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Do We Need a Urine Culture Before Cystoscopy? Time to Shift Away from Routine Testing

Published:November 22, 2022DOI:https://doi.org/10.1016/j.urology.2022.11.005

      ABSTRACT

      OBJECTIVES

      To determine if cystoscopy could be safely performed without a urine culture by analyzing two prospectively cohorts of patients undergoing outpatient cystoscopy, one without urine culture and the other cohort screened and treated for ASB as per protocol. We aim to report the rate of symptomatic UTI and the rate of urinary sepsis within 30 days of cystoscopy.

      METHODS

      All patients who underwent cystoscopy between 2021 and 2022 were invited to participate. Patients were prospectively recruited in a 2:1 ratio. Cohort A: patients who did not require urine culture before cystoscopy. Cohort B: patients with sterile urine before the procedure. Primary endpoint was the occurrence of symptomatic UTI ≤ 30 days after cystoscopy.

      RESULTS

      A total of 461 patients were recruited, 316 for cohort A and 145 for cohort B. Fifteen patients had symptomatic UTIs between both groups, 8 in Cohort A and 7 in Cohort B. The overall rate of symptomatic UTI was 3.2%, 2.5% for Cohort A and 4.8% for Cohort B. We had only one case of urinary sepsis in Cohort B. The RR for developing UTI in cohort B was 1.91 in the univariate model and 1.74 in the multivariate analysis.

      CONCLUSIONS

      Routine urine culture before outpatient cystoscopy is unnecessary. In asymptomatic patients, subsequent UTIs are rare and can be easily treated. Avoiding routine urine culture helps prevent misuse of antibiotics, reduce cancellation rates, and ease the burden of patients that get cancelled because of ASB. The low risk of symptomatic UTI after the procedure must be discussed with the patient.

      KEYWORDS

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      REFERENCES

        • David S.A.
        • Patil D.
        • Alemozaffar M.
        • Issa M.M.
        • Master V.A.
        • Filson C.P.
        Urologist use of cystoscopy for patients presenting with hematuria in the United States.
        Urology. 2017; 100: 20-26
        • Trail M.
        • Cullen J.
        • Fulton E.
        • Clayton F.
        • McGregor E.
        • McWilliam F.
        • Mariappan P.
        Evaluating the Safety of Performing Flexible Cystoscopy When Urinalysis Suggests Presence of “Infection”: Results of a Prospective Clinical Study in 2350 patients.
        European Urology Open Science. 2021; 31: 28-36
        • Cusumano J.A.
        • Hermenau M.
        • Gaitanis M.
        • Travis M.
        • LaPlante K.L.
        • Tran T.Y.
        • McConeghy K.W.
        Evaluation of post–flexible cystoscopy urinary tract infection rates.
        American Journal of Health-System Pharmacy. 2020; 77: 1852-1858
        • Rané A.
        • Cahill D.
        • Saleemi A.
        • Montgomery B.
        • Palfrey E.
        The issue of prophylactic antibiotics prior to flexible cystoscopy.
        European urology. 2001; 39: 212-214
        • Wilson L.
        • Ryan J.
        • Thelning C.
        • Masters J.
        • Tuckey J.
        Is antibiotic prophylaxis required for flexible cystoscopy? A truncated randomized double-blind controlled trial.
        Journal of Endourology. 2005; 19: 1006-1008
        • García-Perdomo Herney Andrés
        • Jiménez-Mejías Eladio
        • López-Ramos Hugo
        Efficacy of antibiotic prophylaxis in cystoscopy to prevent urinary tract infection: a systematic review and meta-analysis.
        International braz j urol. 2015; 41: 412-424
        • Pescheloche P
        • Gallon J
        • Parier B
        • Ondo CZ
        • Bessede T
        • Irani J.
        Is it necessary to test the sterility of urine prior to outpatient cystoscopy?.
        Journal of Hospital Infection. 2019; 101: 483-485
        • Clemens J.Q.
        • Dowling R.
        • Foley F.
        • Goldman H.B.
        • Gonzalez C.M.
        • Tessier C.
        • Young E.
        Joint AUA/SUNA white paper on reprocessing of flexible cystoscopes.
        The Journal of urology. 2010; 184: 2241-2245
      1. Herr HW. Should Antibiotics Be Given Prior to Outpatient Cystoscopy ? A Plea to Urologists to Practice Antibiotic Stewardship. 2014;65:839–42.

      2. Bonkat G, Bartoletti R, Bruyère F, Cai T, Geerlings SE, Köves B, et al. EAU Guidelines on Urological Infections. 2022;

        • Lightner D.J.
        • Wymer K.
        • Sanchez J.
        • Kavoussi L.
        Best practice statement on urologic procedures and antimicrobial prophylaxis.
        The Journal of Urology. 2020; 203: 351-356
      3. Nicolle LE, Gupta K, Bradley SF, Colgan R, Demuri GP, Drekonja D, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria : 2019 Update by the Infectious Diseases Society of America a. 2019;68:83–110.

        • García-Perdomo H.A.
        • López H.
        • Carbonell J.
        • Castillo D.
        • Cataño J.G.
        • Serón P.
        Efficacy of antibiotic prophylaxis in patients undergoing cystoscopy: a randomized clinical trial.
        World journal of urology. 2013; 31: 1433-1439