# Uropathogenic Microorganisms After Pelvic Floor Surgery and Mid-Urethral Sling Application: Detection Under Different Culture Conditions

## TL;DR

This study compares two urine culture methods to detect uropathogens after mid-urethral sling surgery, suggesting a more sensitive method could improve diagnostics and treatment.

## Contribution

The study evaluates enhanced quantitative urine culture's potential for better pathogen detection after mid-urethral sling procedures.

## Key findings

- Enhanced quantitative urine culture detected more uropathogens than conventional methods, though not statistically significant.
- Key pathogens identified include Escherichia coli and Klebsiella pneumoniae with variable antibiotic resistance patterns.
- The study suggests EQUC could improve postoperative diagnostics and targeted antibiotic therapy for mid-urethral sling patients.

## Abstract

Urinary incontinence (UI) is a prevalent condition that significantly affects quality of life and healthcare systems. Stress urinary incontinence (SUI) is often treated with mid-urethral sling (MUS), a procedure associated with a risk of postoperative urinary tract infections.

This study aimed to evaluate the effectiveness of enhanced quantitative urine culture (EQUC) for detecting uropathogens after MUS compared to conventional culture techniques. In total, 104 women of reproductive age and postmenopausal status were included. Thirty-five women with UI underwent MUS (cases), while 69 undergoing other pelvic floor reconstructions served as controls. Catheterized urine samples were collected preoperatively for both groups and postoperatively only for cases, yielding a total of 139 samples. Each sample was cultured using both conventional and EQUC methods.

EQUC detected 66.6% (12 vs. 8 positives) more uropathogens than conventional culture. McNemar’s exact test on paired results showed that this difference was not statistically significant in the two-sided test (p = 0.125), but the one-sided test suggested a trend toward higher sensitivity of EQUC (p = 0.063). Notably, no pathogens identified by conventional culture were missed by EQUC, supporting its potential as a more comprehensive diagnostic technique. Key uropathogens identified included Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Enterococcus faecalis. The antibiotic sensitivity profiles reveal variable resistance patterns in detected uropathogens, especially in Escherichia coli and Klebsiella pneumoniae, highlighting the importance of targeted antibiotic therapies for MUS cases.

Although limited by sample size and single-center design, these findings indicate a promising but not statistically significant trend, which suggests that EQUC may provide clinically meaningful advantages over standard culture. Adoption of EQUC in postoperative urinary diagnostics could improve pathogen detection, enable more targeted antibiotic therapy, and reduce complications in women undergoing MUS procedures. Our results warrant validation in larger, multicenter studies.