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Erschienen in:
22.07.2019 | Original Article
Antibiotic prophylaxis after urethroplasty may offer no benefit
Erschienen in: World Journal of Urology | Ausgabe 5/2020
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Purpose
Patients often receive antibiotic prophylaxis after urethroplasty to minimize the risk of urinary tract infection (UTI). The aim of this study was to determine the frequency of UTIs after urethroplasty and its impact on urethral and incisional healing.
Methods
Patients undergoing urethroplasty by a single surgeon from 2000 to 2012 were retrospectively reviewed. All patients received preoperative antibiotic prophylaxis and postoperative prophylaxis for 30 days or until catheter removal. We reviewed urine cultures obtained within 30 days after urethroplasty in symptomatic patients, and rates of stricture recurrence and wound complications. A positive culture was defined as > 1000 cfu/mL of an organism.
Results
398 patients were included with a mean age of 43.5 years at time of surgery. We identified 102 positive urine cultures (25.6%) within 30 days of urethroplasty. 78 stricture recurrences (19.6%) occurred at an average of 3 years after surgery and 18 (4.5%) experienced a wound complication, with a 52 month mean follow-up. There were no significant differences in stricture recurrence (p = 0.36) or wound complications (p = 0.42) between patients who had a positive and negative urine culture. On multivariate analysis, positive urine cultures (HR 1.0, 95% CI 0.6–1.8, p = 0.88) were not associated with stricture recurrence, while lichen sclerosis (HR 3.2, 95% CI 1.1–9.2, p = 0.03) and previous urethroplasty (HR 2.3, 95% CI 1.1–4.6, p = 0.03) were.
Conclusion
Bacterial colonization and UTIs despite antimicrobial prophylaxis are common in urethroplasty patients. This, however, does not appear to impair urethral healing or influence wound healing, suggesting that postoperative prophylaxis may in fact offer no benefit.