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This article will be of interest to colleagues undertaking reconstructive surgery. Urinary diversions have been performed for decades. Common indications are muscle-invasive bladder cancer, neurological disorders, inflammatory conditions and congenital malformation. The diversions could be continent or non-continent. Complications due to the use of intestinal segments include mucus production, electrolyte imbalance, stones, increased infection rate. A further risk factor is radiotherapy. The Medline search included 26 studies. However, there were inconsistencies in the definition of bacteriuria. The link between preceding bacteriuria and subsequent development of urinary tract infection (UTI) is not yet fully established. Common micro-organisms include: E.coli, Enterococcus, Staphylococcus, Klebsiella and Proteus. Short-term antibiotics can be given in the immediate postoperative period. However, long-term prophylactic antibiotics have been found to be ineffective. European Association of Urology (EAU) and Urological Association of Asia (UAA) guidelines do not suggest a benefit in treating asymptomatic bacteriuria. In one study, some benefit was seen from regular use of cranberry capsules long-term, but this is not proven by other studies.

Systematic review: bacterial colonisation of conduits and neo-bladders - when to test, watch and treat.
Qu L, Adam A, Ranasinhe W, et al.
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Arun K Sharma

West Herts NHS Trust (Watford General Hospital)

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