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Postoperative Antibiotic Duration Affects Infectious Rates in High-Risk Patients Undergoing HoLEP.

Feres Camargo Maluf1, Pablo Suarez2, Maria C Velasquez2

  • 1Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Journal of Endourology
|April 2, 2026
PubMed
Summary
This summary is machine-generated.

Longer postoperative antibiotic durations significantly reduce infection rates in high-risk patients undergoing holmium laser enucleation of the prostate (HoLEP). This finding supports extended antibiotic prophylaxis to prevent complications after HoLEP surgery.

Keywords:
HoLEPantibiotic prophylaxispostoperative complicationsprostatic hyperplasiaurinary tract infections

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Area of Science:

  • Urology
  • Infectious Diseases
  • Surgical Outcomes

Background:

  • Holmium laser enucleation of the prostate (HoLEP) patients are increasingly elderly and comorbid, often presenting with asymptomatic bacteriuria.
  • Postoperative infections are a common concern in this high-risk HoLEP patient subset.
  • Optimal perioperative antibiotic prophylaxis duration for HoLEP remains understudied.

Purpose of the Study:

  • To analyze the association between postoperative antibiotic duration and infection rates in HoLEP patients at increased risk.
  • To determine if extended antibiotic use impacts postoperative infectious complications.

Main Methods:

  • Retrospective single-center cohort study of 204 high-risk HoLEP patients (2018-2023).
  • Inclusion criteria: positive preoperative urine culture, catheter dependency, immunosuppression, or history of urinary tract infections (UTIs).
  • Patients categorized into short-term (≤3 days) vs. long-term (>3 days) postoperative antibiotic groups; propensity score adjustment applied.

Main Results:

  • Long-term antibiotic group showed significantly lower 30-day infection rates (6.6%) compared to the short-term group (18.8%, p=0.016).
  • Adjusted analysis revealed a 12.1% lower chance of infectious complications with longer antibiotic duration (p=0.006).
  • Longer antibiotic use was also associated with a reduced chance of positive urine culture (p=0.032).

Conclusions:

  • Postoperative antibiotic duration significantly influences infectious complication rates in high-risk HoLEP patients.
  • Extended postoperative antibiotic prophylaxis should be considered for patients undergoing HoLEP, especially those at increased infection risk.
  • Findings suggest a potential benefit of longer antibiotic courses in preventing UTIs and other infections post-HoLEP.