Antibiotic prophylaxis after urethroplasty may offer no benefit

Adarsh Manjunath, Liqi Chen, Leah J. Welty, Vincent J. Wong, Channa Amarasekera, Chris M. Gonzalez, Matthias D. Hofer*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1295-1301
Number of pages7
JournalWorld journal of urology
Volume38
Issue number5
DOIs
StatePublished - May 1 2020

Keywords

  • Antibiotic prophylaxis
  • Antimicrobial stewardship
  • Urethral stricture
  • Urinary tract infection

ASJC Scopus subject areas

  • Urology

Fingerprint Dive into the research topics of 'Antibiotic prophylaxis after urethroplasty may offer no benefit'. Together they form a unique fingerprint.

  • Cite this