Refining Bacteriuria as a Risk Factor for Complications After Urethroplasty: Identifying the Culprit

Area of Science:

• Urology
• Infectious Disease
• Microbiology

Background:

• Preoperative bacteriuria is a known risk factor for complications following urethroplasty.
• Identifying specific microorganisms driving these complications is crucial for patient management.

Purpose of the Study:

• To determine which specific bacteria are associated with an increased risk of 90-day complications after urethroplasty.
• To differentiate the risk posed by various microbial species in patients undergoing urethroplasty.

Main Methods:

• Retrospective review of 1611 patients undergoing urethroplasty (08/2003-06/2021).
• Significant preoperative bacteriuria defined by specific colony counts (≥10^8 CFU/L for mixed, ≥10^6 CFU/L for identifiable).
• Statistical analysis (chi-square) used to associate 90-day complications (Clavien ≥2) with bacterial types.

Main Results:

• 23.2% of patients had significant preoperative bacteriuria.
• Gram-negative bacilli (e.g., E. coli, Pseudomonas sp.) and Enterococcus sp. were significantly associated with higher complication rates (14.2% and 15.1%, respectively).
• Gram-positive cocci, gram-positive bacilli, mixed growth, and Candida were not associated with increased complications.

Conclusions:

• Gram-negative bacilli and Enterococcus species are the main drivers of bacteriuria-related complications post-urethroplasty.
• Patients with bacteriuria from other microorganisms can likely undergo urethroplasty without elevated risk.