Antibiotic Prophylaxis After Urethroplasty: A Review of the Literature
Abstract
:1. Introduction
2. Materials and Methods
3. Current Recommendations and Practice Patterns
4. Urethroplasty and Postoperative Infectious Complications
5. Antibiotic Prophylaxis After Urethroplasty: What Does the Evidence Show?
6. Antibiotic Prophylaxis in Other Urologic Procedures
6.1. Radical Prostatectomy
6.2. Hypospadias Repair
7. Future Directions
8. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
Abbreviations
UTI | urinary tract infection |
AP | antibiotic prophylaxis |
AUA | American Urological Association |
SSI | surgical site infection |
MDR | multidrug-resistant |
EAU | European Association of Urology |
IDSA | Infectious Disease Society of America |
CAUTI | catheter-associated urinary tract infection |
IV | intravenous |
BMG | buccal mucosal graft |
RP | radical prostatectomy |
CFU | colony forming units |
PDS | polydioxanone |
References
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Perioperative | Continuous During Postoperative Catheterization | At Time of Catheter Removal | |
---|---|---|---|
AUA [3,9] | Single dose of a first- or second-generation cephalosporin | Not recommended | Consider in certain settings |
EAU [14,15] | Perioperative antibiotics per local antibiotic resistance profile | Not recommended | Not specified |
IDSA [16,17,18] | Single dose of a first-generation cephalosporin | Not recommended | Consider in certain settings |
Study | Study Type | Preoperative Antibiotic Prophylaxis | Perioperative Antibiotic Prophylaxis | Postoperative Antibiotic Prophylaxis | Number of Patients | UTI Criteria | UTI Rate | Wound Infection Rate |
---|---|---|---|---|---|---|---|---|
Kim et al. (2021) [25] | Retrospective Review, Mult-institutional | UA/UCx within 3 weeks of surgery Preoperative UTI defined as
| 24 h of IV 1st-, 2nd-, or 3rd-generation cephalosporins (Fluoroquinolone if allergy) | Nitrofurantoin 100 mg BID until catheter removal (Keflex if allergic) 2 doses of Ciprofloxacin or Bactrim given on day of catheter removal | 390 | >100 K CFU/mL of a single organism + at least one urinary symptom (suprapubic pain, flank pain, fever >101 F, dysuria, frequency or urgency >2 days after catheter removal) | 6.7% | 4.1% |
Kim et al. (2022) [26] | Retrospective Review, Multi-institutional | UA/UCx within 3 weeks of surgery Preoperative UTI defined as
| 24 h of IV 1st-, 2nd-, or 3rd-generation cephalosporins (Fluoroquinolone if allergy) | Cohort A: Nitrofurantoin 100 mg BID until catheter removal (Keflex if allergic) 2 doses of Ciprofloxacin or Bactrim given on day of catheter removal. Cohort B: 2 doses of Ciprofloxacin or Bactrim given on day of catheter removal | 900 | >100 K CFU/mL of a single organism + at least one urinary symptom (suprapubic pain, flank pain, fever > 101 F, dysuria, frequency or urgency >2 days after catheter removal) | Cohort A: 6.7% Cohort B: 3.9% (p > 0.05) | Cohort A: 4.1% Cohort B: 3.7% (p > 0.05) |
Hanasaki et al. (2022) [27] | Retrospective, Single institution | UA/Ucx 1 month prior to surgery Positive cultures treated with IV antibiotics for 2–5 days | Ampicillin or sulbactam until postoperative day 2 | Repeat urine culture after discontinuation of perioperative antibiotics If positive, culture-directed antibiotics beginning 1 day before catheter removal If negative, ampicillin or sulbactam ×3–4 days starting 1 day before catheter removal | 81 | Not defined | 2.5% | 3.7% |
Baas et al. (2021) [28] | Retrospective, Single institution | Not defined | Cefazolin IV x 1 dose (ciprofloxacin for allergy) | Group 1: extended AP until catheter removal. Group 2: AP for 3 days around catheter removal (Bactrim twice daily, Keflex if allergic) | 120 | Positive culture or lower urinary tract symptoms treated empirically | Group 1: 6.7% Group 2: 11.7% (p > 0.05) | Group 1: 3.3% Group 2: 1.7% (p > 0.05) |
Study | Study Type | Preoperative Antibiotic Prophylaxis | Perioperative Antibiotic Prophylaxis | Postoperative Antibiotic Prophylaxis | Number of Patients | UTI Criteria | UTI Rate | Wound Infection Rate |
---|---|---|---|---|---|---|---|---|
Pinochet et al. (2010) [34] | Non-randomized comparative | Not specified | Intraoperative antibiotics (not specified) | 3-day course of ciprofloxacin starting day before catheter removal (treatment group) vs. no antibiotics (control group) | 713 (261 with ABT, 452 without) | Symptomatic UTI within 6 weeks after catheter removal | 3.1% (ABT) vs. 7.3% (no ABT) | Not reported |
Berrondo et al. (2019) [35] | Prospective randomized clinical trial | Not specified | Perioperative antibiotics (not specified) | 2 doses of oral ciprofloxacin prior to urinary catheter removal (treatment group) vs. no antibiotics (control group) | 175 (85 with ABT, 90 without) | Not clearly specified | No significant difference between groups | No significant difference between groups |
Ehdaie et al. (2021) [36] | Cluster randomized trial | Not specified | Not specified | 1-day vs. 3-day regimen of prophylactic antibiotics at catheter removal | Not specified in abstract | Positive urine cultures (≥105 CFU) with at least 1 symptom: fever (>38 °C), urgency, frequency, dysuria or suprapubic tenderness | 1-day not inferior to 3-day regimen | Not reported |
Banks et al. (2013) [37] | Prospective observational | Not reported | Not reported | Prophylactic antibiotics 1 day before, day of, and 5 days after catheter removal | 334 | Not applicable (study focused on bacteriuria and resistance patterns) | Not the focus of study—examined bacteriuria rates; 25% had positive urine culture but only 0.6% developed UTI symptoms | Not reported |
Meir & Livne (2004) [38] | Prospective RCT | None | Single-dose cefazolin | Group 1: None Group 2: 4 days oral cephalexin | 89 patients Group 1: 52 Group 2: 37 | Culture-proven | Group 1: 0% Group 2: 0% | Group 1: 0% Group 2: 0% |
Kanaroglou et al. (2013) [39] | Retrospective Cohort | Not specified | Cefazolin | Group 1: None Group 2: TMP-SMX until catheter removal | 407 patients Group 1: 213 Group 2: 194 | Culture-proven with symptoms | Group 1: 3.3% Group 2: 2.6% (p = 0.66) | Group 1: 2.8% Group 2: 3.1% (p = 0.68) |
Zeiai et al. (2016) [40] | Retrospective Cohort | Not specified | Not specified | Group 1: 5 days trimethoprim Group 2: 1-day trimethoprim | 113 patients Group 1: 63 Group 2: 50 | Not clearly defined | Group 1: 1.6% Group 2: 0% | Group 1: 3.2% Group 2: 6% |
Roth et al. (2018) [41] | Prospective RCT | Not specified | Single dose cefazolin | Group 1: TMP-SMX for 9 days Group 2: No antibiotics | 64 patients Group 1: 30 Group 2: 34 | Positive culture with symptoms | Group 1: 0% Group 2: 2.9% (p = 1.0) | Group 1: 3.3% Group 2: 8.8% (p = 0.618) |
Faasse et al. (2022) [42] | Multicenter Prospective RCT | Not specified | Cefazolin | Group 1: TMP-SMX for 10 days Group 2: Placebo for 10 days | 166 patients Group 1: 81 Group 2: 85 | Positive culture (>50,000 CFU/mL) with fever or symptoms | Group 1: 0% Group 2: 3.5% (p = 0.246) | Group 1: 2.5% Group 2: 7.1% (p = 0.28) |
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Cahill, E.M.; Patel, H.V.; Koch, G.E.; Sterling, J. Antibiotic Prophylaxis After Urethroplasty: A Review of the Literature. J. Clin. Med. 2025, 14, 3915. https://doi.org/10.3390/jcm14113915
Cahill EM, Patel HV, Koch GE, Sterling J. Antibiotic Prophylaxis After Urethroplasty: A Review of the Literature. Journal of Clinical Medicine. 2025; 14(11):3915. https://doi.org/10.3390/jcm14113915
Chicago/Turabian StyleCahill, Ellen M., Hiren V. Patel, George E. Koch, and Joshua Sterling. 2025. "Antibiotic Prophylaxis After Urethroplasty: A Review of the Literature" Journal of Clinical Medicine 14, no. 11: 3915. https://doi.org/10.3390/jcm14113915
APA StyleCahill, E. M., Patel, H. V., Koch, G. E., & Sterling, J. (2025). Antibiotic Prophylaxis After Urethroplasty: A Review of the Literature. Journal of Clinical Medicine, 14(11), 3915. https://doi.org/10.3390/jcm14113915