Risk factors, antibiotic prophylaxis, and treatment of urinary tract infection in transurethral surgery for benign prostatic hyperplasia

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Introduction. Infectious complications (ICs) after transurethral resection of the prostate (TURP) are significant and potentially life-threatening conditions with an incidence 0.5% – 20.0%. Most publications provide data regarding early infectious complications. At the same time, there are currently no studies aimed at a comprehensive assessment of long-term infectious complications after TURP. The problem of prevention and treatment of ICs is also accompanied by insufficient understanding of the role of undiagnosed inflammation in prostate tissues and the lack of representative laboratory markers.Objective. To assess the prostate-specific antigen density (PSAd) as a predictor of long-term infectious complications after transurethral resection of the prostate and to determine the optimal cut-off value.Materials & methods. This single-center study included 162 patients who underwent mono- and bipolar TURP between 2016 – 2023. Inclusion criteria for the study: prostate volume 30–80 cm3, no history of urinary tract infections (UTIs) at the time of hospitalization and antibiotic treatment at least one month before surgery, possible presence of latent UTIs before surgery, no prostate cancer. Exclusion criteria were failure to meet inclusion criteria. Infectious complications assessed included upper and lower UTIs, as well as epididymitis, orchitis and prostatitis, confirmed by clinical and laboratory data. Prostate-specific antigen (PSA) assessment was performed < 2 days before surgery.Results. The median PSAd value was 0.04 [0.03; 0.08] ng/ml2, the variable was significantly different in non-infection and infection groups (0.04 and 0.08 ng/ml2, respectively, p = 0.009). The area under the curve (AUC) was 0.67 (95% CI [0.546 – 0.791]). The optimal cut-off value of the PSAd in prediction of long-term ICs was > 0.07 ng/ml2, sensitivity / specificity: 58.3% and 76.1%, respectively. The analysis showed more than 4 times higher odds of developing an infectious complication in PSAd > 0.07 ng/ml2 patients: OR 4.3 (95% CI [1.7 – 10.5], p = 0.001).Conclusion. This study demonstrates data that defines a new clinical non-oncological significance of PSAd as a predictor of the development of long-term infectious complications after TURP.

PSA density as a predictor of long-term infectious complications during transurethral resection of the prostate: determining an optimal cut-off value

Ivanov,

Kogan,

Naboka

et al. 2024

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Surgical treatment of large-volume benign prostate hyperplasia: a comparative analysis of the outcomes of using standard and modified laparoscopic retropubic simple prostatectomy combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis

Volkov,

Pushkar,

Kolontarev

et al. 2024

Introduction. The optimal approaches to the surgical treatment of large-volume benign prostatic hyperplasia (BPH) have not yet been determined, but laparoscopic retropubic simple prostatectomy (LSP) is one of the preferred methods of surgical treatment for large-volume BPH. There are limitations to standard approaches to LSP, which necessitate the development of improved techniques.Objective. To provide comparative analysis of the efficacy and safety of standard LSP and modified LSP combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis.Materials & methods. The present multicenter study included 300 patients (mean age 67.0 ± 5.2 years) who were randomly assigned to standard and modified LSP groups. The main efficacy criteria of the intervention during 6 months of observation were: the severity of symptoms of urinary disorders (IPSS score), quality of life, peak urine flow rate and residual urine volume. All complications developed during the postoperative follow-up were recorded.Results. Of the 300 patients, 149 underwent standard LSP, and 151 underwent a modified LSP. Significant differences were detected in the hospital stay (p = 0.032), the rate of decrease in hemoglobin (p = 0.020) and the irrigation time (p = 0.001). In addition, the use of the modified technique was associated with a lower incidence of short-term urinary incontinence (p = 0.031), urinary retention due to urethral catheter occlusion (p = 0.002), and incidence of bladder tamponade (p = 0.001). After 6 months of postoperative follow-up, the groups were comparable in most of outcomes, except for peak urine flow (23.9 ± 2.3 and 20.3 ± 1.9 ml/s in the modified and standard LSP groups, respectively, p = 0.001). After 6 months of postoperative follow-up, the modified LSP group had a lower incidence of bladder tamponade (p = 0.010), urge urinary incontinence (p = 0.002) and bladder neck contracture (p = 0.031).Conclusion. The effectiveness of the modified LSP as a method of surgical treatment of large-volume BPH is not inferior to those in the standard LSP group, and the safety profile suggests the feasibility of wider testing of the technique in practice.

Antibiotic resistance of microorganisms isolated from the urine of patients before surgical treatment for benign prostatic hyperplasia: results from a 7-year single-center study

Kogan,

Medvedev,

Naboka

et al. 2024

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Introduction. The tendency of microorganisms to develop resistance mechanisms is a widely discussed and signiﬁcant problem worldwide. Studying regional diﬀerences in the qualitative characteristics of microorganisms provides valuable information for empirically preventing and treating infectious complications, as well as providing an enhanced understanding of the variability in microbial community properties within the clinical context of diseases and patients' comorbidity status.Objective. To assess the antibiotic resistance of microorganisms isolated in high titers from the urine samples of patients with benign prostate hyperplasia (BPH) prior to surgery.Materials & Methods. This single-center, retrospective study conducted from March 2016 to February 2023 included 59 suprapubic-draining BPH-patients (Group I), 46 drainage-free BPH-patients with leukocyturia (Group II), and 44 drainage-free BPH-patients and no leukocyturia (Group III). Inclusion criteria: indications for BPH surgery, no history of sexually transmitted diseases, no symptoms of urinary tract infection, and no prostate cancer. The patient's voluntary informed consents to participate were also obtained.Results. The rates of resistance to ciproﬂoxacin in patients of Group I were statistically signiﬁcantly higher compared to Group II (85.7% vs 55.6%, p = 0.002). Resistance of gram-negative microorganisms to meropenem and imipenem was higher in Group III compared to Group I (31.1% vs 13.7%, p = 0.006 for meropenem and 44.5% vs 9.8%, p = 0.001 for imipenem, respectively). Resistance of Gram-positive microorganisms to ampicillin in Groups I to III was 13.6%,6.3% and 20.0%, respectively with no signiﬁcant diﬀerence between groups (p > 0.05). However, there was extremely high resistance among veriﬁed Gram-positive organisms to all the drugs in the ﬂuoroquinolone class (ciproﬂoxacin, norﬂoxacin, levoﬂoxacin) ranged from 63.6% to 80.0%.Conclusion. The present study demonstrates that the isolation frequency of antibiotic-resistant microorganisms from the urine sample of drainage-free BPH-patients or no clinical and laboratory signs of inﬂammation in the urinary tract is high. The presence of antibiotic resistance provides risks for developing diﬃcult-to-control infectious complications. Currently, assessment of urine-derived microbial antibiotic resistance should be considered in every BPH-patient with indications for surgical management of bladder outlet obstruction, regardless of the presence of risk factors.