Long‐term Follow‐up after Transurethral Prostatic Resection With or Without a Short Peri‐operative Antibiotic Course

Abstract

This study was undertaken to analyse the results in 192 patients who 3 to 4 years earlier had undergone transurethral resection (TUR) in a controlled clinical trial on the value of a short peri-operative course of antibiotics. The survival rate was comparable in both groups. Most deaths were due to cardiovascular disease and/or cancer of the prostate and the gastrointestinal tract. Infectious events predominated in the control group and more antibiotics were prescribed for these patients during follow-up than for the patients in the peri-operative antibiotic group. Bacteriuria was found in 24% of patients, evenly distributed between the groups. Eighty-three per cent were satisfied with the results of prostatectomy but 38% complained of symptoms from the lower urinary tract. The maximum urinary flow rate was not influenced by the presence of bacteriuria and/or symptoms. There was no difference between the groups regarding mortality or morbidity except for the frequency of post-operative urethral stricture formation, which was significantly higher in the controls. It was concluded that prospective long-term follow-up is indicated to assess the effect of short peri-operative antibiotic courses.

The Source of Organisms in the Post‐prostatectomy Bacteriuria of Patients with Pre‐operative Sterile Urine

“…Longterm follow-up studies found that the condition was transient and tended to resolve spontaneously after catheter removal without any further treatment (Hirschmann and Inui, 1980;Grabe, 1987). However, some complications such as urethral stricture and bladder neck stenosis (Grabe and Hellsten, 1985;Hammarsten et al, 1989), secondary haemorrhage (Harvey er a[., 1986), bacteraemia (Sullivan et al, 1973), septicaemia (Cafferkey et al, 1982) and epididymitis (Genster and Madsen, 1970) were reported, although direct evidence to link bacteriuria with these complications is lacking. This perhaps explains why only 10% of urologists in the UK use routine antimicrobial prophylaxis with prostatectomy (Wilson and Lewi, 1985).…”

Bacteremia Resulting from Prostatic Surgery in Patients with or without Preoperative Bacteriuria under Perioperative Antibiotic Use

“…Bacteremia may turn into septi cemia, the most serious hazard following ma nipulation of the urogenital tract. Postopera tive bacteriuria has been reported to develop in about 20-60% of preoperatively nonbacteriuric patients under no chemoprophylaxis [7][8][9][10][11][12][13][14][15], Concerning the importance of postop erative bacteriuria, Grabe and Hellsten [15] reported that bacteriuria was associated with an increased risk for further severe infectious events, and stricture of the urethra and blad der neck. Although many studies have focused on antibiotic use in prostatectomy, the ratio nal use of antibacterial agents in view of the potential seriousness of the postoperative in fectious complications remains controversial.…”

Antimicrobial Prophylaxis in Transurethral Resection of the Prostate with Special Reference to Preoperatively Sterile Urine

“…Interestingly Grabe & Hellsten, in a group of patients who 3 4 years earlier had had TURP in a controlled trial on a short course of perioperative antimicrobics (191, found that infectious events predominated in the control group during follow-up, and the frequency of postoperative urethral stricture formation was significantly higher in that group (20).…”