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.
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.
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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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.
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.
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.
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
- Antimicrobial prophylaxis
- Greenlight laser vaporisation
- Urinary tract infection