Preoperative urine culture in urology: Indications and management - The 2026 French guidelines

Before interventional or surgical procedures, urine culture (UC) is often carried out and probabilistic antibiotic therapy is often prescribed without any real justification. Reducing the inappropriate UC use will contribute to limit antibiotic consumption and antibiotic resistance. The aim of this work was to provide guidelines on: i) UC role in the diagnosis of asymptomatic bacteriuria before urological procedures in adults, depending on the procedure and patient risk factors; ii) how to perform the UC test; and iii) management of patients with positive UC.

A systematic review of studies published between January 2000 and June 2025 was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The guidelines were developed by a multidisciplinary task force following the "formalized consensus of experts" method proposed by the national French Haute Autorité de Santé (two rounds of iterative quotations and reviewing by independent experts).

In total, 84/732 publications met the inclusion criteria. Preoperative UC is no longer recommended before radical prostatectomy, radical cystectomy, cystoscopy, intravesical instillations, artificial urinary sphincter implantation, and penile prosthesis implantation. Bacterial colonization treatment should be initiated 48h before surgery and may be discontinued on surgery day or continued for up to 48h post-surgery. First-line agents for the perioperative management of bacterial colonization of urine include fosfomycin trometamol, nitrofurantoin, pivmecillinam and trimethoprim.

These guidelines describe the recommended UC indications for urological patients to personalize their management and avoid unnecessary urine cultures and antibiotic treatments.