Conduit Urinary Diversion and Urinary-Tract Infection

Abstract

The serum antibody titers against Escherichia coli and/or Proteus mirabilis were elevated in 26 of 80 patients (33%) with a conduit urinary diversion. Urographic findings were abnormal in 44 of these 80 patients (55%). Urography was normal in 59% of the patients with normal antibody titers, but in only 15% of those with elevated titers. Raised antibody levels against E. coli O antigen (>256 before and/or >32 after mercaptoethanol treatment of serum) were associated with wide upper urinary tract or calculi more often than were normal E. coli antibody titers. Raised titers against P. mirabilis (>256 before and/or >32 after mercaptoethanol treatment of serum) were associated with scarring of the renal parenchyma more frequently than were normal titers.

A statistically significant association was found between “small” kidney area and raised serum antibody titers against E. coli or P. mirabilis. The frequency of “small” kidney increased with the time lapse after urinary diversion. At 3 to 11 months postoperatively it was 29%, but among the patients with urinary diversion for more than five years the corresponding frequency was 82%. When at least one kidney was “small”, the serum creatinine was higher than when both kidneys were of normal size. Patients with raised antibody titers tended also to have high serum creatinine (≥124 μmol/1) more often than those with normal titers (23 vs. 10%). These observations imply a connexion between elevation of the antibody titers and destruction of the renal parenchyma in patients with conduit urinary diversion. They illustrate the value of antibody titration in the follow-up of patients with urinary diversion.