Vulvar re-antisepsis and urinary tract infection after CO₂ cystoscopy in laparoscopic hysterectomy

To evaluate whether vulvar re-antisepsis before carbon dioxide (CO₂) cystoscopy after laparoscopic hysterectomy is associated with a lower incidence of postoperative urinary tract infection (UTI).

This prospective observational study included 98 women who underwent laparoscopic hysterectomy between November 25, 2025, and March 1, 2026. All patients received routine preoperative abdominal and vulvovaginal preparation with 10% povidone-iodine. According to routine intraoperative practice and surgeon preference, 53 patients underwent standard antisepsis alone, and 45 received additional vulvar and periurethral re-antisepsis immediately before CO₂ cystoscopy. The primary outcome was a postoperative UTI, defined according to Centers for Disease Control and Prevention/National Healthcare Safety Network criteria. Logistic regression was used to explore factors associated with postoperative UTI. The study was registered at clinicaltrials.gov (NCT07232446).

Postoperative UTI occurred in 8 patients (15.1%) in the standard antisepsis group and in 4 patients (8.9%) in the re-antisepsis group (p=0.538). Vulvar re-antisepsis was not associated with postoperative UTI in the exploratory multivariable model [adjusted odds ratio (OR)=0.89, 95% confidence interval (CI): 0.19-4.23; p=0.881]. Delayed catheter removal (>6 hours) was associated with postoperative UTI (adjusted OR=12.87, 95% CI: 2.13-77.62; p=0.005).

Vulvar re-antisepsis before CO₂ cystoscopy did not result in a statistically significant reduction in postoperative UTIs. Given the limited number of events and the non-randomized design, these findings should be interpreted as exploratory.