Prophylactic antibiotics and urinary tract infections after robot-assisted radical cystectomy: A narrative review.

Abstract

Background: Robot-assisted radical cystectomy (RARC) is a growingly preferred minimally invasive technique for bladder extraction and urinary reconstruction. Postoperative urinary tract infections (UTIs) remain one of the most common complications.

Objective: This narrative review examines the role of prophylactic antibiotics in reducing UTIs following RARC, with attention to risk factors, antimicrobial resistance patterns, and emerging non-antibiotic preventive strategies.

Methodology: A literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for English-language articles published between January 2014 and October 2025. Search terms included "urinary tract infection," "radical cystectomy," "antibiotic prophylaxis," "drug resistance," and "non-antibiotic strategies." Clinical trials, meta analysis, and randomized controlled trials were prioritized. Key themes included UTI prevalence, bacterial resistance trends, prophylactic approaches, and the potential applicability of adjunctive non-antibiotic measures.

Results: UTI incidence after RARC ranges from 14% to 39%, typically within 30 days but occasionally up to 90 days. Risk is influenced by patient factors such as age, female sex, and obesity, as well as surgical variables. Prophylactic antibiotics are associated with reduced UTI rates, though optimal duration remains uncertain. Evidence suggests short-course regimens are often effective, while extended prophylaxis may benefit selected high-risk patients. However, rising resistance, particularly to fluoroquinolones and cephalosporins, complicates empirical treatment.

Conclusion: Prophylactic antibiotics after RARC reduce postoperative UTIs and related complications. However, conflicting RCT evidence and lack of consensus on duration require balancing benefits against risks of antimicrobial resistance and Clostridioides difficile infection. A comprehensive strategy-including culture-guided therapy, protocol adherence, and non-antibiotic preventive measures-may optimize outcomes.