Department of Urology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Int J Urol. 2022 Jul;29(7):707-711. doi: 10.1111/iju.14878. Epub 2022 Mar 31.
We aimed to examine the clinical significance of an antimicrobial administration protocol, in which postoperative prophylaxis was proactively discontinued.
We included 81 adult urethroplasties performed at our institution in the study. Preoperative bacteriuria was treated using an appropriate antimicrobial agent 2-5 days before surgery. All patients were treated with intravenous antimicrobial agents until postoperative day 2, and thereafter without prophylaxis. Antibiotics were resumed from the day before the urethrogram for urethral catheter removal, 2-3 weeks postoperatively. The relationships between pre- and postoperative positive urine culture and postoperative infectious complications, along with factors influencing surgical success rate were examined retrospectively.
Of the 81 patients, 60 underwent anastomotic repair and 21 underwent substitution repair. Positive preoperative urine cultures were more frequent in patients having suprapubic cystostomy tube than in those without (P < 0.0001), but such a difference was not noted postoperatively between the two groups, and approximately half of the patients had a positive urine culture postoperatively. Wound infections and symptomatic urinary tract infections rates were 3.7% and 2.5%, respectively, similar to previous studies with longer prophylaxis, and no significant correlation was noted with pre- and postoperative positive urine culture, treated by this antibiotic protocol. The overall clinical and objective success rates were 96.3% and 79.0%, respectively, and no significant impact of pre- or postoperative positive urine culture was noted. The only significant parameter for objective success was patient age.
Perioperative management of urethroplasty is feasible using the antimicrobial protocol described in this study.
本研究旨在探讨一种主动停止术后预防用抗菌药物的方案的临床意义。
本研究纳入了在我院进行的 81 例成人尿道成形术。术前尿培养阳性者在术前 2-5 天用适当的抗菌药物进行治疗。所有患者均在术后第 2 天前接受静脉用抗菌药物治疗，此后不再进行预防。抗生素在尿道造影前一天开始恢复，即术后 2-3 周。回顾性分析术前和术后阳性尿培养与术后感染性并发症之间的关系，以及影响手术成功率的因素。
81 例患者中，60 例行吻合修复术，21 例行替代修复术。与无耻骨上膀胱造瘘管的患者相比，有耻骨上膀胱造瘘管的患者术前尿培养阳性更为常见（P<0.0001），但术后两组之间无差异，约一半的患者术后尿培养阳性。伤口感染和有症状的尿路感染发生率分别为 3.7%和 2.5%，与之前使用更长时间预防用抗菌药物的研究相似，且与本研究中采用的这种抗菌药物方案治疗的术前和术后阳性尿培养无显著相关性。总体临床和客观成功率分别为 96.3%和 79.0%，术前和术后阳性尿培养无显著影响。客观成功率的唯一显著参数是患者年龄。
采用本研究中描述的抗菌药物方案，可对尿道成形术进行围手术期管理。
