Abstract
Office cystoscopy may be associated with urinary tract infection (UTI) in up to 10–20% of patients. Current practice of surgical part preparation in males with povidone-iodine excludes distal urethra in males, leaving a possibility for resident intra-urethral flora to cause post-procedural UTI. We designed this randomized study to assess whether additional cleaning of distal urethra with povidone-iodine solution can help reduce post-procedural incidence of UTIs in this setting. Additionally, urethral swab culture was done in the entire cohort to identify the prevalent microflora in the distal male urethra and to evaluate its role in causation of post-procedural UTI. Using a specialized urethral swab culture methodology, 85% males demonstrated some bacteria and 16% showed common uro-pathogens. 28 (14.5%) cases had post-procedure culture positive UTI. The incidence of UTI in control group (22%) was significantly more than the intervention group (7%) (p value <0.007). This result strongly supports inclusion of distal urethral irrigation with povidone-iodine in males before office cystoscopy, even when pre-procedure mid-stream urine culture is sterile.
Highlights
The terminal portion of the male urethra is covered with stratified squamous epithelium and colonization of the urogenital tract by several microorganisms does occur after birth
All eight patients in which the same commensal was the cause of urinary tract infection (UTI), were part of the control group. These results indicate that whenever pathogenic resident/commensal bacteria are present in urethra they may have some role to play in post-procedural UTI’s
UTI by definition is an inflammatory response of the urothelium to bacterial invasion that is usually associated with bacteriuria and pyuria
Summary
The terminal portion of the male urethra is covered with stratified squamous epithelium and colonization of the urogenital tract by several microorganisms does occur after birth. Many factors control this phenomenon, including keratinization and mucus in the epithelial surface, bacterial adherence, microbial interaction, antimicrobial substances phagocytosis, and humoral and cellular immunities[3]. The coronal sulcus and distal urethra of healthy men at least episodically supports bacterial communities[5,6,7,8]. We planned to identify the prevalent intra-urethral microflora in all these men and to correlate the type of bacterial growths with the occurrence of post-procedural UTI in this setting
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