High incidence of urinary tract infections after photoselective laser vaporisation of the prostate: a risk factor analysis of 665 patients

Abstract

Purpose

Although photoselective laser vaporisation of the prostate (PVP) is a recognised alternative to transurethral resection in treating benign prostatic obstruction, there is limited data on the incidence and determinants of postoperative urinary tract infections (UTI). We assessed patients subjected to PVP, evaluating incidence and potential determinants of postoperative UTIs.

Materials and methods

Consecutive patients undergoing PVP between April 2010 and August 2018 were candidates for this retrospective cohort study. The primary outcome measure was microbiologically confirmed postoperative UTI. We fitted uni- and multi-variable Cox models to identify potential risk factors.

Results

Among the 665 included patients, 20% developed postoperative UTIs. The overall incidence rate per 100 patient-days was 0.65 (95% confidence interval [CI] 0.55–0.77). Risk factors for postoperative UTIs were end-stage renal failure (adjusted hazard ratio [aHR] = 14.10, 95% CI 2.08-64.58; p = 0.001) and presence of at least one of the following factors in the 3 months preceding PVP: (i) placement of urinary catheter, (ii) bacteriuria, (iii) UTI, or (iv) antimicrobial treatment (composite aHR = 1.99, 95% CI 1.22−3.24; p < 0.001). There was no apparent association between choice or duration of antimicrobial prophylaxis and incident UTIs.

Conclusions

Our analysis revealed a high incidence of UTIs after PVP and served to identify certain preoperative risk factors. Neither the choice of antimicrobial regimen nor its duration affected the incidence of UTIs. Prolonged antimicrobials proved to be disproportionately high, warranting further scrutiny in randomised controlled trials.

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References

  1. 1.

    Castellan P, Marchioni M, Rizzoli A et al (2018) The surgical experience influences the saftey and efficacy of photovaporization of prostate with 180-W XPS greenlight laser: comparison between novices vs expert surgeons. J Endourol 32(11):1071–1077. https://doi.org/10.1089/end.2018.0437

    Article  PubMed  Google Scholar 

  2. 2.

    Lee DJ, Rieken M, Halpern J et al (2016) Laser vaporization of the prostate with the 180-W XPS-Greenlight laser in patients with ongoing platelet aggregation inhibition and oral anticoagulation. Urology 91:167–173. https://doi.org/10.1016/j.urology.2016.01.021

    Article  PubMed  Google Scholar 

  3. 3.

    Colau A, Lucet JC, Rufat P et al (2001) Incidence and risk factors of bacteriuria after transurethral resection of the prostate. Eur Urol 39(3):272–276. https://doi.org/10.1159/000052452

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Alsaywid BS, Smith GH (2013) Antibiotic prophylaxis for transurethral urological surgeries: systematic review. Urol Ann 5(2):61–74. https://doi.org/10.4103/0974-7796.109993

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Berry A, Bratt A (2002) Prophylactic antibiotic use in transurethral prostatic resection: a meta-analysis. J Urol 167(2):571–577. https://doi.org/10.1016/s0022-5347(01)69088-8

    Article  PubMed  Google Scholar 

  6. 6.

    Bonkat G, Pickard R, Bartoletti R, et al. (2017) EAU Guidelines on urological infections. Perioperative antibacterial prophylaxis in urology. In: Complete European Association of Urology Guidelines. Edn. presented at the EAU annual congress, London, 2017

  7. 7.

    Schneidewind L, Kranz J, Schlager D et al (2017) Mulitcenter study on antibiotic prophylaxis, infectious complications and risk assessment in TUR-P. Cent European J Urol 70(1):112–117. https://doi.org/10.5173/ceju.2017.941

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Hargreave TB, Botto H, Rikken GHJM et al (1993) European collaborative study of antibiotic prophylaxis for transurethral resection of the prostate. Eur Urol 23(4):437–443. https://doi.org/10.1159/000474649

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Taylor EW, Lindsay G (1988) Antibiotic prophylaxis in transurethral resection of the prostate with reference to the influence of preoperative catheterization. J Hosp Infect 12(2):75–83. https://doi.org/10.1016/0195-6701(88)90129-6

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Wagenlehner FME, Wagenlehner C, Schinzel S, Naber KG, Members of the Working Group “Urological Infections” of the German Society of Urology (2005) Prospective, randomized, multicentric, open, comparative study on the efficacy of a prophylactic single dose of 500 mg levofloxacin versus 1920 mg trimethoprim/sulfamethoxazole versus a control group in patients undergoing TUR of the prostate. Eur Urol 47(4):549–556. https://doi.org/10.1016/j.eururo.2005.01.004

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Girou E, Rioux C, Brun-Buisson C et al (2006) The postoperative bacteriuria score a new way to predict nosocomial infection after prostate surgery. Infect Control Hosp Epidemiol 27(8):847–854. https://doi.org/10.1086/506398

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Bachmann A, Tubaro A, Barber N et al (2014) 180-Q XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European multicentre randomised trial-the GOLIATH study. Eur Urol 65(5):931–942. https://doi.org/10.1016/j.eururo.2013.10.040

    Article  PubMed  Google Scholar 

  13. 13.

    Cai T, Verze P, Brugnolli A et al (2016) Adherence to european association of urology guidelines on prophylactic antibiotics: an important step in antimicrobial stewardship. Eur Urol 69(2):276–283. https://doi.org/10.1016/j.eururo.2015.05.010

    Article  PubMed  Google Scholar 

  14. 14.

    Bausch K, Roth J, Seifert H et al (2018) Overuse of antimicrobial prophylaxis in low-risk patients undergoing transurethral resection of the prostate. Swiss Med Wkly 148:w14594. https://doi.org/10.4414/smw.2018.14594

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Peng SY, Kang H, Pirzadeh H, et al. (2011) MoXy fiber with active cooling cap for bovine prostate vaporization with high power 200 W 532 nm laser. In: Proceedings Volume 7883, Photonic Therapeutics and Diagnostics VII; 78831D. https://doi.org/10.1117/12.875195

  16. 16.

    Muir G, Gomez-Sancha F, Bachmann A et al (2008) Techniques and training with GreenLight HPS 120-W laser therapy of the prostate: position paper. Eur Urol Suppl 7:370–377. https://doi.org/10.1016/j.eursup.2008.01.012

    Article  Google Scholar 

  17. 17.

    Vandenbroucke JP, von Elm E, Altman DG et al (2014) Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Int J Surg 12(12):1500–1524. https://doi.org/10.1016/j.ijsu.2014.07.014

    Article  PubMed  Google Scholar 

  18. 18.

    Osthoff M, Sidler JA, Lakatos B et al (2016) Low-dose acetylsalicylic acid treatment and impact on short-term mortality in Staphyloccocus aureus bloodstream infection: a propensity score-matched cohort study. Crit Care Med 44(4):773–781. https://doi.org/10.1097/CCM.0000000000001554

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Reich O, Gratzke C, Bachmann A et al (2008) Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 180(1):246–249. https://doi.org/10.1016/j.juro.2008.03.058

    Article  PubMed  Google Scholar 

  20. 20.

    Teichmann H, Herrmann TR, Bach T (2007) Technical aspects of lasers in urology. World J Urol 25(3):221–225. https://doi.org/10.1007/s00345-007-0184-5

    Article  PubMed  Google Scholar 

  21. 21.

    Hermanns T, Strebel DD, Hefermehl LJ et al (2011) Lithium triborate laser vaporization of the prostate using the 120 W, high performance system laser: high performance all the way? J Urol 185(6):2241–2247. https://doi.org/10.1016/j.juro.2011.02.023

    Article  PubMed  Google Scholar 

  22. 22.

    Hermanns T, Sulser T, Fatzer M et al (2009) Laser fibre deterioration and loss of power output during photo-selective 80-W potassium-titanyl-phosphate laser vaporisation of the prostate. Eur Urol 55(3):679–686. https://doi.org/10.1016/j.eururo.2008.03.035

    Article  PubMed  Google Scholar 

  23. 23.

    Ahmed HU, Thwaini A, Shergill IS et al (2007) Greenlight prostatectomy: a challenge to the gold standard? Surg Laparosc Endosc Percutan Tech 17(3):156–163. https://doi.org/10.1097/sle.0b013e31805f6d7b

    Article  PubMed  Google Scholar 

  24. 24.

    Heinrich E, Schiefelbein F, Schoen G (2007) Technique and short term outcome of Green Light Laser (KTP, 80 W) vaporisation of the prostate. Eur Urol 52(6):1632–1637. https://doi.org/10.1016/j.eururo.2007.07.033

    Article  PubMed  Google Scholar 

  25. 25.

    Hermanns T, Grossmann NC, Wettsein MS et al (2019) Is loss of power output due to laser fiber degradation still an issue during prostate vaporization using the 180 W GreenLight XPS laser? World J Urol 37(1):181–187. https://doi.org/10.1007/s00345-018-2377-5

    Article  PubMed  Google Scholar 

  26. 26.

    Brunken C, Munsch M, Tauber S et al (2014) The 532-nm 180-W (GreenLight®) laser vaporization of the prostate for the treatment of lower urinary tract symptoms: how durable is the new side-fire fiber with integrated cooling system? Laser Med Sci 29(3):1307–1312. https://doi.org/10.1007/s10103-013-1320-7

    Article  Google Scholar 

  27. 27.

    Bachmann A, Muir GH, Collins EJ et al (2012) 180-W XPS GreenLight laser therapy for benign prostate hyperplasia: early safety, efficacy, and perioperative outcome after 201 procedures. Eur Urol 61(3):600–607. https://doi.org/10.1016/j.eururo.2011.11.041

    Article  PubMed  Google Scholar 

  28. 28.

    Loeffler JM, Garbino J, Lew D et al (2009) Antibiotic consumption, bacterial resistance and their correlation in a Swiss University Hospital and its adult Intensive Care Units. Scand J Infect Dis 35(11–12):843–850. https://doi.org/10.1080/00365540310016646

    Article  Google Scholar 

  29. 29.

    Speich B, Bausch K, Roth A et al (2019) Single-dose versus 3-day cotrimoxazole prophylaxis in transurethral resection or greenlight laser vaporisation of the prostate: study protocol for a multicentre randomised placebo controlled non-inferiority trial (CITrUS trial). Trials 20(1):142. https://doi.org/10.1186/s13063-019-3237-3

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

A special thanks to Linda Stamm and Brian Duggan (University Hospital of Basel) for their help with the initial draft and to Purva Kristina Khanduja (Mount Sinai Hospital, University of Toronto) and Thenral Socrates (University Hospital of Basel), who reviewed the manuscript.

Funding

The Division of Infectious Diseases and Hospital Epidemiology at the University Hospital of Basel in Basel, Switzerland funded this study. The efforts of Kathrin Bausch were funded by the Department of Surgery, University Hospital of Basel.

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Authors

Contributions

KB: protocol/project development, methodology, data collection, manuscript writing, manuscript editing; JM: data collection, manuscript writing; JAR: protocol/project development, methodology, data analysis, manuscript review; MD: data management; HHS and AFW: protocol/project development, manuscript review.

Corresponding author

Correspondence to Hans-Helge Seifert.

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Conflict of interest

All authors have no financial and/or personal relationships with other people or organisations that could have inappropriately influenced their work. The authors declared that there were no conflicts of interest.

Research involving human participants and/or animals

The Ethics Committee of Northwestern and Central Switzerland approved our study protocol, waiving individual informed consent (No. 2018-01539). The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. We adhered to the ‘Strengthening the Reporting of Observational.

Informed consent

Due to the retrospective nature of the study, patients were not asked for individual informed consent. At University Hospital Basel, patients are asked to sign a general informed consent form for the further use of healthcare data. If patients declined this general informed consent, they were withdrawn from study participation. This procedure was approved by the Ethics Committee of Northwestern and Central Switzerland (No. 2018-01539).

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Bausch, K., Motzer, J., Roth, J.A. et al. High incidence of urinary tract infections after photoselective laser vaporisation of the prostate: a risk factor analysis of 665 patients. World J Urol 38, 1787–1794 (2020). https://doi.org/10.1007/s00345-019-02969-3

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Keywords

  • Antimicrobial prophylaxis
  • Catheter
  • Greenlight laser vaporisation
  • Urinary tract infection