Incidence and Risk Factors of Postoperative Bacteriuria after Transurethral Resection of the Prostate using Distilled Water as Irrigating Fluid: A Retrospective Cohort Study

Abstract

Objective: To establish the incidence of postoperative bacteriuria (PBU) in patients after undergoing transurethral resection of the prostate (TURP) using sterile distilled water as irrigating fluid, and determine the possible risk factors for its development.

Methods: A retrospective cohort study of patients who underwent TURP using distilled water as irrigating fluid from 2014-2018 at a tertiary government hospital was performed. Included were patients who had urine culture results upon admission, treated with antibiotics or received antibiotic prophylaxis within 24 hours prior to operation, as appropriate, and had a repeat culture prior to discharge. PBU was defined as the presence of significant (≥ 105 CFU/mL) bacteriuria upon catheter removal in patients with either no growth on preoperative urine culture or growth of a different organism from that of the preoperative culture. Chi-square and Student’s T-test were used to compare those with and without PBU and attributable risk (AR) values were determined for identified risk factors.

Results: Eighty-four patients with a mean age of 65 (± 6.32) years were included. Sixteen (19%) patients developed PBU. Preoperative catheterization and resection time of more than 30 minutes were found to be associated with the development of PBU (p=0.020 and 0.047, respectively), with AR of 24.24% (95% CI [13.90,34.58]) and 22.86% (95% CI [13.02,32.69]). Age, resected prostate weight, and diabetes mellitus were not found to be associated with PBU.

Conclusion: Postoperative bacteriuria rate of 19% was noted with the use of distilled water as irrigant during TURP. Significant risk factors for its development included preoperative catheterization and prolonged resection times.