Post-Operative Urinary Tract Infections After Radical Cystectomy: Incidence, Pathogens, and Risk Factors

Abstract

Background: The incidence of urinary tract infections (UTIs) after radical cystectomy (RC) with urinary diversion (UD), the typical pathogens, and associated patient risk factors have not been well documented. In this study, we examined the incidence of post-op UTIs after RC to identify associated risk factors. Methods: Single-center, retrospective case series of 386 patients with bladder cancer who underwent RC with UD between 2012 and 2024. The primary objective was UTI incidence, defined by the frequency of patients with urine culture with >10⁵ colony-forming units per high-powered field, spanning from post-op day 0 (POD0) to 90 days after discharge. Isolated pathogens were reported. Risk factors for UTIs were assessed. Results: The average age was 69 years old at surgery, and patients were predominantly male (80%). The cumulative incidence of post-op UTIs was 14%, among which 12 patients had more than one UTI. The UTI incidence was 2%, 8%, and 7% during the immediate post-op period, within 30 days, and within 31-90 days, respectively. Isolated pathogens included Escherichia coli (26%), Enterococcus faecalis (24%), Klebsiella pneumoniae (21%), and Pseudomonas species (21%). In the immediate post-op period, female sex was the only significant risk factor. At 31 to 90 days, cutaneous ureterostomy UD was the predominant risk factor for UTIs. For ileal conduit patients, those with a Wallace ureteral anastomosis were associated with UTI 31-90 days from discharge for RC. Conclusions: Our retrospective data suggests the incidence of UTIs and their causative pathogens after RC differ based on post-operative time points and vary according to different patient risk factors.

Keywords: antibiotics; bacteria; bladder cancer; radical cystectomy; urinary tract infection.

Figure 1

Kaplan-Meier survival curve. The following table represents a comparison of overall survival between patients who did and did not develop a UTI at both 30– (A) and 31–90 days (B) after discharge from radical cystectomy. Patients who formed a UTI are on the red line, and those who did not form a UTI are on the blue line. The number at risk table is also provided below with time in months. There was a statistically significant difference in overall survival, favoring patients who did not develop a UTI 31–90 days after discharge using the log-rank test (p = 0.014).

Figure 2

Kaplan-Meier survival curve. The following table represents a comparison of cancer-specific survival between patients who did and did not develop a UTI at both 30- (A) and 31–90 days (B) after discharge from radical cystectomy. Patients who formed a UTI are on the red line, and those who did not form a UTI are on the blue line. The number at risk table is also provided below with time in months. There was not a statistically significant difference in cancer-specific survival (p > 0.05).