Clinical Implications of Discordant Urinalysis and Urine Culture Findings Before Urologic Surgery

To compare the associations of preoperative urinalysis (UA) and urine culture (UCx) findings, including concordant and discordant results, with postoperative infectious complications following common urologic procedures.

Using TriNetX adult patients who underwent radical prostatectomy, partial or radical nephrectomy, or transurethral resection of bladder tumor (TURBT) between 2006 and 2026 were identified. Patients were stratified by preoperative UA and UCx findings. Postoperative outcomes within 30-day of surgery were compared using measures of association.

A total of 278,653 patients, including 109,605 radical prostatectomy, 79,613 partial or radical nephrectomy, and 89,435 TURBT patients, were included. Abnormal preoperative UA findings were present in 6.9% of radical prostatectomy, 11.2% of nephrectomy, and 22.1% of TURBT patients. Among patients with abnormal UA findings, only 5.9%, 7.1%, and 10.4%, respectively, also had a positive urine culture. Across all procedural cohorts, abnormal UA findings (without positive UCx) were associated with increased risks of postoperative UTI, sepsis, pyelonephritis, bacteremia, inpatient encounters, emergency department visits, and systemic antibiotic use. Among patients with abnormal UA findings, concurrently positive UCx provided limited additional prognostic information. Additionally, isolated positive UCx findings without abnormal UA demonstrated less consistent associations with adverse postoperative outcomes.

Abnormal preoperative UA findings were more strongly and consistently associated with postoperative infectious complications than isolated positive UCx findings. These findings do not support omission of clinically indicated UCx but warrant prospective research on UA-guided or selective reflex UCx strategies to inform future preoperative testing practices.