ABSTRACT
The main indications for reconstruction of the lower urinary tract are bladder cancer requiring cystectomy, and benign conditions such as interstitial cystitis and neuropathic bladder disorders, where augmentation of the bladder is needed. The reconstruction involves interposition of isolated intestinal tissue in the lower urinary tract, and in most cases a neoanastomosis between the ureter and intestine. Protection of renal function is a main goal in these patient groups why the anastomosis is crucial. There may be stenosis and/or reflux. Since patients with reconstructed lower urinary tracts frequently have bacteriuria, the reflux involves a risk for pyelonephritis, with potential development of kidney scars and decrease in renal function. Therefore antireflux ureteric implantation techniques have been advocated. However, stenosis of the ureteric anastomosis or insufficiency of the antireflux mechanism may occur resulting in exposure of the upper urinary tract to contaminated urine. Therefore an understanding of the frequency and composition of bacteriuria in patients with reconstructed lower urinary tract is of major importance. It should, however, be recognized that issues as the local host response and the role of antibacterial defenses in the reconstructed lower urinary tract are not well understood.
