How to Manage Urinary Tract Infections After Bladder Cancer Surgery
Urinary tract infections (UTIs) are a common concern following bladder cancer surgery, particularly after procedures such as transurethral resection of bladder tumors (TURBT) or radical cystectomy with urinary diversion. Effective management is essential to prevent complications and support recovery. The treatment approach varies depending on the type of surgical intervention and the patient's overall condition.
Treatment Strategies After Transurethral Resection (TURBT)
Following TURBT, patients are at increased risk of developing UTIs due to instrumentation of the urinary tract. A primary recommendation is to encourage increased fluid intake, which helps flush bacteria from the urinary system. Drinking plenty of water not only dilutes the urine but also promotes frequent urination, reducing bacterial colonization.
In addition to hydration, urine alkalization can be beneficial. Consuming foods or medications that raise urine pH may help reduce irritation and discomfort. However, the cornerstone of treatment remains appropriate antibiotic therapy based on urine culture and sensitivity results. It's crucial to select antibiotics that effectively target the causative pathogens while minimizing the risk of resistance.
For patients undergoing intravesical therapy (such as BCG or chemotherapy instillation), postponing treatments during active infection is often advised. Extending the interval between instillations allows the urinary tract to heal and reduces the likelihood of recurrent or persistent infections.
Managing Infections After Radical Cystectomy and Urinary Diversion
After complete removal of the bladder and creation of a urinary diversion, the risk of UTIs persists due to anatomical changes. The management strategy depends on the type of reconstruction performed. Each method—whether it's an orthotopic neobladder, ileal conduit, or continent cutaneous reservoir—requires tailored care.
Orthotopic Neobladder and UTI Management
Patients with an orthotopic neobladder, which allows for more natural voiding, may experience lower urinary tract symptoms and infections. When a UTI occurs, temporary catheterization is often necessary to ensure complete bladder emptying and proper drainage. This prevents urine stasis, a key factor in bacterial growth.
Antibiotic therapy should be initiated promptly, guided by culture results. In cases of recurrent infections, long-term low-dose prophylactic antibiotics may be considered. Additionally, patients should be educated on proper hygiene, adequate hydration, and self-catheterization techniques if needed.
Upper Tract Infections and Drainage Solutions
If the infection ascends to the upper urinary tract—resulting in pyelonephritis or hydronephrosis—more aggressive intervention is required. Percutaneous nephrostomy tube placement is a common procedure to drain infected urine directly from the kidneys. This not only relieves pressure but also enhances the effectiveness of systemic antibiotics.
Ileal Conduit-Related Infections
In patients with an ileal conduit—a non-continent urinary diversion using a segment of the small intestine—UTIs are relatively common. Similar to other types, treatment involves broad-spectrum antibiotics adjusted according to culture findings. If obstruction or poor drainage is suspected, imaging studies like ultrasound or CT scans are recommended.
When kidney function is compromised or sepsis is a concern, percutaneous nephrostomy is often employed to achieve immediate urinary decompression and control the infection source. Close monitoring of renal function and electrolyte balance is critical, especially since intestinal segments used in diversions can affect acid-base status.
Prevention and Long-Term Care
Long-term success in managing postoperative UTIs hinges on prevention. Regular follow-ups, routine urine testing, and patient education play vital roles. Encouraging lifestyle modifications such as staying well-hydrated, practicing good perineal hygiene, and recognizing early signs of infection can significantly reduce recurrence rates.
Healthcare providers should adopt a personalized approach, considering each patient's anatomy, functional status, and medical history. With timely intervention and comprehensive care, most post-bladder cancer surgery infections can be effectively managed, improving both quality of life and clinical outcomes.