Controversies in antibiotic prophylaxis in urology.

Antibiotic prophylaxis in urologic surgery remains controversial. However, progress has been made and some of the controversies have been answered. Firstly, it is important to underline that urologic diagnostic and therapeutic procedures can induce surgical site infections (SSIs), bacteriuria, pyelonephritis and septicaemia in a substantial number of patients, too great to be neglected. Secondly, as patients are different and have various risk factors, a careful assessment of the patient and its individual risk is crucial. Thirdly, the same procedure may be totally different from one individual to another and they can rarely be grouped as standard procedures. A floating level of invasiveness is followed by a variation of the risk of infection. Fourthly, the pathogens and their susceptibility pattern vary extensively in Europe so that no clear-cut recommendations as for the choice of antibiotics can be given. Basic principles of antibiotic prophylaxis in terms of timing, mode of administration and length of regiment apply for urologic interventions. Thus, clean operations will usually not require antimicrobial prophylaxis except for those including the implant of a prosthetic device, while clean-contaminated will benefit from preventive antimicrobials. It is the task of the urologists to carefully assess each individual patient and procedure to opt for an optimal prophylaxis.