Postoperative urinary tract infection (UTI) is a known complication in women undergoing prolapse repair surgery, although the rates vary widely. While screening and treating asymptomatic bacteriuria prior to surgery is considered as a preventive strategy – as positive preoperative urine culture has been linked to higher infection rates – the supporting evidence remains limited. The primary objective of this study was to evaluate whether obtaining a routine preoperative urine culture, followed by treatment of positive cases, lowers the risk of postoperative UTI within six weeks in women undergoing reconstructive pelvic organ surgery. Secondary objectives were to identify if such strategy is associated with changes in postoperative complications.

A retrospective cohort study included women who underwent reconstructive pelvic surgery at our institution between January 1, 2018, and December 31, 2024. Electronic medical records were reviewed for preoperative urine cultures, antibiotic use, postoperative UTI diagnoses and postoperative complications within 30 days. Patients were divided into two groups: those who had a preoperative urine culture obtained prior to surgery and those who did not. Post operative UTI rates were compared between the two groups. Postoperative UTI was defined by a positive urine culture (>100,000 CFU) and documented symptoms. In addition, factors associated with postoperative UTI risk and complication rates were analyzed. Assuming a 20% rate of postoperative UTI [1] and based upon a 0.8 power to reject the null hypothesis, with a Type I error probability of 0.05, a sample size of 88 patients per group was needed.

A Total of 150 patients were included in the study, 97 (64.66%) patients were screened for asymptomatic bacteriuria vs. 53 (35.33%) who did not. Demographic, clinical and surgical characteristics are presented in Table 1. Twelve patients were diagnosed with pre-operative asymptomatic bacteriuria. A total of 14 patients (9.33%) were diagnosed with post-operative UTI, 11 (11.3%) in the screening group vs 3 (5.7%) in the other (p=0.380). Postoperative complications were similar between both groups. Such findings were similar when comparing those who were screened, and treated, if found positive for UTI to those who were negative (Table 2).

Routine preoperative urine culture screening and treatment in asymptomatic women did not reduce postoperative UTI rates in those undergoing pelvic organ prolapse surgery. Furthermore, such strategy didn’t alter the differences of postoperative complication, even in the sub-group who were positive at the initial screening. The lack of association between culture results and infection outcomes suggests that other factors may play a more prominent role in postoperative UTI development. These findings support a more selective approach to preoperative urine screening, potentially avoiding unnecessary testing and antibiotic use.

Despite relatively small sample size, we can carefully suggest that there is no need for preoperative routine screening for asymptomatic bacteriuria among patients undergoing reconstructive pelvic organ surgery, as it doesn’t affect rates of postoperative UTI, and postoperative complications. Further prospective studies are needed to determine the role of preoperative urinary culture analysis.

Hjalmar A. Schiøtz & Kristian Guttu (2002) Value of urinary prophylaxis with methenamine in gynecologic surgery, Acta Obstetricia et Gynecologica Scandinavica, 81:8, 743-746