Treatment of Preoperative Asymptomatic Bacteriuria

Procedure-Specific Recommendations

The American Urological Association recommends screening and treating asymptomatic bacteriuria before endoscopic urologic procedures that breach the mucosal lining, such as transurethral resection of prostate, transurethral resection of bladder tumor, ureteroscopy with lithotripsy, and percutaneous stone surgery, to prevent sepsis 1, 2, 3, 4
For endoscopic urologic procedures with mucosal trauma, the treatment protocol includes obtaining preoperative urine culture for targeted therapy, administering short-course antibiotics (1-2 doses only), and initiating antibiotics 30-60 minutes before the procedure 1, 3
The risk of postoperative sepsis is substantial (13% in untreated patients vs 0-4.5% in treated patients in RCTs) for endoscopic urologic procedures with mucosal trauma 4, 3
The Infectious Diseases Society of America recommends against screening or treating asymptomatic bacteriuria before non-urologic surgeries, such as orthopedic surgery, cardiac surgery, vascular surgery, and general abdominal surgery 5, 6, 7, 8
For low-risk urologic procedures, such as diagnostic cystoscopy without biopsy or incision, simple catheter removal or exchange, and removal of ureteral stents, no treatment is needed for asymptomatic bacteriuria 1, 3, 9

Treating asymptomatic bacteriuria when not indicated can cause increased antimicrobial resistance, Clostridioides difficile infection risk, drug adverse effects, and increased healthcare costs, without reducing surgical site infections or mortality 2, 8, 9

If bacteriuria is present preoperatively, the urine must be sterile before any mucosal-trauma urologic procedure to reduce bacteremia risk 7
Pyuria accompanying asymptomatic bacteriuria is not an indication for treatment in any surgical context 10