The Headache of Post-Transurethral Prostate Surgery Pyuria: Pursuit for Evidence

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Transurethral prostate surgery (TUPS) is a common procedure for benign prostate obstruction.
• Understanding postoperative urinary changes, including pyuria and bacteriuria, is crucial for patient management.
• The clinical relevance of early postoperative urinalysis and urine cultures following TUPS requires further investigation.

Purpose of the Study:

• To prospectively evaluate early changes in urinalysis and bacteriuria after transurethral prostate surgery (TUPS).
• To assess the clinical relevance of these urinary findings in patients undergoing TUPS.
• To determine the optimal timing for urine culture follow-up post-TUPS.

Main Methods:

• Prospective assessment of 152 patients undergoing TUPS for benign prostate obstruction.
• Patients were evaluated using the dysuria-visual-analogue-scale (DVAS), international prostate symptom scores (IPSS)-quality of life, uroflow, and postvoid residual.
• Urinalysis and midstream urine cultures (MSUC) were performed at various intervals: pre-discharge, and 2, 4, 8, 12, and 24 weeks postoperatively.

Main Results:

• Significant pyuria was prevalent post-TUPS, with over 50% of patients showing pyuria at 24 weeks.
• The mean time to non-significant pyuria varied by surgical technique, with prostate incision and enucleation showing earlier resolution.
• Positive preoperative urine leukocyte esterase was an independent predictor of positive 4-week MSUC; routine urinalysis showed limited correlation with IPSS or DVAS.

Conclusions:

• Persistent pyuria and microhematuria are common for up to 6 months after TUPS, gradually declining over time.
• Prostate incision and enucleation techniques are associated with earlier resolution of pyuria.
• Routine urine culture at 1 month post-TUPS is clinically significant, whereas routine urinalysis during the first 6 months has limited value.