# Preoperative Urine Testing in Elective Endourology Procedures: Is a Change in Practice the Need of the Hour?

## TL;DR

This study questions the routine preoperative urine testing for asymptomatic bacteriuria in elective endourology procedures, suggesting it may lead to unnecessary treatments and cancellations.

## Contribution

The study provides evidence that routine preoperative urine testing may not be necessary for all patients, promoting a more targeted antibiotic approach.

## Key findings

- Only 15% of patients had urine cultures done within 2 weeks before surgery.
- 7% of patients developed postoperative UTIs, but none became seriously ill.
- None of the six patients with preoperative positive cultures developed symptomatic UTIs post-op.

## Abstract

Introduction

Urine testing is routinely done preoperatively in patients undergoing elective endourology procedures to ensure that any asymptomatic bacteriuria is picked up and treated. This practice, in addition to leading to overtreatment, can also lead to unnecessary cancellations of elective procedures. With the emergence of multidrug-resistant bacteria and the implementation of stricter antibiotic stewardship programmes, it is the need of the hour to re-examine this innocuous practice.

Patients and methods

One hundred patients undergoing elective endourology surgery were studied retrospectively to assess current practice at a district and general hospital in Wales, UK. All patients received a single dose of intraoperative antibiotic at induction. These patients were followed up for two weeks to look for postoperative septic complications.

Results

Of the 100 patients, 15% had cultures done in the stipulated 2-week period preceding surgery. Seven patients (7%) developed postoperative UTIs, of which none became acutely unwell. Of the six patients with preoperative positive cultures, none developed symptomatic UTIs post-op. Only upper tract stone surgeries were managed with a preoperative antibiotic course prior to surgery.

Conclusions

In the era of emerging antibiotic resistance and stricter antibiotic stewardship programmes, the routine practice of treating asymptomatic bacteriuria in all patients undergoing endourology surgery needs revisiting. There is an urgent need to identify the subset of patients most at risk for post-op septic complications and use targeted perioperative antibiotic prophylaxis to overcome this risk.