The source of organisms in the post-prostatectomy bacteriuria of patients with pre-operative sterile urine

Ninety patients undergoing prostatectomy for benign prostatic hyperplasia (BPH) with sterile urine pre-operatively were prospectively studied for post-prostatectomy bacteriuria; 26 of 90 patients (29%) developed bacteriuria (18 of 64 after transurethral resection (TUR) and 8 of 26 after open prostatectomy), of whom 15 had pre-operative indwelling urethral catheters. The correlation of bacteriuria with several factors was studied, namely the presence of a histological inflammatory reaction within the prostatic adenoma, prostatic culture, intra-operative outgoing irrigation fluid culture, intra-operative blood culture and post-operative external meatal swab culture. The only significant correlation was between bacteriuria and meatal cultures. It was concluded that post-prostatectomy bacteriuria is probably caused by post-operative ascending infection along urethral catheters. There was not enough evidence to ascribe bacteriuria to pre-existing septic foci within the adenoma. Intra-operative contamination and infection from distant foci were also unlikely causes.