Is Routine Preoperative Urine Culture Warranted in Urogynecologic Surgery?

Objectives: The primary objective of this study is to evaluate the relationship between preoperative urine culture screening and the incidence of 6-week postoperative complications (UTI, pyelonephritis, urosepsis) in asymptomatic patients undergoing surgery for urinary incontinence and/or pelvic organ prolapse.

Methods: Retrospective chart review of patients who underwent surgical management of urinary incontinence and/or pelvic organ prolapse at our hospital by the urogynecology department between July 1 2019 and May 26 2023. Medical records were reviewed to determine if patients underwent routine preoperative urine culture, the results of the culture (if ordered) and postoperative outcomes. Poisson regression with robust variance estimation was used to estimate risk ratios (RR) and 95% confidence intervals (CIs) representing the association between urine culture and post operative complication. Models were adjusted for sociodemographic and clinical characteristics that were maldistributed during the two time periods and have been found to clinically associated with the risk of UTI. A p-value of < 0.20 in univariate analyses was used to determine which variables to include in the adjusted model.

Results: 321 patients were screened; of those 242 were deemed eligible based on inclusion and exclusion criteria and their charts were reviewed. We included 121 asymptomatic patients who underwent routine urine culture screening and 121 asymptomatic patients who did not. Patients in this study had a mean age of 58.5 (± 13.2) and a mean BMI of 29 (± 6.2). There were no statistically significant differences in age, BMI, race and ethnicity between the two groups. 165 patients underwent prolapse surgery, 127 patients underwent incontinence surgery and of these, 54 patients had combined prolapse and incontinence surgery. The rate of postoperative UTI was 17.4% in patients who underwent routine culture and 11.6% in patients who did not. The rate of postoperative pyelonephritis was 0.8% in patients who underwent routine urine culture and 0% in patients who did not. Neither group had urosepsis in the 6 week postoperative period. Patients undergoing routine urine culture were 2 times more likely to have a post operative urinary tract complication (adjusted RR: 1.95, 95% CI: 0.91-4.17), although this was not statistically significant.

Conclusions: Routine preoperative urine culture in asymptomatic patients undergoing incontinence and/or pelvic organ prolapse surgery did not decrease rates of postoperative urinary tract complications (UTI, pyelonephritis, urosepsis) in the 6-week postoperative period.