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

Peri-operative antibiotic usage during endourological surgery: A multi-institutional, national-level, cross-sectional audit of prevalent practice pattern in India

“…As discussed previously, preoperative antibiotics prescribed to treat asymptomatic bacteriuria based on the urine culture reports, were found to be detrimental with significantly higher chances of UTI in those who received them. This finding corroborates with the recent evidence from other well-conducted clinical studies[ 10 ] and calls for a radical change in the antibiotic prophylaxis protocol for cystoscopy, regardless of the presence of predisposing factors for the development of infection.…”

“…On the contrary, some recent evidence suggests that preoperative antibiotic use, despite reducing the bacteriuria, is an independent risk factor for systemic inflammatory response syndrome (SIRS) and the risk remains high even if one follows a strategy of prolonged preoperative culture-directed antibiotics and confirms a sterile urine on the repeat culture. [ 8 9 10 ] A sterile urinary tract status is more of an assumption than a reality as the uropathogens can be demonstrated in the urinary tract using more potent methods, even when the urine culture is sterile by the standard methods. [ 11 ] Stones and biofilms also harbor bacteria shielded from the impact of antibiotics which may get released into the urinary tract during the surgery.…”