{"id":56991,"date":"2024-03-20T11:30:51","date_gmt":"2024-03-20T11:30:51","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=56991"},"modified":"2024-04-01T19:12:24","modified_gmt":"2024-04-01T19:12:24","slug":"uropathogenic-infection-associated-with-prostate-hypertrophy-and-transurethral-resection-of-prostate","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol17no1\/uropathogenic-infection-associated-with-prostate-hypertrophy-and-transurethral-resection-of-prostate\/","title":{"rendered":"Uropathogenic Infection Associated with Prostate Hypertrophy and Transurethral Resection of Prostate"},"content":{"rendered":"\n

Introduction <\/strong><\/p>\n\n\n\n

Benign prostatic hyperplasia (BPH) is a common male disease\nin the Urology clinics and occurs more frequently in the middle-aged and\nelderly men1<\/sup>. The\nprevalence of BPH was estimated to be 26% in men aged 40 to 49 years and 41% in\nmen aged 60 to 69 years2<\/sup>. Urine\nretention resulting in dysuria, incomplete voiding, and urinary incontinence is\nthe primary prognosis of the disease3<\/sup>. The Transuretha Resction of Prostate (TURP) procedure\nhad a satisfying sequel, nevertheless few patients are exposed to uropathogenic\nbacteria beyond the procedure due to age advancement, chronic diseases, and\nprevious catheter insertion4<\/sup>. Postoperative sequels, such as\nurinary tract infection (UTI), bacteremia and prostatitis are known\ncomplications after TURP; their incidence is 6\u201364%, depending on the type of\nurethral instrumentation used and the use of prophylactic antibiotics5,6<\/sup>. UTIs are common with a prevalence\nof 0.7% in terms of community-acquired infection7,8<\/sup>. Studies have reported rates of\npostoperative morbidity greater than 10% as complication for BPH, the UTI was included9\u201312<\/sup>.\nThe focus of\nthis study was to analyze urinary tract infection (UTI) defined as bacteriuria\nand identify potential risk factors in patients with BPH during the three\nstages preoperative, intraoperative\nand postoperative associated with TURP procedure.<\/p>\n\n\n\n

Materials and Methods<\/strong><\/p>\n\n\n\n

General information <\/strong><\/p>\n\n\n\n

A prospective clinical study involving 90 patients suffering\nfrom BPH who were scheduled for a TURP procedure at the Urology clinic,\nAl-Yarmouk Teaching Hospital, Baghdad from January to August 2019 was designed.\nThe range of their ages was 35 to 87 years, with an\naverage age of 59.64 \u00b1 9.35 years. This study also included 30 subjects as\ncontrols selected from matched age range (55 – 70 years), with no previous\nhospital admission for any urological procedures, neither previous history of\nUTIs, nor diabetes mellitus (DM). Written consent for participation was\ntaken from the patients. The hospital Ethics Committee and the University of\nBaghdad, College of Science approved the study. Inclusion criteria included\npatients with main symptoms of BPH, then they were confirmed by color Doppler\nultrasound, cystoscopy, and Prostate serum Antigen (PSA) positive tests.\nConcomitant bladder pathology, including stones, prostate cancer, diseases like\nurinary system deformity, obstruction, bladder calculi, or previous urethral\nsurgery were considered an exclusion criteria. <\/p>\n\n\n\n

Surgical procedure<\/strong><\/p>\n\n\n\n

The surgical procedure (TURP) was performed by\nsurgeons who had more than 15 years of experience. For all operations,\ndistilled water was the suggested fluid for irrigation fluid. After that, a\ncontinuous irrigation system was applied to insert a three-way urethral Foley\ncatheter. A three-day course of intravenous third-generation cephalosporin\nwas part of the postoperative care unless the preoperative urine antibiotic\nsensitivity indicated otherwise. After three days, the catheter was taken out. <\/p>\n\n\n\n

Study design<\/strong><\/p>\n\n\n\n

Clinical data of all patients were collected including age, disease course, Body Mass Index (BMI), prostate volume, and International Prostate Symptom Score (IPSS). The time of indwelling catheter after the procedure; and prophylactic application of antibiotics before surgery were recorded. Urine and culture analysis were taken on three times for all patients: before 24 hours of the procedure (60 mid-stream urine (MSU) and 30 catheterized urine), immediately after the procedure ends (90 per cystoscopy), and (90 MSU) after the catheter removal at 3rd day post TURP procedure. For bacterial growth assessment the guidelines of European Association of Urology were applied.  The urine was steriley collected and incubated at 37\u00b0C for 24 hours on blood and MacConkey agar. A minimum of 1×105<\/sup> colony forming units (CFU)\/ml was defined as significant bacterial growth. Less bacterial growth was defined as bacteriuria. Biochemical analysis to identify the isolates and the antimicrobial susceptibility test were performed (Figure 1). Any potential risk factor\u2014preoperative, intraoperative, and postoperative\u2014was investigated associated with post-TURP-UTIs (Table 1). <\/p>\n\n\n\n

Statistical analysis<\/strong><\/p>\n\n\n\n

For data processing, SPSS software (version\n22.0) was applied. The experimental data’s continuous variables were presented\nas mean standard deviation (x\u00b1s), and the independent t-test was employed for\nunivariate analysis to determine statistical significance for both continuous\nand categorical variables. Both descriptive analysis and classified variable\ndata were expressed as (%) and adopted X2 test. A multivariate logistic\nregression model was performed to assess the independent factors affecting UTI.\nThe significant difference was considered when P < 0.05.<\/p>\n\n\n\n\n\n
\"\"<\/td>\n\n

Figure 1: <\/strong>Urine samples for bacterial analysis of studied groups.<\/strong><\/p>\n

<\/p>\n

Click here to view Figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Table 1: Potential risk factors associated with TURP-UTI (preoperatively, intra-operatively, and post operatively)<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Preoperative<\/strong><\/p>\n<\/td>\n

\n

Intraoperative<\/strong><\/p>\n<\/td>\n

\n

Post-operative<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Age<\/p>\n<\/td>\n

\n

Duration of the operation (minutes)<\/p>\n<\/td>\n

\n

Catheter duration (Days)<\/p>\n<\/td>\n<\/tr>\n

\n

Presentation<\/p>\n<\/td>\n

\n

Irrigation fluid (distilled water)<\/p>\n<\/td>\n

\n

Urine analysis\/culture (3rd<\/sup>  day)<\/p>\n<\/td>\n<\/tr>\n

\n

BMI<\/p>\n<\/td>\n

\n

Sterilization solution (CIDEX\u00ae)<\/p>\n<\/td>\n

\n

Antibiotic duration (days)<\/p>\n<\/td>\n<\/tr>\n

\n

Prostate size<\/p>\n<\/td>\n

\n

 Urine analysis\/culture<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

PSA level<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Urine analysis\/culture<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Diabetes mellitus<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Catheter duration (days)<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Antibiotic prophylactic use<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n

Results<\/strong><\/p>\n\n\n\n

Incidence of urinary tract infection<\/strong><\/p>\n\n\n\n

A total of 90 patients with BPH were enrolled in this study.\nThere were a total 180 positive cultures of pathogenic bacteria in 270\nspecimens, divided into three occasions as follows: there were 61 positive\ncultures with UTIs after operation, accounting for (67.7%) comparing to 40\n(44.4%) cases with UTIs pre-operatively, there were 79 cases reported (87.7%)\nas UTIs during the procedure. The most common isolated uropathogen was Escherichia\ncoli<\/em> (37.5%) pre-operatively, the scenario was changed in intra- and\npost-operatively in term that Pseudomonas aeruginosa <\/em>was the master of\nthe scene by (44%) and (36%) respectively (Table 2). From presumably health\nsubjects, 30 MSU were taken. They attended the clinic as relatives of the\npatients having the TURP, there were five bacterial isolates form 14 subjects\nrepresented (46.6%), E. coli<\/em> was the most prevalent recorded (35.7%)\n(Table 2).    <\/p>\n\n\n\n

Table 2: Pathogens distribution associated with TURP-UTI (pre, intra, and post-operative).<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

UTI Pathogen<\/strong><\/p>\n<\/td>\n

\n

Transurethral resection of prostate <\/strong><\/p>\n<\/td>\n

\n

Control No. (%)<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Pre-Op No. (%)<\/strong><\/p>\n<\/td>\n

\n

Intra-Op No. (%)<\/strong><\/p>\n<\/td>\n

\n

Post-Op No. (%)<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Escherichia coli<\/em><\/p>\n<\/td>\n

\n

15 (37.5%)<\/p>\n<\/td>\n

\n

18 (23%)<\/p>\n<\/td>\n

\n

12 (20%)<\/p>\n<\/td>\n

\n

5 (35.7%)<\/p>\n<\/td>\n<\/tr>\n

\n

Pseudomonas aeruginosa<\/em><\/p>\n<\/td>\n

\n

3 (7.5%)<\/p>\n<\/td>\n

\n

35 (44%)<\/p>\n<\/td>\n

\n

22 (36%)<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n<\/tr>\n

\n

Klebsiella pneumoniae<\/em><\/p>\n<\/td>\n

\n

2 (5%)<\/p>\n<\/td>\n

\n

5 (6%)<\/p>\n<\/td>\n

\n

4 (6.5%)<\/p>\n<\/td>\n

\n

3 (21.4%)<\/p>\n<\/td>\n<\/tr>\n

\n

Proteus mirabilis<\/em><\/p>\n<\/td>\n

\n

2 (5%)<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n<\/tr>\n

\n

Serratia marcescens<\/em><\/p>\n<\/td>\n

\n

1 (2.5%)<\/p>\n<\/td>\n

\n

3 (4%)<\/p>\n<\/td>\n

\n

5 (8%)<\/p>\n<\/td>\n

\n

2 (14.2%)<\/p>\n<\/td>\n<\/tr>\n

\n

Staphylococcus aureus <\/em><\/p>\n<\/td>\n

\n

6 (15%)<\/p>\n<\/td>\n

\n

9 (11%)<\/p>\n<\/td>\n

\n

4 (6.5%)<\/p>\n<\/td>\n

\n

3 (21.4%)<\/p>\n<\/td>\n<\/tr>\n

\n

Staphylococcus epidermidis<\/em><\/p>\n<\/td>\n

\n

4 (10%)<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n

\n

2 (3%)<\/p>\n<\/td>\n

\n

1 (7.3%)<\/p>\n<\/td>\n<\/tr>\n

\n

Enterococcus faecalis<\/em><\/p>\n<\/td>\n

\n

2 (5%)<\/p>\n<\/td>\n

\n

3 (4%)<\/p>\n<\/td>\n

\n

9 (15%)<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n<\/tr>\n

\n

Mixed<\/p>\n<\/td>\n

\n

5 (12.5)<\/p>\n<\/td>\n

\n

6 (8%)<\/p>\n<\/td>\n

\n

3 (5%)<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n<\/tr>\n

\n

Total positive culture<\/p>\n<\/td>\n

\n

40 (100%)<\/p>\n<\/td>\n

\n

79 (100%)<\/p>\n<\/td>\n

\n

61 (100%)<\/p>\n<\/td>\n

\n

14 (100%)<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n

Univariate Analysis<\/strong><\/p>\n\n\n\n

There was\nno statistically significant difference in the patient’s associations between\npre-operative risk variables and post-TURP bacteriuria with age \u2265 65 years old,\nBMI, prostate size, PSA level, and prophylactic use of antibiotics before\noperation (p <\/em>> 0.05). However, the differences were statistically\nsignificant (p<\/em> < 0.05) with pre-operative positive urine and culture\nanalysis, history of DM, and preoperative catheterization (Table 3). <\/p>\n\n\n\n

Regarding\nthe association of post-TURP bacteriuria to intraoperative risk factors, <\/em>the\npost-TURP bacteriuria indicated significant results were only related to the\nduration of the operation and pre-operative positive urine and culture analysis\n(Table 3). <\/p>\n\n\n\n

Concerning\nthe association between post-TURP bacteriuria and post-operative risk factors,\npersistent post-TURP bacteriuria was found to be significantly linked with both\nurine analysis and culture with the third postoperative catheterization (Table\n3).  <\/p>\n\n\n\n

Multivariate Analysis<\/strong><\/p>\n\n\n\n

The results of multivariate logistic regression\nanalysis showed a statistically significant correlation between the following\nrisk factors and post-TURP bacteriuria: prostatic size, older age of patients, positive\npre-operative urine analysis, use of pre-operative catheters, prophylactic use\nof antibiotics, history of DM, and longer operation duration. <\/p>\n\n\n\n

Table 3: Univariate analysis of bacteriuria associated with transurethral resection of prostate.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Risk factor<\/strong><\/p>\n<\/td>\n

\n

Pre-TURP patients (n = 90)<\/strong><\/p>\n<\/td>\n

\n

Chi-squared test<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Negative n = 50 (%)<\/strong><\/p>\n<\/td>\n

\n

Positive n = 40 (%)<\/strong><\/p>\n<\/td>\n

\n

\u03c7 2<\/sup><\/strong><\/p>\n<\/td>\n

\n

P<\/em><\/strong> value<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Age, years<\/p>\n<\/td>\n

\n

 <\/p>\n

20 (83%)<\/p>\n

36 (55%)<\/p>\n<\/td>\n

\n

 <\/p>\n

4 (17%)<\/p>\n

30 (45%)<\/p>\n<\/td>\n

\n

8.93<\/p>\n<\/td>\n

\n

0.005<\/p>\n<\/td>\n<\/tr>\n

\n

      < 65 y<\/p>\n

      \u2265 65 y<\/p>\n<\/td>\n<\/tr>\n

\n

BMI<\/p>\n

      < 24 kg\/m2<\/sup><\/p>\n

      \u2265 24 kg\/m2<\/sup><\/p>\n<\/td>\n

\n

 <\/p>\n

9 (22.5%)<\/p>\n

12 (24%)<\/p>\n<\/td>\n

\n

 <\/p>\n

31 (77.5%)<\/p>\n

38 (76%)<\/p>\n<\/td>\n

\n

3.107<\/p>\n<\/td>\n

\n

0.076<\/p>\n<\/td>\n<\/tr>\n

\n

Prostate size, g<\/p>\n

      < 60 g<\/p>\n

      \u2265 60 g<\/p>\n<\/td>\n

\n

 <\/p>\n

26 (65%)<\/p>\n

27 (54%)<\/p>\n<\/td>\n

\n

 <\/p>\n

14 (35%)<\/p>\n

23 (46%)<\/p>\n<\/td>\n

\n

4.54<\/p>\n<\/td>\n

\n

0.019 S<\/p>\n<\/td>\n<\/tr>\n

\n

PSA level, ng\/mL<\/p>\n

      Mean (SD)<\/p>\n

      Range<\/p>\n<\/td>\n

\n

 <\/p>\n

3.78 (2.25)<\/p>\n

0-5.9<\/p>\n<\/td>\n

\n

 <\/p>\n

3.8 (1.85)<\/p>\n

0-6.8<\/p>\n<\/td>\n

\n

1.68<\/p>\n<\/td>\n

\n

0.102<\/p>\n<\/td>\n<\/tr>\n

\n

Urine analysis\/culture<\/p>\n

      No Bacteriuria<\/p>\n

      Bacteriuria<\/p>\n<\/td>\n

\n

 <\/p>\n

46 (78%)<\/p>\n

10 (32%)<\/p>\n<\/td>\n

\n

 <\/p>\n

13 (22%)<\/p>\n

21 (68%)<\/p>\n<\/td>\n

\n

21.75<\/p>\n<\/td>\n

\n

0.001 HS<\/p>\n<\/td>\n<\/tr>\n

\n

Diabetes mellitus<\/p>\n

      No<\/p>\n

      Yes<\/p>\n<\/td>\n

\n

 <\/p>\n

50 (72%)<\/p>\n

10 (48%)<\/p>\n<\/td>\n

\n

 <\/p>\n

19 (28%)<\/p>\n

11 (52%)<\/p>\n<\/td>\n

\n

4.66<\/p>\n<\/td>\n

\n

0.025 S<\/p>\n<\/td>\n<\/tr>\n

\n

Cather insertion<\/p>\n

      No<\/p>\n

      Yes<\/p>\n<\/td>\n

\n

 <\/p>\n

54 (73%)<\/p>\n

4 (25%)<\/p>\n<\/td>\n

\n

 <\/p>\n

20 (27%)<\/p>\n

12 (75%)<\/p>\n<\/td>\n

\n

16.55<\/p>\n<\/td>\n

\n

0.001 HS<\/p>\n<\/td>\n<\/tr>\n

\n

Antibiotic<\/p>\n

      No<\/p>\n

      Yes<\/p>\n<\/td>\n

\n

 <\/p>\n

52 (68%)<\/p>\n

6 (43%)<\/p>\n<\/td>\n

\n

 <\/p>\n

24 (32%)<\/p>\n

8 (57%)<\/p>\n<\/td>\n

\n

3.17<\/p>\n<\/td>\n

\n

0.077<\/p>\n<\/td>\n<\/tr>\n

\n

Risk factor<\/strong><\/p>\n<\/td>\n

\n

Intra-TURP patients (n = 90)<\/strong><\/p>\n<\/td>\n

\n

Chi-squared test<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Negative (n = 29)<\/strong><\/p>\n<\/td>\n

\n

Positive (n = 61)<\/strong><\/p>\n<\/td>\n

\n

\u03c7 2<\/sup><\/strong><\/p>\n<\/td>\n

\n

P<\/em><\/strong> value<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Duration of procedure, min<\/p>\n

      < 60 min<\/p>\n

      \u2265 60 min<\/p>\n<\/td>\n

\n

 <\/p>\n

18 (78%)<\/p>\n

39 (58%)<\/p>\n<\/td>\n

\n

 <\/p>\n

5 (22%)<\/p>\n

28 (42%)<\/p>\n<\/td>\n

\n

9.78<\/p>\n<\/td>\n

\n

0.003 HS<\/p>\n<\/td>\n<\/tr>\n

\n

Irrigation fluid (distilled water), L<\/p>\n

      Mean (SD)<\/p>\n

      Range<\/p>\n<\/td>\n

\n

 <\/p>\n

16.66 (2.62)<\/p>\n

11\u201326<\/p>\n<\/td>\n

\n

 <\/p>\n

19.89 (3.75)<\/p>\n

12\u201324<\/p>\n<\/td>\n

\n

1.40<\/p>\n<\/td>\n

\n

0.199<\/p>\n<\/td>\n<\/tr>\n

\n

Sterilization solution (CIDEX\u00ae), days<\/p>\n

      Mean (SD)<\/p>\n

      Range<\/p>\n<\/td>\n

\n

 <\/p>\n

6.12 (3.15)<\/p>\n

1\u201314<\/p>\n<\/td>\n

\n

 <\/p>\n

5.72 (3.15)<\/p>\n

1\u201312<\/p>\n<\/td>\n

\n

\u20131.06<\/p>\n<\/td>\n

\n

0.518<\/p>\n<\/td>\n<\/tr>\n

\n

Urine analysis\/culture<\/p>\n

      No Bacteriuria<\/p>\n

      Bacteriuria<\/p>\n<\/td>\n

\n

 <\/p>\n

18 (90%)<\/p>\n

40 (57%)<\/p>\n<\/td>\n

\n

 <\/p>\n

2 (10%)<\/p>\n

30 (43%)<\/p>\n<\/td>\n

\n

7.35<\/p>\n<\/td>\n

\n

0.006 HS<\/p>\n<\/td>\n<\/tr>\n

\n

Risk factor<\/strong><\/p>\n<\/td>\n

\n

Post-TURP patients (n = 90)<\/strong><\/p>\n<\/td>\n

\n

Chi-squared test<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Negative (n = 11)<\/strong><\/p>\n<\/td>\n

\n

Positive (n = 79)<\/strong><\/p>\n<\/td>\n

\n

\u03c7 2<\/sup><\/strong><\/p>\n<\/td>\n

\n

P<\/em><\/strong> value<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Cather duration (days)<\/p>\n

      No<\/p>\n

      Yes<\/p>\n<\/td>\n

\n

 <\/p>\n

35 (73%)<\/p>\n

23 (53%)<\/p>\n<\/td>\n

\n

 <\/p>\n

12 (26%)<\/p>\n

20 (47%)<\/p>\n<\/td>\n

\n

5.70<\/p>\n<\/td>\n

\n

0.019 S<\/p>\n<\/td>\n<\/tr>\n

\n

Urine analysis\/culture (3rd<\/sup> day<\/sup>)<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

      No Bacteriuria<\/p>\n

      Bacteriuria<\/p>\n<\/td>\n

\n

 <\/p>\n

54 (73%)<\/p>\n

7 (44%)<\/p>\n<\/td>\n

\n

 <\/p>\n

20 (27%)<\/p>\n

9 (56%)<\/p>\n<\/td>\n

\n

6.75<\/p>\n<\/td>\n

\n

0.015 S<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

S, significant; HS, highly significant<\/p>\n\n\n

Table 4: Multivariate analysis of bacteriuria associated with transurethral resection of prostate.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Variable<\/strong><\/p>\n<\/td>\n

\n

Coefficient<\/strong><\/p>\n<\/td>\n

\n

Std. error<\/strong><\/p>\n<\/td>\n

\n

P <\/em><\/strong>value <\/strong><\/p>\n<\/td>\n

\n

Odd ratio<\/strong><\/p>\n<\/td>\n

\n

95% CI<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Age<\/p>\n<\/td>\n

\n

1.55<\/p>\n<\/td>\n

\n

0.57<\/p>\n<\/td>\n

\n

0.007 S<\/p>\n<\/td>\n

\n

4.82<\/p>\n<\/td>\n

\n

1.53 \u2013 15.28<\/p>\n<\/td>\n<\/tr>\n

\n

Prostate size<\/p>\n<\/td>\n

\n

1.23<\/p>\n<\/td>\n

\n

0.56<\/p>\n<\/td>\n

\n

0.24 S<\/p>\n<\/td>\n

\n

3.50<\/p>\n<\/td>\n

\n

1.20 \u2013 10.19<\/p>\n<\/td>\n<\/tr>\n

\n

Preoperative urine culture<\/p>\n<\/td>\n

\n

2.16<\/p>\n<\/td>\n

\n

0.48<\/p>\n<\/td>\n

\n

0.001 HS<\/p>\n<\/td>\n

\n

8.47<\/p>\n<\/td>\n

\n

3.26 \u2013 21.95<\/p>\n<\/td>\n<\/tr>\n

\n

Preoperative catheter<\/p>\n<\/td>\n

\n

1.23<\/p>\n<\/td>\n

\n

0.44<\/p>\n<\/td>\n

\n

0.006 S<\/p>\n<\/td>\n

\n

3.46<\/p>\n<\/td>\n

\n

1.38 \u2013 8.59<\/p>\n<\/td>\n<\/tr>\n

\n

Prophylactic antibiotic<\/p>\n<\/td>\n

\n

1.44<\/p>\n<\/td>\n

\n

0.46<\/p>\n<\/td>\n

\n

0.002 S<\/p>\n<\/td>\n

\n

4.24<\/p>\n<\/td>\n

\n

1.65 \u2013 11.10<\/p>\n<\/td>\n<\/tr>\n

\n

Diabetes mellitus<\/p>\n<\/td>\n

\n

1.03<\/p>\n<\/td>\n

\n

0.48<\/p>\n<\/td>\n

\n

0.028 S<\/p>\n<\/td>\n

\n

2.74<\/p>\n<\/td>\n

\n

1.12 \u2013 6.89<\/p>\n<\/td>\n<\/tr>\n

\n

Duration of operation<\/p>\n<\/td>\n

\n

2.06<\/p>\n<\/td>\n

\n

0.79<\/p>\n<\/td>\n

\n

0.007 S<\/p>\n<\/td>\n

\n

7.71<\/p>\n<\/td>\n

\n

1.67 \u2013 35.38<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

S, significant; HS, highly significant<\/p>\n\n\n

Discussion<\/strong><\/p>\n\n\n\n

Studies on the post-TURP\nbacteriuria risk factors have been conducted on numerous occasions13\u201316<\/sup>.\nTherefore, the purpose of the current investigation was to determine the\npossible risk factors\u2014particularly UTIs and bacteriuria\u2014that could raise the\nincidence of post-TURP infection. Our findings revealed UTIs incidence\naccounted for (67.7%) compared to (44.4%) of cases with UTIs pre-operatively\n(87.7%) of UTIs during the procedure as well as there were 14 subjects\nrepresented (46.6%) of presumably healthy males had bacteriuria (Figure 1) which comes in line with Zhu <\/sup>et al., (2021)17 <\/sup>who\nreported an incidence of UTIs reached 60.40% but contradicted with Xu\net al., (2024)18<\/sup> in\nwhich showed that the infection rate in 92 patients with BPH was 43.48%. These\nfindings emphasize nosocomial acquired UTIs, these infections are not already present\nor incubating at the time of admission but are acquired during hospital stay19\u201321<\/sup>.\nTruzzi, et al.22<\/sup>\nobserved a positive urine culture in 53 of 196 asymptomatic patients.\nThe most common isolated uropathogenic was Escherichia coli<\/em> (37.5%)\npre-operatively and Pseudomonas aeruginosa<\/em> for intra- and\npost-operatively by (44%) and (36%) respectively (Table 2), these results in\nconsistent with Li <\/sup>et al., (2017)14<\/sup>.  <\/p>\n\n\n\n

For the effect of preoperative risk factors on\npost-operative UTIs, our findings revealed no significant association with risk\nfactors including age \u2265 65 years old, BMI, prostate size, PSA level, and\nprophylactic use of antibiotics before operation (Table 3). The age > 60\nyears was not a risk factor according to Bouassida et al.19<\/sup>.  A\nstudy by Stangl-Kremser et al.11<\/sup> stated that BMI and preoperative\nPSA level are not predictive factors for the risk of developing UTIs. A study\nby Edmond et al.21<\/sup> reported that the occurrence of complications,\nincluding bacteriuria, was not significantly related to prostate volume.\nNevertheless, our findings come opposite to what was reported by Xu et al.18<\/sup>\nin regards to \u201cage, volume of prostate, concomitant DM, preoperative\nprophylactic application of antibiotics, insertion catheterization\npreoperatively, operation duration, and indwelling catheter postoperative\nduration were the single factors affecting postoperative urine-derived\npathogenic bacteria infection in BPH patients\u201d. <\/p>\n\n\n\n

After assessing the possible intraoperative risk\nvariables, we observed a statistically significant association between a\nlengthy surgical recovery and post-TURP bacteriuria (Table 3). Both the\nmajority of research and the current investigation agree that a longer surgery\n(more than 60 minutes) is a significant risk factor for post-operative UTIs13,18,21,25<\/sup>. However, this has also\nbeen denied in another study by Diagana et al.23<\/sup>. There was no\nsignificant association between post-TURP bacteriuria related to both\nirrigation duration and sterilization solution (Table 3), Longer irrigation\ntimes have been linked to the development of bacteriuria, according to Pourmand\net al. report, which runs counter to our current findings24<\/sup>. Osman\net al.13<\/sup> correspond with our findings regarding the irrigation\nduration and the sterilization solution considering them as a non-risk factor\nfor post-TURP bacteriuria. Regarding urine analysis, our results come in line\nwith several studies (Stangl-Kremser\net al., 2017; Osman et al., 2019; Bouassida et al., 2016; Al-Fatlawi and Jasim,\n2022)11,13, 19, 26<\/sup>.<\/p>\n\n\n\n

Regarding post-operative catheter insertion with\npostoperative bacteriuria, this study finds a highly significant statistical\nassociation which concurs with (Zhu et al., 2021; Xu et al., 2024;\nEdmond et al., 2023)17,18,21<\/sup>. Meanwhile Osman et al.13<\/sup>\ncontradicted this finding in that interval of the catheter post-operatively\nmore than 3 days The study’s limitations include the need for a larger cohort\nstudy due to the numerous risk factors involved: the short patient follow-up\nperiod, the failure to evaluate persistent bacteriuria lasting longer than\nthree weeks, the failure to assess the correlation between bacteriuria,\nsymptoms, complications, and the lack of investigation into previous sexual\nactivity or the family history of UTIs. In summary, pre-operative catheter use,\nhistory of DM, and pre-operative positive urine analysis were independent risk\nfactors for post-TURP UTI in this investigation, for the intra-operatively\nwere: a long duration of operation and persistent bacteriuria, meanwhile,\npost-operative catheter insertion and post-operative persistent bacteriuria\nwere the post-TURP UTI risk factors. <\/p>\n\n\n\n

Conclusion<\/strong> <\/p>\n\n\n\n

The study\nunderscores the multifactorial nature of post-TURP UTIs and emphasizes the\nimportance of comprehensive risk assessment and tailored preventive strategies\nto mitigate the risk of infection in BPH patients undergoing TURP particularly\nduring the postoperative recovery phase. The shifting of microbial landscape\nunderscores the importance of tailored antimicrobial strategies based on the\nprocedural phase.  These findings provide\nvaluable insights for optimizing patient care and enhancing surgical outcomes\nin the urology clinic setting.  <\/p>\n\n\n\n

Acknowledgment<\/strong><\/p>\n\n\n\n

The authors would like to thank all the medical staff in Urology\nclinic, Al-Yarmouk Teaching Hospital, Baghdad for their cooperation, thanks are\nextended to all patients who agree to share their affliction through that\ndifficult period.<\/p>\n\n\n\n

Conflict of interest <\/strong><\/p>\n\n\n\n

The\nauthors declare that they have no conflict of interests<\/p>\n\n\n\n

Funding Source<\/strong>s<\/p>\n\n\n\n

Self-funding<\/p>\n\n\n\n

 References<\/strong><\/p>\n\n\n\n

  1. Miernik A, Gratzke C. Current treatment for benign prostatic hyperplasia. Dtsch Arztebl Int<\/em>. 2020;117(49): 843 \u2013 54.
    CrossRef<\/a><\/li>
  2. Roehrborn CG, Strand DW. Benign Prostatic Hyperplasia: Etiology, Pathophysiology, Epidemiology, and Natural History. In: Campbell-Walsh-Wein Urology<\/em>. Vol III. ; 2021.
    CrossRef <\/li>
  3. Dornbier R, Pahouja G, Branch J, McVary KT. The New American Urological Association Benign Prostatic Hyperplasia Clinical Guidelines: 2019 Update. Curr Urol Rep<\/em>. 2020;21(9): 32.
     CrossRef <\/a><\/li>
  4. Monreal R, Robles C, S\u00e1nchez-Casado M, Ciampi JJ, L\u00f3pez-Guerrero M et al. Embolisation of prostate arteries in benign prostatic hyperplasia in non-surgical patients. Radiologia<\/em>. 2020;62(3): 205 \u2013 212.
     CrossRef <\/a><\/li>
  5. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of Transurethral Resection of the Prostate (TURP)-Incidence, Management, and Prevention. Eur Urol<\/em>. 2006;50(5): 969 \u2013 79.
    CrossRef <\/a><\/li>
  6. Qiang W, Jianchen W, MacDonald R, Monga M, Wilt TJ. Antibiotic prophylaxis for transurethral prostatic resection in men with preoperative urine containing less than 100,000 bacteria per ml: A systematic review. J Urol<\/em>. 2005;173(4): 1175 \u2013 81.
    CrossRef <\/a><\/li>
  7. Assafi MS, Ali FF, Polis RF, Sabaly NJ, and Qarani SM. An Epidemiological and Multidrug Resistance Study for E. coli Isolated from Urinary Tract Infection (Three Years of Study). Baghdad Sci. J.<\/em> 2022;19(1): 7 \u201315.  
     CrossRef <\/a><\/li>
  8. Haddad M. Antimicrobial resistance of uropathogens and rationale for empirical therapy in Jordan. Biomed. Pharmaco. J<\/em>. 2014;7(1): 01 \u2013 8.
    CrossRef  <\/a><\/li>
  9. McPhee A, Cottom L. Administration of surgical prophylaxis in transurethral resection and risk of post-operative infection: A retrospective cohort study. J Endourol<\/em>. 2018;32.<\/li>
  10. Bhojani N, Gandaglia G, Sood A, Rai A, Pucheril D, et al. Morbidity and mortality after benign prostatic hyperplasia surgery: Data from the American college of Ssurgeons national surgical quality improvement program. J Endourol<\/em>. 2014;28(7): 831 \u2013 40.  
     CrossRef <\/a><\/li>
  11. Stangl-Kremser J, Br\u00f6nimann S, Abufaraj M, Pozo C, Shariat SF. Risk Factors for Urinary Tract Infection in Men Treated with Transurethral Resection of the Prostate for Lower Urinary Tract Symptoms. Int Arch Urol Complic<\/em>. 2019;5(2).<\/li>
  12. Al-Hasnawy HH, Judi MR, and Hamza HJ. The Dissemination of Multidrug Resistance (MDR) and Extensively Drug Resistant (XDR) Among Uropathogenic E. Coli (UPEC) Isolates from Urinary Tract Infection Patients in Babylon Province, Iraq. Baghdad Sci. J. <\/em>2019;16 (4) Suppl.: 986 \u2013 92.
     CrossRef <\/a><\/li>
  13. Osman T, ElSaeed KO, Youssef HA, Shabayek M, Emam A, Hussein MS. Evaluation of the risk factors associated with the development of post-transurethral resection of the prostate persistent bacteriuria. Arab J Urol<\/em>. 2017;15(3): 260 \u2013 66.  
    CrossRef<\/a><\/li>
  14. Li YH, Li GQ, Guo SM, Che YN, Wang X, Cheng FT. Clinical analysis of urinary tract infection in patients undergoing transurethral resection of the prostate. Eur Rev Med Pharmacol Sci<\/em>. 2017;21(20): 4487 \u2013 92. <\/li>
  15. El Basri A, Petrolekas A, Cariou G, Doublet JD, Hoznek A, Bruyere F. Clinical significance of routine urinary bacterial culture after transurethral surgery: Results of a prospective multicenter study. Urology<\/em>. 2012;79(3): 564 \u2013 9.
    CrossRef <\/a><\/li>
  16. Dadashpour M, Bagheri SM. Acute prostatitis after transrectal ultrasound-guided prostate biopsy: Comparing two different antibiotic prophylaxis regimen. Biomed Pharmacol J<\/em>. 2016;9(2): 593 \u2013 97.  
     CrossRef <\/a><\/li>
  17. Zhu C, Wang DQ, Zi H, Huang Q, Gu JM, et al. Epidemiological trends of urinary tract infections, urolithiasis and benign prostatic hyperplasia in 203 countries and territories from 1990 to 2019. Mil Med Res<\/em>. 2021;8(1): 64.  
     CrossRef <\/a><\/li>
  18. Xu B, Liu M, Liu Y, Zuo J. Risk Factors of Urinary Pathogenic Bacteria Infection after Benign Prostatic Hyperplasia Surgery and Curative Effect Analysis of Shuangdong Capsule Intervention. Emerg Med Int<\/em>. 2024; 2024: 9786504.
    CrossRef <\/a><\/li>
  19. Bouassida K, Jaidane M, Bouallegue O, Tlili G, Naija H, Mosbah AT. Nosocomial urinary tract infections caused by extended-spectrum beta-lactamase uropathogens: Prevalence, pathogens, risk factors, and strategies for infection control. Can Urol Assoc J<\/em>. 2016;10(3-4): E87 \u2013 93.
     CrossRef <\/a><\/li>
  20. Matta R, Dvorani E, Wallis C, Hird A, LaBossiere J, et al. Complications after surgery for benign prostatic enlargement: A population-based cohort study in Ontario, Canada. BMJ Open<\/em>. 2019;9(12): e032170.  
     CrossRef <\/a><\/li>
  21. Edmond GE, Gnalen DM, K\u00e9vin K, Cyrille VC, G\u00e9rard KP, et al. Complications of Surgery for Benign Prostate Hyperplasia (BPH) in the Urology Department of University Hospital of Cocody. Int. Arch. Urol. Complic. <\/em>2023;9(1): 089.  
     CrossRef <\/a><\/li>
  22. Truzzi JCI, Almeida FMR, Nunes EC, Sadi M V. Residual Urinary Volume and Urinary Tract Infection-When are They Linked? Journal of Urology<\/em>. 2008;180(1): 182 \u2013 5.  
     CrossRef <\/a><\/li>
  23. Diagana M, Tfeil Y, Boya MM, Essalem MB. Transurethral Resection of the Prostate (TURP): About 146 Cases at Sheikh Zayed Hospital in Nouakchott Mauritania. Open Journal of Urology<\/em>. 2021;11(12): 518 \u2013 24.
     CrossRef <\/a><\/li>
  24. Pourmand G, Abedi AR, Karami AA, Khashayar P, Mehrsai AR. Urinary infection before and after prostatectomy. Saudi J Kidney Dis Transpl<\/em>. 2010;21(2): 290 \u2013 4.<\/li>
  25. AL-Jubouri SS. and Shami AM. Molecular Detection of Cephalosporin Resistance Genes in Escherichia coli Isolated from Urinary Tract Infections in Baghdad Hospitals. Iraqi J Biotech. <\/em>2022;21(2): 145 \u2013 52.<\/li>
  26. Al-Fatlawi BG. and Jasim AL. Determining the Prevalence of Upper and Lower Urinary Tract Infections\u2019 Pathogens and Their Antibiotic Susceptibility Profile for Adult Patients in Al-Diwaniya, Iraq. Iraqi J Pharm Sci<\/em>. 2022;31 (Suppl.)<\/em>: 86 \u2013 91.
     CrossRef <\/a><\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"

    Introduction Benign prostatic hyperplasia (BPH) is a common male disease […]<\/p>\n","protected":false},"author":15,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[113],"tags":[],"class_list":["post-56991","post","type-post","status-publish","format-standard","hentry","category-vol17no1"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/56991","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=56991"}],"version-history":[{"count":5,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/56991\/revisions"}],"predecessor-version":[{"id":57408,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/56991\/revisions\/57408"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=56991"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=56991"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=56991"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}