Infectious factor in transuretral surgery of benign prostate hyperplasia: a systematic review and meta-analysis

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Abstract

Purpose. To assess postoperative bacteriuria and infectious complications in terms of antibiotic prophylaxis (ABP) regimens, preoperative urine bacterial status and total prostate-specific antigen (PSA) level in patients with benign prostate hyperplasia (BPH) undergoing transurethral prostate surgery.

Materials and Methods. The PubMed, ClinicalKey, Google Scholar and the Cochrane bibliographic databases were searched from 1992 to 2022. The Mantel-Haenszel method was used to calculate the odds ratio (OR) and inverse variance method was used to calculate mean difference (MD) with 95% confidence interval (CI). Primary outcome was the development of asymptomatic bacteriuria, secondary – development of infectious complications.

Results. This meta-analysis showed that ABP significantly decreased level of postoperative bacteriuria and infection complications. This meta-analysis was in favour of prolonged ABP (≥ 3 days) in lowering postoperative infectious complications rate compared to short regimens (≤ 24 hours). Preoperative bacteriuria was not significantly associated with postoperative bacteriuria level and infectious complications. Mean preoperative PSA level significantly differed in patients with and without postoperative bacteriuria.

Conclusion. This meta-analysis demonstrated significant gaps in the knowledge of perioperative bacterial status and antibiotic prophylaxis strategies efficacy in the group of patients undergoing transurethral prostate surgery. There is no consensus on optimal ABP regimen. Most of included studies had significant heterogeneity. Further studies are required.

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About the authors

Sergey N. Ivanov

Department of Urology and Pediatric Urology, Rostov State Medical University

Author for correspondence.
Email: ivanovsergey19@gmail.com
ORCID iD: 0000-0002-9772-937X

Postgrad. Student, Dept. of Urology and Human Reproductive Health (with pediatric Urology and Andrology course), Rostov State Medical University

Russian Federation, Rostov-on-Don

Mikhail I. Kogan

Department of Urology and Pediatric Urology, Rostov State Medical University

Email: kogan_dept@mail.ru
ORCID iD: 0000-0002-1710-0169

MD, PhD, Honored Scientist of the Russian Federation, Full Professor; Head at the Department of Urology and Human Reproductive Health with the course of Pediatric Urology and Andrology, Advanced Training and Specialist Professional Retraining Faculty, Rostov State Medical University

Russian Federation, Rostov-on-Don

Yulia L. Naboka

Deparment of Microbiology and Virology №1, Rostov State Medical University

Email: nagu22@mail.ru
ORCID iD: 0000-0002-0937-4573

MD, PhD, Full Professor, Head of the Department of Microbiology and Virology №1, Rostov State Medical University

Russian Federation, Rostov-on-Don

Vladimir L. Medvedev

Department of Urology, Kuban State Medical University

Email: medvedev_vl@mail.ru
ORCID iD: 0000-0001-8335-2578

MD, PhD, Honored Doctor of the Russian Federation, Full Professor; Deputy Chief Doctor on Urology, Scientific Research Institute – Ochapovsky Regional Clinical Hospital №1, Head of Regional Uronephrologic Center, Chief External Urologist of Health Care Ministry of Krasnodar Region, Head of Urology Department, Kuban State Medical University

Russian Federation, Krasnodar

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2. Fig. 1. Assessing the risk of bias: randomized trials (A - B); non-randomized studies (C - D). Risk of bias plots (A, C): authors' judgments of each risk of bias element (B, D): authors' judgments of each risk of bias element for each included study.

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3. Fig. 2. Flowchart of search strategy for meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses principles

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4. Fig. 3. Meta-analysis diagrams. A) The effect of antibiotic prophylaxis on the incidence of significant postoperative bacteriuria. B) The effect of antibiotic prophylaxis on the incidence of infectious complications. C) The frequency of infectious complications depending on the duration of antibiotic prophylaxis. D) The effect of postoperative bacteriuria on the incidence of urinary tract infections in the postoperative period. F) Effect of postoperative PSA level on the incidence of postoperative bacteriuria.

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