Presentation Authors: Omotola Ashorobi*, Joseph Fougerousse, Kimberly Martin, John Patrick Selph, Birmingham, AL
Introduction: While it is common practice among surgeons to prescribe antibiotics after urethroplasty, it is unclear if this provides any benefit regarding patient options. Our objective was to evaluate infection and recurrence rates after single stage urethroplasty stratified by the use of postoperative antibiotics and to provide recommendations for best practices based on our experience with a diverse cohort.
Methods: Retrospective chart review of men with a history of single stage urethroplasty from 2011 to 2017 based on hospital coding data. The procedures were performed by three surgeons at a single academic institution. Primary outcomes that were reviewed included: post-operative antibiotic prophylaxis, post-operative infection, and stricture recurrence requiring intervention of any type.
Results: 160 men were identified with a mean age of 47 +/- 15.8 years, and 30% of the cohort was African-American. Mean follow-up was 1 year (+/- 1.3 years). All patients received preoperative antibiotic prophylaxis. Post-operatively, 97/160 (60.6%) patients received prophylactic antibiotics and 63/160 (39.4%) did not. At initial follow-up, patients who received antibiotics at discharge were routinely cultured prior to foley catheter removal, while the non-antibiotic patients were only selectively cultured if symptomatic. Positive urine cultures (defined as the presence of any growth of bacteria/fungi) were noted in 36/160 (22.5%) patients. Of the 36 with positive cultures, 26 (72.2%) had received antibiotics at discharge, while 10 (27.8%) had not. Despite receiving antibiotics at discharge, 26/97 (26.8%) had a positive urine culture postop. Among the 14 men with symptomatic urinary tract infections, 9 had received antibiotics at time of discharge from surgery. Men who had a positive urine culture at initial follow-up were significantly more likely to develop disease recurrence (30.6% vs 15.3%, p = 0.04), though culture was not routinely done in the non-antibiotic group, perhaps missing some positive cultures. There were 30/160 (20%) symptomatic urethral stricture recurrences. 17/30 men with stricture recurrence received antibiotics at discharge vs 13/30 men who did not (56.7% vs 43.3%, p=0.62).
Conclusions: Despite receiving post-operative antibiotic prophylaxis after urethroplasty, 26.8% of men still have positive urine cultures. Furthermore, postoperative antibiotic use did not reduce symptomatic stricture recurrence rate. Routine antibiotic prescription after urethroplasty should be abandoned.