Do Routine Preoperative and Intraoperative Urine Cultures Benefit Pediatric Vesicoureteral Reflux Surgery?
Daniel R Hettel1, Bradley C Gill1,2, Audrey C Rhee1,2,3
1Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH, USA.
Insights
Routine urine cultures before pediatric vesicoureteral reflux surgery are not necessary for asymptomatic patients. Symptomatic children may benefit from preoperative urine cultures to guide treatment.
Area of Science:
- Pediatric Urology
- Infectious Disease Management
- Surgical Optimization
Background:
- Vesicoureteral reflux (VUR) is a common condition in children, often requiring surgical intervention.
- The necessity of routine preoperative and intraoperative urine cultures (UCx) in pediatric VUR surgery remains debated.
- Identifying asymptomatic bacteriuria is crucial for preventing postoperative complications.
Purpose of the Study:
- To evaluate the necessity of routine preoperative and intraoperative urine cultures in pediatric VUR surgery.
- To determine the association between urine culture results and preoperative symptoms.
- To assess the impact of urine cultures on surgical outcomes in VUR patients.
Main Methods:
- Retrospective review of 87 pediatric patients undergoing ureteral reimplantation for primary VUR (2000-2014).
- Analysis of preoperative urine cultures (within 30 days) and intraoperative cultures.
- Correlation of culture results with preoperative symptoms and postoperative complications.
Main Results:
- Only 45% of patients had preoperative urine cultures; 8% were positive, exclusively in symptomatic patients.
- No asymptomatic patients had positive preoperative cultures.
- All intraoperative cultures were negative; no association found between culture results and postoperative complications.
Conclusions:
- Routine preoperative and intraoperative urine cultures may not be necessary for asymptomatic pediatric VUR patients undergoing surgery.
- Preoperative urine cultures may be beneficial for children presenting with urinary tract infection symptoms.
- Selective urine culture screening could optimize resource utilization and patient management.
Abstract:
Objective. To determine if routine preoperative and intraoperative urine cultures (UCx) are necessary in pediatric vesicoureteral (VUR) reflux surgery by identifying their association with each other, preoperative symptoms, and surgical outcomes. Materials and Methods. A retrospective review of patients undergoing ureteral reimplant(s) for primary VUR at a tertiary academic medical center between years 2000 and 2014 was done. Preoperative UCx were defined as those within 30 days before surgery. A positive culture was defined as >50,000 colony forming units of a single organism. Results. A total of 185 patients were identified and 87/185 (47.0%) met inclusion criteria. Of those, 39/87 (45%) completed a preoperative UCx. Only 3/39 (8%) preoperative cultures returned positive, and all of those patients were preoperatively symptomatic. No preoperatively asymptomatic patients had positive preoperative cultures. Intraoperative cultures were obtained in 21/87 (24.1%) patients; all were negative. No associations were found between preoperative culture results and intraoperative cultures or between culture result and postoperative complications. Conclusions. In asymptomatic patients, no associations were found between the completion of a preoperative or intraoperative UCx and surgical outcomes, suggesting that not all patients may require preoperative screening. Children presenting with symptoms of urinary tract infection (UTI) prior to ureteral reimplantation may benefit from preoperative UCx.
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