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Do We Need a Urine Culture Before Cystoscopy? Time to Shift Away from Routine Testing
Julian Chavarriaga1, Juliana Villanueva2, Daniela Varela2
1Division of Urology, Clinica Imbanaco - Quiron Salud, Cali, Colombia; Division of Urology, Pontificia Universidad Javeriana, Bogota, D.C., Colombia; Division of Urology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Urology
|November 25, 2022
Summary
Routine urine cultures before cystoscopy are unnecessary. Symptomatic urinary tract infections (UTIs) after the procedure are rare in asymptomatic patients, reducing antibiotic misuse and patient burden.
Area of Science:
- Urology
- Infectious Diseases
- Healthcare Management
Background:
- Outpatient cystoscopy is a common urological procedure.
- Asymptomatic bacteriuria (ASB) screening before cystoscopy can lead to antibiotic misuse and procedure cancellations.
- The necessity of pre-procedure urine cultures for asymptomatic patients is debated.
Purpose of the Study:
- To evaluate the safety and outcomes of performing cystoscopy without routine pre-procedure urine cultures.
- To compare the rates of symptomatic urinary tract infection (UTI) and urinary sepsis after cystoscopy in patients with and without pre-procedure urine screening.
Main Methods:
- A prospective study analyzed two cohorts of patients undergoing outpatient cystoscopy (2021-2022).
- Cohort A (n=316) did not require urine culture before cystoscopy.
- Cohort B (n=145) required sterile urine before the procedure, with ASB treated as per protocol.
Main Results:
- A total of 461 patients were recruited.
- The overall symptomatic UTI rate was 3.2% (2.5% in Cohort A, 4.8% in Cohort B).
- One case of urinary sepsis occurred in Cohort B; Cohort A had no sepsis.
Conclusions:
- Routine urine culture before outpatient cystoscopy is not necessary for asymptomatic patients.
- Avoiding pre-procedure urine cultures reduces antibiotic misuse, cancellations, and patient burden.
- The low risk of symptomatic UTI post-cystoscopy should be communicated to patients.
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