Department of Urology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 2300, Chicago, IL, 60611, USA.
Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
World J Urol. 2020 May;38(5):1295-1301. doi: 10.1007/s00345-019-02880-x. Epub 2019 Jul 22.
Patients often receive antibiotic prophylaxis after urethroplasty to minimize the risk of urinary tract infection (UTI). The aim of this study was to determine the frequency of UTIs after urethroplasty and its impact on urethral and incisional healing.
Patients undergoing urethroplasty by a single surgeon from 2000 to 2012 were retrospectively reviewed. All patients received preoperative antibiotic prophylaxis and postoperative prophylaxis for 30 days or until catheter removal. We reviewed urine cultures obtained within 30 days after urethroplasty in symptomatic patients, and rates of stricture recurrence and wound complications. A positive culture was defined as > 1000 cfu/mL of an organism.
398 patients were included with a mean age of 43.5 years at time of surgery. We identified 102 positive urine cultures (25.6%) within 30 days of urethroplasty. 78 stricture recurrences (19.6%) occurred at an average of 3 years after surgery and 18 (4.5%) experienced a wound complication, with a 52 month mean follow-up. There were no significant differences in stricture recurrence (p = 0.36) or wound complications (p = 0.42) between patients who had a positive and negative urine culture. On multivariate analysis, positive urine cultures (HR 1.0, 95% CI 0.6-1.8, p = 0.88) were not associated with stricture recurrence, while lichen sclerosis (HR 3.2, 95% CI 1.1-9.2, p = 0.03) and previous urethroplasty (HR 2.3, 95% CI 1.1-4.6, p = 0.03) were.
Bacterial colonization and UTIs despite antimicrobial prophylaxis are common in urethroplasty patients. This, however, does not appear to impair urethral healing or influence wound healing, suggesting that postoperative prophylaxis may in fact offer no benefit.
患者在尿道成形术后常接受抗生素预防治疗，以最大程度降低尿路感染（UTI）的风险。本研究旨在确定尿道成形术后 UTI 的发生频率及其对尿道和切口愈合的影响。
回顾性分析 2000 年至 2012 年间由同一位外科医生进行的尿道成形术患者。所有患者均接受术前抗生素预防治疗，并在术后 30 天或直至导管拔出时接受术后预防治疗。我们分析了术后 30 天内有症状患者的尿液培养结果，并评估了狭窄复发和伤口并发症的发生率。阳性培养定义为> 1000cfu/mL 的病原体。
共纳入 398 例患者，平均年龄为 43.5 岁。我们在尿道成形术后 30 天内发现 102 例阳性尿液培养（25.6%）。78 例（19.6%）出现狭窄复发，平均在术后 3 年发生，18 例（4.5%）发生伤口并发症，平均随访 52 个月。阳性和阴性尿液培养患者的狭窄复发（p=0.36）或伤口并发症（p=0.42）无显著差异。多因素分析显示，阳性尿液培养（HR 1.0，95%CI 0.6-1.8，p=0.88）与狭窄复发无关，而硬化性苔藓（HR 3.2，95%CI 1.1-9.2，p=0.03）和既往尿道成形术（HR 2.3，95%CI 1.1-4.6，p=0.03）是狭窄复发的独立危险因素。
尽管给予了抗菌预防治疗，尿道成形术患者仍常出现细菌定植和 UTI。但这似乎并不影响尿道愈合或伤口愈合，表明术后预防治疗实际上可能无益。
