Assessment of Infectious Risk Factors in Benign Prostatic Hyperplasia Surgery: Results of the French Multicenter TOCUS Study

PURPOSE: Surgery for benign prostatic hyperplasia (BPH) has undergone technical innovations in recent years. The aim of this study was to evaluate the factors associated with postoperative infectious in patients treated surgically for BPH. MATERIALS AND METHODS: TOCUS is a multicenter, retrospective study including all patients treated for prostatic BPH surgery requiring screening for asymptomatic bacteriuria (ABU) from January 2016 to April 2023. The primary endpoint was occurrence of an infectious complication (surgical site infection or febrile urinary tract infection UTI) defined by postoperative fever associated with a clinical, biological and radiological exam suggestive of prostatitis or pyelonephritis, occurring within 30 days after surgery. RESULTS: In our study, 498 patients were included. Median age at surgery was 71 years (interquartile range IQR 65-77). Median operative time was 70 minutes (IQR 47-105). Patients mostly underwent endoscopic techniques (95.2%), while 4.8% underwent open simple prostatectomy. The postoperative infection rate was 5.1%. Even though infected patients had positive preoperative urine culture (UC) (96.0%), only 68.0% received preoperative antibiotic therapy. UTI in the previous year was an associated factor for postoperative infection (odds ratio OR 4.84, 95% confidence interval CI 1.78-13.69, p=0.002), as were positive preoperative mono or bimicrobial UC (OR 35.44, 95% CI 3.51-864.11, p=0.006) and preoperative polymicrobial UC (OR 48.13, 95% CI 7.03-977.27, p<0.001). Preoperative antibiotic therapy (OR 0.46, p=0.367) and antibiotic prophylaxis (OR 1.79, p=0.303) were not associated with infectious complications. There was no significant difference between the different surgical techniques in terms of postoperative infection (p=0.11). CONCLUSIONS: This study did not find an association between the surgical technique used for BPH treatment and postoperative infectious risk. However, ABU, whether monomicrobial, bimicrobial, or polymicrobial, was strongly associated with postoperative infectious complications, with no impact of preoperative antibiotic therapy or antibiotic prophylaxis.