Stone Formation in the Infected Pediatric Enterocystoplasty

Abstract

Proteus mirabilis is one of the most frequent bacterial agents that can induce infection stone formation by urease production. In recent years the influence of Proteus mirabilis on stone formation in enterocystoplasties has been primarily related to the presence of urease. Usually the definition of a symptomatic infection: “The multiplication and maintenance of pathogenic bacteria, fungi, parasites or viruses after contamination, causing local inflammation or systemic disease of the host”, was overlooked. Often the symptom “bacteriuria” was evaluated rather than the disease “symptomatic urinary tract infection” or “cystitis” which are correlated with stone formation in enterocystoplasties. Symptomatic infection assumes an initial interaction between bacteria and the bladder epithelium, followed by a cellular reaction that is associated with cellular, urinary and bacteriological factors. As an objective parameter for infection, bacteriuria or a nitrite test are usually regarded as a sufficient clinical indication of infection. The strong correlation between bacteriuria and cystitis in the normal bladder fuels misinterpretations of scientific data on the effect of treatment and of the definition of disease in enterocystoplasties by clinicians and scientists alike. Bacterial adherence to epithelial surfaces is important for starting the infection and may be a target in prevention.