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Urinary Tract Infection in Patients Undergoing TURP

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Urinary Tract Infection in Patients Undergoing TURP European Review for Medical and Pharmacological Sciences 2017; 21: 4487-4492 Clinical analysis of urinary tract infection in patients undergoing transurethral resection of the prostate Y.-H. LI1, G.-Q. LI2, S.-M. GUO3, Y.-N. CHE2, X. WANG4, F.-T. CHENG1 1Department of Urinary Surgery, Binzhou Central Hospital, Binzhou, China 2Department of Gynecology, Binzhou Central Hospital, Binzhou, China 3Operating Room, Binzhou Central Hospital, Binzhou, China 4Department of Hepatobiliary surgery, Binzhou Central Hospital, Binzhou, China Abstract. – OBJECTIVE: To analyze the relat- Introduction ed influencing factors of urinary tract infection in patients undergoing transurethral resection Benign prostatic hyperplasia (BPH) is exces- of the prostate (TURP). PATIENTS AND METHODS: A total of 343 pa- sively common in males, approximately 50% in tients with benign prostatic hyperplasia admit- people aged 50 years old, and as high as 90% in ted to this hospital from January 2013 to Decem- those aged 90 years old1. Half of the patients with ber 2016, were selected and treated by TURP. BPH are complicated with progressive urinary Patients were divided into infection group and tract irritation, also summarized as lower urinary non-infection group according to the occur- tract symptoms (LUTS), which are manifested by rence of urinary tract infection after operation. The possible influencing factors were collect- irritative symptoms of bladder such as frequent ed to perform univariate and multivariate logis- micturition, urgent urination and painful urina- tic regression analysis. tion, micturition and obstruction symptoms such RESULTS: There were 53 cases with urinary as residual urine and urinary retention2. Ther- tract infection after operation among 343 pa- apies for BPH include waiting and observation, tients with benign prostatic hyperplasia, ac- medication and surgery3. For patients with mod- counting for 15.5%. The univariate analysis dis- erate and severe prostatic hyperplasia, the most played that the occurrence of urinary tract in- fection in patients undergoing TURP was close- effective therapy is surgery at present, which has ly associated with patient’s age ≥ 65 years old, a variety of modes; therein, the open surgery was complicated diabetes, catheterization for uri- applied formerly, but transurethral resection of nary retention before operation, no use of an- the prostate (TURP) has been widely utilized in tibiotics before operation and postoperative in- recent years4,5. dwelling catheter duration ≥ 5 d (p < 0.05). Multi- Although TURP has become increasingly ma- variate logistic regression analysis revealed that age ≥ 65 years old, complicated diabetes, cath- ture and its postoperative effect is significant, eterization before operation, indwelling catheter there are still some complications after TURP duration ≥ 5 d and no use of antibiotics before due to older patients, many chronic medical dis- operation were risk factors of urinary tract infec- eases or bad habits such as smoking and drink- tion in patients receiving TURP (p < 0.05). ing, unskilled operation6, mainly including ure- CONCLUSIONS: The patient’s age ≥ 65 years thral injury, postoperative bleeding, transurethral old, catheterization before operation, complicat- resection syndrome, bladder spasm, postoper- ed diabetes and long-term indwelling catheter after operation, can increase the occurrence of ative urinary infection, urethral stricture and 7-9 urinary tract infection after TURP, while preop- urinary incontinence . Genitourinary infection erative prophylactic utilization of anti-infective after TURP generally occurs within one week drugs can reduce the occurrence of postopera- to one month after discharge, which is typically tive urinary tract infection. manifested as irritative symptoms of bladder such as frequent micturition, urgent urination and Key Words: painful urination10. The body resistance in partial Transurethral resection of the prostate (TURP), Uri- nary tract infection, Risk factors. patients is relatively weak after the onset, coupled with the invasion surgery operation, resulting in Corresponding Author: Fengtao Cheng, MD; e-mail: [email protected] 4487 Y.-H. Li, G.-Q. Li, S.-M. Guo, Y.-N. Che, X. Wang, F.-T. Cheng a high occurrence of urinary tract infection in dexes included patient’s age, body mass index patients after surgery, thus affecting the surgical (BMI), smoking history, hypertension, diabetes effect11. Hence, it is of great significance to inves- mellitus, catheterization for urinary retention be- tigate the related influencing factors of urinary fore operation, use of antibiotics before operation, tract infection after transurethral resection of the operation time and postoperative indwelling cath- prostate in clinical practice. eter duration. The primary purpose of this study was to in- vestigate the causes and prophylactic-therapeutic Diagnostic Criteria for Urinary measures of urinary tract infection after TURP. Tract Infection Criteria for the diagnosis of urinary tract in- fection were according to the latest guideline of Patients and Methods European Association of Urology. The methods are shown as follows: patients were treated with General Information postoperative indwelling catheterization, and the A total of 343 patients with benign prostatic sealed drainage bag was uniformity used. The hyperplasia admitted to our hospital from Janu- urine was collected from patients at postoperative ary 2013 to December 2016 were retrospectively 3 d and 6 d under aseptic operation, followed by analyzed. All patients were conformed to the di- bacterial culture. If the same bacteria pathogen agnostic criteria of benign prostatic hyperplasia. was simultaneously cultured from two mediums Patients were confirmedly diagnosed via interna- in the same patient, and the infection was con- tional prostate symptom score (I-PSS), quality of firmed when bacteria count ≥ 105 CFU/mL. life (QOL) scale, serum prostate-specific antigen (PSA) and urodynamic examination, and treated Statistical Analysis by TURP. Exclusion criteria: (1) patients with Statistical Product and Service Solutions prostatic carcinoma or previous history of pelvic (SPSS, Version X; IBM, Armonk, NY, USA) or urethral surgery; (2) patients who were compli- 20.0 software was used for analysis of clinical cated with urethral stricture, urethral stone, ves- data. Measurement data were expressed as x– ± ical calculus or neurogenic cystitis; (3) patients s, and analyzed by t-test. Enumeration data were with previous history of infection or immune expressed by constituent ratio, and x2 test was dysfunction. The age of patients was 55-84 years utilized for intergroup comparison. Logistic re- old, with an average age of 64.4 ± 4.2 years old. gression analysis was u sed for the related factors Patients were divided into infection group and of urinary tract infection. p < 0.05 suggested that non-infection group according to the occurrence the difference was statistically significant. of urinary tract infection after operation. This experiment was carried out under the informed consent of patients and approved by the Ehics Results Committee of Binzhou Central Hospital. Morbidity of Urinary Tract Infection Surgery A total of 343 patients with benign prostatic All patients were treated by prostate resecto- hyperplasia were enrolled in this study; among scope (Olympus, Tokyo, Japan), and the surgery them, there were 53 cases with urinary tract was completed by physicians and anesthetist in infection after operation, accounting for 15.5%. the same medical team. Epidural anesthesia or There were 316 cases with pathogenic bacteria spinal anesthesia was utilized. The power of in 343 specimens, and the detection rate was transurethral resection was 280 W and coagula- 92.13%; there were 238 cases of Gram-nega- tion power was 80 W; normal saline solution was tive bacteria, accounting for 75.32%, and the used as rinsing liquid. The three-cavity ureter most common for Escherichia coli, accounting was routinely indwelt after operation, followed by for 39.56%. Gram-positive bacteria accounted for continuous bladder irrigation with normal saline. 23.73%; there were 3 cases with fungus, account- ing for 0.95% (Table I). Research Index The occurrence and risk factors of urinary Results of Univariate Analysis tract infection in patients after operation were The results of univariate analysis displayed analyzed by the questionnaire. The research in- that there was no statistically significant differ- 4488 Urinary tract infection in patients undergoing TURP Table I. The Distribution of pathogens in urinary tract duration ≥ 5 d were distinctly higher in the infec- infection. tion group than those in the non-infection group, and the differences were statistically significant Pathogens Number Proportion (%) (p < 0.05) (Table II). Gram-negative bacteria 238 75.32 Escherichia coli 125 39.56 Results of Multivariate Analysis Proteus 42 13.29 Whether there was urinary tract infection in Pseudomonas aeruginosa 28 8.87 patients after operation was regarded as the de- Klebsiella 19 6.01 Acinetobacter baumannii 13 4.11 pendent variable, and the independent variable Others 11 3.48 with statistical significance via univariate analy- Gram-positive bacteria 75 23.73 sis was set as the multivariable case. The results Enterococcus faecalis 43 13.61 of multivariate logistic analysis displayed that Staphylococcus epidermidis 21 6.64 urinary tract infection after TURP was closely Others 11 3.48 Fungi 3 0.95 associated with
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