https://doi.org/10.1016/j.jamcollsurg.2011.08.013 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Alexander C. Small
    • 1
  • Alejandra Perez
    • 2
  • Jayant Radhakrishnan
    • 3
  • Stanley Desire
    • 2
  • Philip Zachariah
    • 4
  • Lisa C. Creelman
    • 5
  • Shumyle Alam
    • 5
    Email author
  1. 1.Department of UrologyNew York Presbyterian Hospital/Columbia University Medical CenterNew YorkUSA
  2. 2.Columbia University College of Physicians and SurgeonsNew YorkUSA
  3. 3.Department of SurgeryUniversity of Illinois College of MedicineChicagoUSA
  4. 4.Division of Pediatric Infectious DiseaseNew York Presbyterian Hospital/Morgan Stanley Children’s HospitalNew YorkUSA
  5. 5.Division of Pediatric UrologyNew York Presbyterian Hospital/Morgan Stanley Children’s HospitalNew YorkUSA

Personalised recommendations