Question:

My brother had an ileal conduit surgery in June 2023 and is now experiencing recurrent urinary tract infections (UTIs). Do probiotics help? Does anything else help?

Answer:

Recurrent UTIs in individuals with an ileal conduit can sometimes be misdiagnosed, depending on how the urine specimen is collected.

Accurate Testing:

The most accurate way to determine if someone has a UTI is to collect a urine specimen directly from the stoma. This can be done by:

• Cleansing the stoma and allowing urine to drip into a sterile specimen container, or
• Having a Nurse Specialized in Wound, Ostomy and Continence (NSWOC) collect the sample using a sterile catheter inserted into the conduit.

Either method is acceptable, but it is critical to note on the lab form that the patient has an ileal conduit or urostomy, as a section of bowel is used to form the conduit. This impacts the bacterial content and can affect interpretation of the results.

Important:

Do not take specimens from the urostomy pouch (even a newly applied one), as the pouch can contain bacteria that may lead to inaccurate test results.

For a helpful reference:

Ostomy Care Resources – Clinical Pathway

Signs and Symptoms of a UTI:

• Flank pain
• Fever and chills
• Change in urine color (e.g., blue or purple urine in the pouch or night drainage bag may indicate high bacterial presence, though not necessarily infection)

Prevention Tips:

• Drink 6–8 glasses of water daily unless otherwise advised by your physician.
• For each caffeinated or alcoholic beverage consumed, increase your water intake.
• Urine should be pale yellow, like a “pale yellow Post-it note.” Dark urine indicates dehydration.
• Maintain proper hydration to help flush bacteria from the urinary tract.
• Consider adding pure (unsweetened) cranberry juice, cranberry pills, or vitamin C (1000 mg daily) to lower urine pH—only after consulting your physician or nurse practitioner.
• Empty your pouch when it is one-third to half full.
• Clean night drainage containers each morning and change them regularly:
  • Urine bags – monthly
  • Night drainage bottles – every 6–9 months
  • Always replace drainage systems after a course of antibiotics to minimize lingering bacteria.

Probiotics and UTIs:

According to an infectious disease physician, there is no strong clinical evidence supporting probiotics for UTI prevention.

However, if all other preventative strategies have been tried and UTIs continue (and have been properly diagnosed through correct sampling and confirmed by a urologist), a three-month trial of probiotics could be considered.

When choosing probiotics, it’s best to use live, refrigerated probiotics, as most yogurts do not contain enough active cultures to make a difference.

Answered by

Lauren Wolfe, MClSc-WH, BSN, RN, NSWOC, CWOCN