Antibiotic Prophylaxis After Urethroplasty: A Review of the Literature

Urethroplasty is a highly effective surgical treatment for urethral stricture disease. While overall complication rates are low, surgical site infections and urinary tract infections (UTIs) represent the most common complications. Due to the prolonged need for catheterization following reconstruction, many urologists place patients on extended antibiotic prophylaxis postoperatively. However, antibiotic stewardship is important given the risks of antibiotic overuse including opportunistic infections and the emergence of multidrug-resistant organisms. There are currently no established guidelines for the management of antibiotics for patients undergoing urethroplasty, specifically with regard to postoperative prophylaxis through the time of foley catheter removal. In this review, we examine the current literature regarding antibiotic prophylaxis and urethroplasty. Research has shown no clear benefit for extended antibiotic prophylaxis in preventing symptomatic urinary tract infections or stricture recurrence. This is congruent with evidence from other urologic procedures requiring indwelling catheters and/or stents including radical prostatectomy, hypospadias repair, and pyeloplasty. Prospective, randomized trials are needed to further understand the impact of antibiotic prophylaxis on both urethroplasty outcomes and its broader impact on recurrent UTIs and microbial resistance.