Mp52-11 Can Histopathological Diagnosis of Lichen Sclerosus in Patients Without Clinical Findings Predict Urethral Reconstruction Outcomes?

Abstract

urologists perceive preoperative positive urine culture rate to be > 25%. 71% order a urine culture preoperatively in all despite UA result, and 32% do so 1 week prior. Regardless of catheter status, 41.8% use a urine bacteria threshold of 10K CFU/mL to initiate treatment preoperatively. Ideal duration of treatment was 7 days in 35%, 5 days in 26%, and < 3 days in 26%. 58.8% would not post-pone surgery if preferred duration was not me. 15% repeated a urine culture preoperatively after treatment, and 35% would empirically treat with antimicrobials if a urine culture was not performed. The majority of experts administer 2 antimicrobials at time of urethroplasty with 42% preferring Aminoglycoside + Penicillin regardless of the urine culture. 18-24% of experts continue IV antimicrobials for longer than 24 hours. 61% administer oral antimicrobials until postoperative catheter removal (2-3 weeks). The majority give additional antimicrobials at catheter removal.CONCLUSIONS: There is substantial variability in antimicrobial administration for urethroplasty. Concern of over use of antimicrobials is based on the extensive use of antibiotics preoperatively and postoperatively. Opportunity and obligation exists to improve antimicrobial stewardship. Randomized trials are requisite to establish guidelines for judicious yet effective regimen(s).