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Abstract
Purpose
To determine the risk factors of infectious complications after transurethral surgery of the prostate in patients with sterile urine.
Materials and Methods
A total of 183 patients who underwent transurethral resection of the prostate or holmium laser enucleation of the prostate were reviewed. All patients had urinalyses and urine cultures preoperatively, on the day of catheter removal, and at two weeks postoperatively. Patients were divided into two groups according to whether preoperative urinalysis showed sterile urine (group I, n=99) or not (group II, n=84). Clinical parameters were compared between the two groups. Univariate and multivariate logistic regression were used for estimation of infectious complications after surgery in group I.
Results
Compared with group II, group I showed younger age, fewer post voided residuals, low prostate specific antigen levels, short-term duration of oral antibiotic therapy, and low incidence of infectious complications (p<0.05). In univariate analysis in group I, age, diabetes mellitus (DM), prostate volume, resection weight, and duration of oral antibiotic therapy showed an association with infectious complications (p<0.05). Factors showing independent association with infectious complications in group I were DM (odds ratio [OR], 7.31; 95% confidence interval [CI], 1.83-29.0; p=0.005), resection weight (OR, 1.03; 95% CI, 1.01-1.06; p=0.039), and duration of oral antibiotics (OR, 0.64; 95% CI, 0.43-0.94; p=0.025).
Conclusions
Kinds of antibiotics showed no effect on infectious complication, therefore, second generation cephalosporin is recommended for reduction of antibiotic resistance. Clinicians should be aware of the high risk for infectious complication in patients with DM and who underwent large volume resection of the prostate.
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Table 1.
Comparisons of clinical parameters between two groups
| Variable | Group I (n=99) | Group II (n=84) | p-value |
|---|---|---|---|
| Age (y) | 71.6±7.4 | 74.8±6.4 | 0.003a |
| Maximal flow rate (ml/sec) | 9.9±6.9 | 8.1±5.5 | 0.104a |
| Post void residual (ml) | 100.4±74.6 | 196.3±245.2 | 0.002a |
| Prostate volume (ml) | 49.2±31.3 | 52.2±28.1 | 0.503a |
| Prostate specific antigen (ng/ml) | 0.2±0.6 | 0.5±0.7 | 0.002a |
| International Prostate Symptom Score | 21.9±9.0 | 20.6±10.2 | 0.409a |
| Storage symptom | 9.2±3.9 | 9.4±4.9 | 0.764a |
| Obstructive symptom | 12.7±5.8 | 12.1±6.3 | 0.515a |
| Quality of life | 4.1±1.0 | 4.0±1.3 | 0.795a |
| Resection weight (g) | 21.4±19.8 | 23.8±17.0 | 0.412a |
| Foley duration (d) | 4.3±1.2 | 4.5±1.5 | 0.296a |
| Intravenous antibiotics duration (d) | 3.7±1.1 | 3.6±1.1 | 0.754a |
| Oral antibiotics duration (d) | 5.8±2.2 | 6.7±2.3 | 0.010a |
| Diabetes mellitus | 17 (17.2) | 16 (19.0) | 0.847b |
| Surgical method | 0.083b | ||
| TUR | 60 (60.6) | 62 (73.8) | |
| HoLEP | 39 (39.4) | 22 (26.2) | |
| Antibiotics (cephalosporin) | 0.371b | ||
| 2nd generation | 59 (59.6) | 44 (52.4) | |
| 3rd generation | 40 (40.4) | 40 (47.6) | |
| Infectious complication incidence | 27 (27.3) | 37 (44.0) | 0.020b |
| Operation time (min) | 110.7±49.4 | 115.8±50.4 | 0.484a |
Table 2.
Univariate analysis of factors affecting infectious complicationsin groupI
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