Preoperative Bacteriuria and Antimicrobial Resistance in Men Undergoing Urethral Stricture Surgery

Background/Objectives: Perioperative antibiotics are standard in urethral stricture surgery, but timely uncontaminated preoperative urine cultures are not always available, and empiric regimens are often selected before current susceptibility data are known. We aimed to characterize preoperative bacteriuria and antimicrobial resistance in men undergoing urethral stricture surgery and to assess associations with recorded clinical variables. Methods: We retrospectively analyzed 304 men undergoing urethral stricture surgery at two referral centers, representing the subset of the surgical population for whom a complete preoperative microbiology report, including antimicrobial susceptibility data when culture-positive organisms were recovered, was retrievable from the institutional microbiology laboratory information systems. Clinical contributors were assigned by structured chart review. The primary microbiologic endpoint was preoperative bacteriuria, defined by final local laboratory interpretation of the urine culture. Urine culture was requested at admission and repeated within 24 h before surgery if missing or non-diagnostic. MDR was defined as resistance to three or more clinically relevant antimicrobial classes, excluding expected intrinsic resistance patterns. Results: Among patients with retrievable complete preoperative microbiology data, urine cultures were positive in 164/304 patients (53.9%). The most frequent recorded contributors were iatrogenic exposure (119; 39.1%), prior endoscopic treatment (71; 23.4%), and trauma (64; 21.1%); 108/304 patients (35.5%) had more than one contributor. Among culture-positive patients, MDR occurred in 18/164 (11.0%). On exploratory multivariable analysis, suprapubic catheter status was independently associated with culture positivity (adjusted OR 4.41, 95% CI 2.47–7.87; p < 0.001), whereas PFUI was not significant after adjustment. Conclusions: In this analytic cohort, preoperative bacteriuria was common, and suprapubic catheter status was the strongest independent correlate of urine culture positivity. The observed MDR burden supports recent preoperative urine culture acquisition and stewardship-based perioperative antibiotic selection.