The role of antibacterial prophylaxis in urologic surgery

The possible origins of post-TUR bacteriuria (urethral flora, prostate, bladder tumors, or contaminated irrigating fluids or instruments) are discussed. A review of the literature on antibacterial prophylaxis during TUR led to a positive assessment of its value. Preferred agents for prophylaxis of urinary tract infections include cephalosporins, extended-spectrum penicillins, ampicillin, and aminoglycosides. The value of antibacterial prophylaxis in open urologic surgery, such as prostatectomy, has not yet been clearly established, but studies have demonstrated significant benefit in patients undergoing transrectal needle biopsy of the prostate. New techniques of stone removal have not yet been thoroughly evaluated with respect to their potential for causing urinary tract infection and bacteremia. Since as many as 77 per cent of stones harbor bacteria, however, antibiotic prophylaxis is recommended. Nonurologic indications for antibacterial prophylaxis are outlined.