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An extensive clinical, microbiological and biochemical study was carried out in patients with intestinal segments transposed into the urinary tract. Three main questions were addressed in the present work. What is the cause of persistence or recurrence of urinary tract infection in this cohort of patients? Within the urinary tract, mucosal cells or urinary mucus plugs could form two potential sources of recurrences of infections in these patients. The preliminary electron microscopic observation suggested that mucus plugs contained multiple colonies of various bacterial strains. This work was supported by a subsequent molecular analysis of cultured isolates from mucus plugs and urine, which showed at least one bacterial isolate to be common between mucus plugs and urine. Is it possible to predict recurrent urinary tract infections in these patients? An assessment of the urinary proteome in this cohort of patients was carried out, specifically to find out any differences in the proteins profile of patients with or without urinary tract infections. Urinary proteins were isolated and resolved by two dimensional gel electrophoresis (2-DE). The 2-DE profiles obtained in patients were compared with normal healthy volunteers. The identified proteins included pancreatitis-associated protein 1, human lithostathine alpha 1 precursor, liver fatty acid binding protein and testis expressed protein 12. One of these proteins (pancreatitis associated protein 1) was validated using ELISA technique. What is the effect of cranberry juice intake on the symptomatic recurrence of infections in these patients? In order to answer this question, we assessed the effect of cranberry juice intake on recurrent symptomatic urinary tract infections, bacteriuria, pyuria and quality of life of patients with urinary bladder replaced or reconstructed using intestinal segments in a randomized placebo-controlled cross over trial. The trial showed no significant impact of cranberry intake on recurrent symptomatic urinary tract infections, however, there was a significant improvement in patients reported quality of life.

This thesis describes a prospective study of health outcomes in chronic dialysis patients in ten centres across Europe. There are five main aims: - To describe and compare patients entering chronic dialysis programmes across Europe; - To examine the effect of referral to a nephrologist and transition onto dialysis on early QOL; - To establish the contraindications to haemodialysis and peritoneal dialysis and identify a cohort of comparable patients for comparative studies; - To overcome variations in defining and recording new ESRD patients in different countries; - To compare health outcomes among the ten participating dialysis centres. Among incident patients (n=361), a smooth transition onto dialysis was associated with better early QOL, highlighting the importance of reducing the proportion of patients followed by a nephrologist who require an urgent first dialysis. In the subset of patients suitable for both haemodialysis and peritoneal dialysis, approximately equal numbers choose each modality. In this homogeneous cohort no difference in physical or mental QOL was found in baseline between the two modes of dialysis. However, follow up of these patients found general QOL and mental QOL to improve significantly in patients commencing treatment on haemodialysis, while no significant change was observed in QOL of those beginning on peritoneal dialysis. Incident dialysis patients in west European centres were older and more co-morbid than in central and east European centres. After adjusting for differences in casemix differences in health outcomes were found, with one centre, Thessaloniki, having significantly better QOL, haemoglobin and hospitalisation rates than the reference centre, Aberdeen. The heterogeneity of the centres makes linking single processes of care to improve outcomes difficult, but this study found no link between staffing levels and better health outcomes. Further research into how the health and culture of general populations influences outcomes in dialysis patients is now necessary.