Recommendations for Antibacterial Prophylaxis in Endourological Procedures

Doo Yong Chung; Joo Yong Lee

doi:10.14777/uti.2019.14.1.1

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Chung and Lee: Recommendations for Antibacterial Prophylaxis in Endourological Procedures

Review

Urogenit Tract Infect 2019;14(1):1-8.

Published online: 20 April 2019

DOI: https://doi.org/10.14777/uti.2019.14.1.1

Recommendations for Antibacterial Prophylaxis in Endourological Procedures

Doo Yong Chung, Joo Yong Lee^1,

Department of Urology, Inha University School of Medicine, Incheon, Korea

¹Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Joo Yong Lee https://orcid.org/0000-0002-3470-1767 Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-2320, Fax: +82-2-312-2538 E-mail: joouro@yuhs.ac

Received 11 February 2019 Revised 17 April 2019 Accepted 18 April 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This review discusses the evidence and newly identified findings of antibiotic prophylaxis in endourological procedures based on recently published studies. Endoscopic procedures and surgeries are performed widely to treat a variety of urologic diseases. The panel of European Association of Urology (EAU) guidelines on UTIs decided not to make recommendations for specific agents for particular procedures because there are considerable variations in Europe and worldwide regarding bacterial pathogens, their susceptibility, and the availability of antibiotic agents in 2018. In the EAU guidelines, antimicrobial prophylactic therapies cannot decrease the rate of symptomatic UTI in several procedures, including cystoscopy and extracorporeal shock wave lithotripsy. Perioperative antibiotic prophylaxis can be helpful in all patients undergoing endourological treatment, including ureteroscopic surgery and percutaneous nephrolithotomy. Because the urological practice is a part of the surgery, most urological treatment can be performed mainly by surgery. The prevention of surgical infections in each surgical field is a critical issue, but the evidence and number of guidelines are limited.

Keywords: Urinary tract infections, Urology, Endoscopy, Urinary calculi, Cystoscopy

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Table 1.

Recommendations according to the guidelines for antibiotic prophylaxis in endourological procedures

Procedure	Risk factor	Guidelines
Procedure	Risk factor	European Association of Urology	American Urological Association	Japanese Urological Association	Canadian Urological Association
Cystoscopy	Most patients	Not recommended	Not recommended	Not recommended	Not recommended
	High risk patients (the presence of a urethral catheter or ureteral stent, intermittent self-catheterization, urinary retention, and recent history of UTIs, etc.)	Not mentioned	Not mentioned	Recommended	Recommended
TURP^a)	All patients	Recommended	Recommended	Recommended	Recommended
TURBT^a)	All patients	Weakly recommended	Recommended	Recommended	Not mentioned
ESWL	Most patients	Not recommended	Not recommended	Not recommended	Not recommended
	High risk patients (preoperative bacteriuria, repeated ESWL, infected stones, and stones with a size of ≥2 cm, etc.)	Not mentioned	Recommended	Recommended	Recommended



Ureteroscopy	All patients	Recommended	Recommended	Recommended	Recommended
Percutaneous nephrolithotomy	All patients	Recommended	Recommended	Recommended	Recommended

TURP: transurethral resection of prostate, TURBT: transurethral resection of bladder tumor, ESWL: extracorporeal shock wave lithotripsy, UTI: urinary tract infection.

^a) Asymptomatic bacteriuria should be screened and treated before procedures with mucosal bleeding including TURP and TURBT.

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