IMPORTANCE: Acute urinary tract infections (UTIs) are common after prolapse and anti-incontinence surgery, with incidence rates varying from 14% to 64%. OBJECTIVE: The objective was to decrease rates of symptomatic urinary tract infections in patients undergoing pelvic organ prolapse repair and/or anti-incontinence surgery using an intraoperative bundle. STUDY DESIGN: This change in practice was implemented on January 19, 2024, for all patients undergoing prolapse and/or anti-incontinence surgery within our division, with data collected until July 18, 2024. A similar cohort from 1 year before the implementation was used as a comparison. The regimen consisted of re-prepping the urethral meatus with 4% chlorhexidine swab before any instrumentation, including placement of the transurethral catheter or cystoscope. Any time the urethral catheter was temporarily removed, it was placed in a solution of 80 mg gentamicin/500 mL normal saline in the operative field. The number of times urethral instrumentation occurred was recorded. No changes were made to our standard of care for prophylactic intraoperative antibiotics. Patients discharged with a Foley catheter received methenamine hippurate and cranberry tablets per our standard practice. The primary outcome, incidence of symptomatic UTIs within 30 days postoperatively, was determined for pre-bundle and post-bundle implementation participants. Secondary analyses included the association between UTI rates and urethral instrumentation, specific surgeon, and procedure type. We also sought to determine if these interventions were associated with increasing resistance in bacterial isolates from urine cultures. RESULTS: The total of 461 patients in pre-bundle and post-bundle groups were similar in age, body mass index, and race distribution, with similar rates of baseline comorbidities of interest: diabetes, recurrent UTIs, and current smoking status. For the primary outcome of symptomatic UTI within 30 days of index surgery, there was a significant decrease from 18.1% to 10.9% (P=0.034). When analyzing the number of urethral instrumentations per case, the median number was 3, with no difference between those who developed UTI and those who did not. There was no difference in rates of failed voiding trial and no increase in resistant bacterial strains after the bundle implementation. An almost 50% decrease in secondary postoperative urinary retention was demonstrated in the post-bundle group, postulated to be related to the lower rate of UTIs. CONCLUSIONS: An intraoperative bundle that includes urethral re-prepping before all intraoperative instrumentation and keeping the Foley catheter in a gentamicin/saline solution when not in use demonstrated a 40% decrease in symptomatic UTIs within 30 days of surgery. Given the low cost and ease of implementation of these interventions, surgeons should consider incorporating these measures to help minimize postoperative UTIs after prolapse and anti-incontinence surgery.
Bonglack et al. (Mon,) studied this question.