Safety of no bowel preparation before ileal urinary diversion

Abstract

Study Type - Harm (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Recent studies show no advantage of bowel preparation before ileal urinary diversion and that avoidance of bowel preparation led to early restoration of intestinal function and shorter hospital stay. However, this was not tested in a prospective comparison. The current study is a prospective comparison to test for the safety of omitting bowel preparation before ileal urinary diversion. This study also examines simultaneous effects of bowel preparation on the ileal flora and mucosa.

Objective: • To evaluate the safety of no bowel preparation before ileal reconstructive procedures of the lower urinary tract, in comparison to standard 3-day bowel preparation. The present study also examines the effects of bowel preparation on small bowel wall and bacterial flora.

Patients and methods: • This study enrolled 40 patients scheduled for radical cystectomy and ileal urinary diversion, presenting to the department of urology, Alexandria University, Alexandria, Egypt during the period from January 2009 to September 2010. • Patients were prospectively randomized into two groups: Group (I) had standard 3-day bowel preparation. Group (II) had only over-night fasting before surgery. • Intra-operatively, one ml of ileal fluid was collected for bacteriological studies and an ileal wall biopsy was taken for histopathological examination. • Postoperative complications were reported for all patients using modified Clavien system.

Results: • Both groups showed insignificant difference regarding the frequency and Clavien grade of postoperative complications (P = 0.30). • Under aerobic and anaerobic conditions, 5 cases in group (I) had bacterial overgrowth of E. coli (>105) versus none in group (II) (P = 0.04). Eight patients in group (I) had sterile ileal fluid cultures versus 18 patients (90%) in group (II). No correlation could be made between would infections and the organisms isolated in ileal fluid cultures. • Histopathological examination of ileal biopsies revealed mucosal edema and submucosal congestion in 9 cases in group (I) versus 2 cases in group (II) (P = 0.0310).

Conclusions: • Omitting bowel preparation before ileal urinary diversion is safe, with no added complications. • Non-preparation of the small bowel is not associated with bacterial overgrowth.