Presented by: Fabrice Henry MD
Cleveland Clinic Glickman Urological Institute

Introduction

There are minimal data to guide antibiotic management of patients undergoing holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH), specifically patients at high risk of infection. Also, management of these patients varies widely. We therefore aim to evaluate the effect of preoperative antibiotic duration on infectious complications in high-risk patients undergoing HoLEP.

Materials

A multi-institutional retrospective review of patients undergoing HoLEP between 2018-2023 at five institutions with differing antibiotic protocols was performed. Patients were defined as high risk if they were catheter-dependent (indwelling urethral catheter, self-catheterization, or suprapubic tube) or had a positive preoperative urine culture.  These patients were categorized into long course (> 3 days) or short course (≤ 3 days) of pre-operative antibiotics. The primary outcome was 30-day infectious complications defined as a positive urine culture.  A t-test or Wilcoxon rank-sum test was used for continuous variables and Fischer’s exact test was used for categorical variables.  

Results

,

Our cohort included 409 patients, of which 146 (35.7%) and 263 (64.3%) were categorized as short course and long course of pre-operative antibiotic use, respectively. Median pre-operative antibiotic duration was 1 day (IQR: 0-3 days) and 7 days (IQR: 5-7 days) in the short and long cohorts, respectively. 30 day post-op infectious complications occurred in 11 (7.59%) of the patients who received a short course of antibiotics and 5 (1.94%) patients who received a long course of antibiotics (OR (95% CI) = 0.24 (0.08, 0.71); p = 0.007). There was no significant difference in prostate size, catheter-dependence, and length of procedure between the two groups though enucleation time was longer in the long course cohort. Postoperative antibiotics use was noted to be more common in the long course cohort.

Conclusion

In our multi-institutional study of high-risk patients undergoing HoLEP, infectious complications were significantly lower on long-course vs. short-course of antibiotics. Prospective trials are needed to identify optimal pre- and post-operative antibiotic regimens for HoLEP.

Funding

None

Lead Authors

Nikhil Pramod, BS
Cleveland Clinic Glickman Urological Institute

Co-Authors

Suruchi Ramanujan, BS
Cleveland Clinic Glickman Urological Institute

Will Jevnikar, BS
Cleveland Clinic Glickman Urological Institute

James Bena,
Cleveland Clinic Glickman Urologic Institute

Ryan Schwartz, BS
University of Montreal

Jaxon Jeffery,
Mayo Clinic Arizona

Samuel Sorkhi,
Mayo Clinic Arizona

Ruben Sauer, MD
University of Illinois Chicago

Shannon McNall, MD
Lahey Clinic

Samantha Freeman, MD
Lahey Clinic

Kevin Wymer, MD
Mayo Clinic Arizona

Jessica Mandeville, MD
Lahey Clinic

Simone Civellaro, MD
University of Illinois Chicago

Mitchell Humphreys, MD
Mayo Clinic Arizona

Naeem Bhojani, MD
University of Montreal

Smita De, MD,PHD
Cleveland Clinic Glickman Urologic Institute