Presented by: Mohammad Mohaghegh MD, FRCSC
The Ohio State University, Department of Urology

Introduction

Holmium laser enucleation of the prostate is a size-independent surgical treatment for benign prostatic hypertrophy. As with many outlet procedures, UTI and sepsis are feared complications and antibiotics are given with this procedure. Currently, there is a lack of data on peri-operative antibiotic prescribing patterns for HoLEP and, thus, no consensus on optimal practices. We set out to determine what the current prescribing practices are for peri-operative antibiotic therapy for HoLEP in various clinical scenarios.

Materials

Members of the Endourologic Society (n=3000) were invited through the endourologic society email list to complete a REDCap survey. The study was exempt from IRB approval. The survey included questions about surgeons’ practice setting, training, surgical volume, antibiotic prescribing practices and different factors affecting their choices of what antibiotic to administer.  Data was tabulated an analyzed using SAS v9.4.

Results

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Urologists (n= 70, 66 male, 4 female) reported that they performed an average of 108 HoLEPs per year with mean clinical experience of 11 years. More surgeons were based out of the United States, and worked at an academic center (36%, 69%, respectively). HoLEP training for the cohort consisted of fellowship training (39%), self-taught (33%) and course-based training (17%). Urologists consider a variety of factors when determining the type and duration of antibiotic therapy with HoLEP, Figure 1. In the case of a negative pre-operative urine culture and the patient is not catheterized/self-catheterizing (C/ISC), most urologists would only give a single dose of antibiotic on the day of the procedure (96%). However, this did not hold true if patient is C/ISC (Figure 1). If the pre-operative urine culture resulted “mixed-flora”, 34% of surgeons will request further speciation and 42% will treat in the absence of further speciation (Figure 1). If the pre-operative urine culture is negative 39% of surgeons will prescribe postoperative antibiotics if the patient is not catheterized vs 64% if the patient is catheterized (Figure 1).

Conclusion

There remains significant variability amongst surgeons for perioperative antibiotic prescribing practices for HoLEP. In general, more antibiotic are prescribed if the patient has a history of catheterization or infection.  Further clinical studies are needed to identify the best antibiotic prescribing protocols when HoLEP is performed.

Funding

NA

Co-Authors

Tasha Posid, PHD
The Ohio State University, Department of Urology

Nicholas Dean, MD
The Northwestern University

Bodo Knudsen, MD, FRCSC
The Ohio State University, Department of Urology

Amy Krambeck, MD
The Northwestern University

Matthew Lee, MD
The Ohio State University, Department of Urology