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Are Urine Cultures at Time of Elective Lower Urinary Tract Surgery Necessary?
Rudolph Bowens, MD, Deepak Agarwal, MD, Benjamin Whittam, MD, Rosalia Misseri, MD, Mark Cain, MD, Kirsten Meldrum, MD, Richard Rink, MD, Martin Kaefer, MD.
Indiana University, Indianapolis, IN, USA.
Background: Vesicoureteral reflux (VUR) is associated with urinary tract infections (UTI). Due to the fact that UTIs are common, our policy has been to send intraoperative urine cultures at the time of ureteral reimplantation. We sought to determine the necessity of this practice and to determine if our policy could be tailored in order to limit cost and maximize benefit.
Methods: We evaluated urine cultures obtained over a 2-year period at the time of elective ureteral reimplantation for VUR. All surgery was performed intravesically. Patient records were reviewed for patient age, preoperative culture results, intraoperative visual description of bladder condition and intraoperative urinary culture results. A positive intraoperative urine culture was defined as > 50,000 CFU of a pathogenic organism.
Results: A total of 234 patients (average age of 5.4 years) undergoing VUR between 2010-2012 were evaluated. Urine cultures were found to be positive in only six patients (6/234 = 2.6%). Intraoperative bladder wall assessment was abnormal in four of the six patients (i.e. bladder wall thickening/mucosal edema). Two of the six patients had a treated positive preoperative urine culture (something we send on all patients). A single patient had neither a positive preoperative culture nor abnormal cystoscopic findings. If abnormal intraoperative bladder appearance and positive preoperative cultures had been used as criteria for sending intraoperative urine cultures, only one asymptomatic urinary tract infection would have gone undetected and a cost savings of nearly $18,300 would have been realized over this period of this review.
Conclusions: Our data suggests that routine intraoperative urine cultures are of minimal benefit. If a decision to send an intraoperative culture is based on having either abnormal cystoscopic findings and/or a positive preoperative culture then nearly all asymptomatic urinary tract infections will be identified while at the same time realizing a substantial cost savings.
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