The incidence and risk factor for febrile urinary tract infection after robot-assisted laparoscopic radical cystectomy in bladder cancer patients

Abstract

Introduction: Febrile urinary tract infections are major complications of radical cystectomy; however, their characteristics after robot-assisted radical cystectomy remain unclear. Thus, we investigated the rate, severity, pathogens, and risk factors of febrile urinary tract infections after robot-assisted radical cystectomy.

Patients and methods: Patients who underwent robot-assisted radical cystectomy at three institutions between April 2018 and March 2022 were retrospectively analyzed. The febrile urinary tract infections occurring within 90 days of surgery were evaluated.

Results: Overall, 191 patients were included. Of the 157 patients with ileal urinary diversions, 138 and 19 received ileal conduit and ileal neobladder, respectively; 42 febrile urinary tract infections were observed in 36 patients (22.9 %). Of the 32 patients who underwent cutaneous ureterostomy, four patients had febrile urinary tract infections (12.5 %). The incidence of postoperative febrile urinary tract infections was significantly higher in patients with ileal neobladder (52.9 %) than in those with an ileal conduit (18.8 %) (p < 0.05, log-rank test). Gram-positive strains were the dominant pathogen (60.0 %), followed by gram-negative strains (37.1 %) and fungi (2.9 %). The blood culture was positive in 28.6 % for febrile urinary tract infections. The primarily isolated strains were Enterococcus faecalis, Staphylococcus aureus, and Staphylococcus epidermidis, Escherichia coli and Pseudomonas aeruginosa. Female was the only risk factor for febrile urinary tract infections in those with an ileal conduit.

Conclusions: Gram-positive strains account for 60 % of pathogens causing febrile urinary tract infections after robot-assisted radical cystectomy, that may cause severe complications, rendering management of febrile urinary tract infections paramount.

Keywords: Febrile urinary tract infection; Gram-positive strains; Infectious complication; Robotic-assisted laparoscopic radical cystectomy; Staphylococcus aureus.