Introduction: Urinary tract infection (UTI) following office based urology procedures is the most common complication but occurs at a relatively infrequent rate. Due to the volume of office cystoscopy, prostate biopsy, and intravesical bladder cancer therapies (IVT) performed globally, UTI following these procedures is a potential source of significant morbidity to patients and cost to the health systems. Screening urinalysis (UA) is frequently performed prior to these office-based procedures to minimize the risk of UTI. Whether screening UA can reduce the risk of UTI following these procedures is unknown.
Methods: We conducted a multicenter (University of Wisconsin and Madison VA), randomized non-inferiority trial involving patients undergoing office cystoscopy, prostate biopsy, or IVT, in which we compared screening UA vs. no screening UA. Patients were blinded to their randomization arm. We excluded patients with UTI within 1 year, chronic catheter use, and those undergoing stent removals. Both groups completed a questionnaire about their Lower Urinary Tract Symptoms (LUTS) on the day of their procedure, 1-week post-procedure, and 1-month post-procedure. Each follow-up visit we assessed for UTI, hospitalizations, or adverse events. The primary end point was UTI within 30 days of office procedure. UTI was defined as a positive urine culture >10,000 cfu/mL accompanied by symptoms.
Results: From 10/2018 to 10/2021, 641 patients were randomly assigned to screening UA (318 patients) or no screening UA (323 patients) of which 157 (24.5%) underwent IVT, 427 (66.6%) underwent cystoscopy, and 57 (8.9%) underwent prostate biopsy. For the entire cohort, the median age was 70 (IQR 63-76), 530 were male (82.7%), 509 (79.4%) had Charlson-comorbidity index > 3, and 621 (97.3%) were white. Prior transurethral urologic procedures (office based or operative) were common in the cohort with 601 (93.8%) patients having undergone a median of 13 (IQR 5-25). History of UTI was present in 115 (17.9%) patients. On the day of the procedure, 48 (11.1%) were noted to have bacteriuria. UTI occurred in five (1.6%, 95% CI 0.7-3.7) patients in the screening UA group and four (1.2%, 95% CI 0.5-3.3) patients in the no screening UA group (OR 0.78, 95% CI 0.21-2.95; p=0.72) which met our predefined non-inferiority difference of 1% between arms.
Conclusions: Omission of pre-procedure urinalysis is not inferior to routine screening urinalysis to prevent post-procedure urinary tract infection in patients undergoing office cystoscopy, intravesical bladder cancer treatment, or prostate biopsy.
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