Postoperative Abdominal Distention,Ileus And Fever After The Removal Of Ureteral Stents After Laparoscopic Radical Cystectomy:A Clinical Analysis

Objective Bladder cancer is one of the most common malignancies in the urinary system,with an incidence ranking among the top ten cancers worldwide.Radical cystectomy(RC)remains the standard procedure for muscle invasive bladder cancer.However,RC is associated with several complications,including postoperative abdominal distention(PAD),postoperative ileus(POI),and infection.While the first peak of infection is typically monitored via blood and urine cultures,research has primarily focused on identifying the risk factors for and prevention of POI,overlooking the relationship between PAD and POI,as well as the occurrence of the second peak of infection,which majorly is urinary tract infection(UTI)after the removal of the ureteral stent.This study aims to analyze the risk factors for PAD and POI after RC through a retrospective study and summarize the prevention and treatment strategies for POI.Additionally,this study aims to identify the risk factors for UTI after the removal of ureteral stents,characterize the spectrum of pathogens causing UTI,and evaluate the effectiveness of sensitive antibiotics.Methods The first part of the study involved a retrospective analysis to summarize clinical and laboratory data,identify the risk factors for PAD and POI after RC,and explore the relationship between PAD and POI.The second part of the study involved a prospective randomized trial to compare intervention outcomes,analyze the statistical significance of the interventions,and identify the risk factors for UTI after the removal of ureteral stents.The spectrum of pathogens causing UTI and their sensitivity to antibiotics were also characterized.Results The incidence of PAD was 38.06%.Multivariate logistic regression analysis showed that a history of chronic constipation,increased laxative dose,and delayed ambulation after surgery were independent risk factors for PAD.The incidence of POI was 30.77%.Independent risk factors for POI included a history of chronic constipation,increased laxative dose,previous abdominal surgery,and delayed ambulation after surgery.A total of 94 patients developed PAD,while 76 patients developed POI.Among them,50 patients had both POI and PAD,indicating an association between the occurrence of PAD and POI(P<0.001).Regarding infections,17 patients(56.67%)in the experimental group had positive cultures at the catheter tip,and 8 patients(26.67%)eventually developed infections.In the control group,19 patients(63.33%)had positive cultures at the catheter tip,and 14 patients(46.67%)developed infections.The use of carbapenem antibiotics within six hours of ureteral stents removal significantly reduced the risk of UTI(P=0.038,OR=2.414).Increased body mass index,history of diabetes,preoperative hypoalbuminemia,and postoperative return to the ICU were independent risk factors for it.The most common pathogens causing UTI were Escherichia coli and Enterococcus.The blood culture for identifying pathogenic bacteria after catheter removal may have a certain false positive rate and lag time.Conclusion Correcting chronic constipation,reducing the use of preoperative bowel preparation drugs,and promoting postoperative mobilization may help reduce the incidence of PAD and POI.The use of carbapenem antibiotics during ureteral stents removal could reduce the risk of UTI,and for patients undergoing RC with intestine related urinary diversion,collecting and testing the tips of the ureteral catheters while removing stents is recommended.