Does Routine Urine Culture Testing Before Endoscopic Prostate Surgery Decrease Postoperative Urinary Tract Infection? An Analysis of the Veteran Affairs Surgical Quality Improvement Program.

Introduction: Endoscopic prostate surgery increases septic morbidity and mortality. While urology guidelines recommend preoperative urine testing, surgeons determine what test to obtain. It remains unknown whether preoperative urine culture (UCX) decreases postoperative UTIs in these patients.

Methods: A retrospective analysis of a prospectively collected cohort of men who underwent benign prostate endoscopic surgery including transurethral resection of the prostate (TURP), laser enucleation (LEP), laser vaporization, and redo-TURP was collected through the Veteran Affairs Surgical Quality Improvement Program between 2015 and 2022. We evaluated patients with postoperative UTI within 30 days of surgery and identified factors associated with preoperative UCX testing.

Results: The cohort included 22,825 veterans, with 83.5% undergoing preoperative UCX. Adjusted analysis showed no association between preoperative UCX and postoperative UTI (aOR = 0.89; 95% CI [0.72-1.10]; P = .29). A historically positive UCX within a year before surgery was the strongest factor associated with postoperative UTI (aOR = 1.33; 95% CI [1.13-1.57]; P = .001). Men who had LEP (vs TURP) were less likely to have postoperative UTI (aOR = 0.56; 95% CI [0.31-0.92]; P = .031). Factors associated with preoperative UCX testing included men with a historically positive UCX (aOR = 1.62; 95% CI [1.51-1.73]; P < .001) and undergoing LEP (vs laser vaporization; aOR = 1.83; 95% CI [1.49-2.27]; P < .001).

Conclusions: Routine preoperative UCX testing was not associated with postoperative UTI risk in endoscopic prostate surgery. Veterans with a historically positive UCX were more likely to receive a preoperative UCX but still had higher postoperative UTI risk. It remains unclear if these patients may be better served by broader spectrum periprocedural antibiotics as opposed to culture-directed antibiotics.