NEUROUROLOGY & FEMALE UROLOGY

Urodynamic studies in women with stress urinary incontinence: Significant bacteriuria and risk factors
Choe JH, Lee JS, Seo JT
Department of Urology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
Neurourol Urodyn. 2007; 26: 847-51

• Aim: A prospective study was performed to determine the incidence of significant bacteriuria and to identify the risk factors for bacteriuria after urodynamic studies (UDSs) in women with urodynamic stress urinary incontinence (SUI).
• Methods: A total of 225 women with urodynamic SUI were evaluated. All women were negative on double-screened urine cultures, in clean-catch midstream urine (MSU) specimens, before UDS. Another urine specimen was obtained for urinalysis and culture at 3-7 days after UDS. Urinary culture with 10(5) CFU/ml or more was regarded as significant bacteriuria. To identify the risk factors for significant bacteriuria, the clinical characteristics of all patients including age, BMI, parity, medical and operation history, degree of pelvic organ prolapse, results of urinalysis, and UDS were evaluated.
• Results: The prevalence of significant bacteriuria was 6.2%. The most common identified microorganism was Escherichia coli (57.1%). Univariate analysis demonstrated that a history of recurrent urinary tract infection (UTI; P = 0.002) and urological surgery or procedure (P = 0.02) were significant predictors of significant bacteriuria. On multiple logistic regression analysis the past history of recurrent UTI was the only significant independent risk factor (OR = 28.5, 95% CI = 4.309-188.488, P = 0.009).
• Conclusions: This study suggests that for most women with SUI it may be unnecessary to use preventive prophylactic antibiotics in UDS. However, our results suggest that in patients with a previous history of recurrent UTI or urologic surgery the risk for significant bacteriuria is increased and use of prophylactic antibiotics should be considered. Neurourol. Urodynam. 26:847-851, 2007. (c) 2007 Wiley-Liss, Inc.
  
  
• Editorial Comment
  Investigators performed a prospective study examining the prevalence of significant bacteriuria after urodynamic studies and to identify risk factors for same. It was noted that recurrent cystitis and previous urologic instrumentation or procedures were significant risk factors of bacteriuria. The authors obtained urine approximately one week before the urodynamics, at the time of the urodynamic studies, as well as 3-7 days after urodynamic studies were done. These investigators concluded that because the cultures were sterile for the procedure that all acquired infections within the week after the urodynamic studies were most likely due to the urodynamic studies. Of note is that the bacteriuria after the urodynamic studies was most likely non-nosocomial. It would have been or great interest if the authors had been able to query the patients on the frequency and intensity of coitus for the period immediately after the urodynamic studies to the time that the post-procedure urine studies were obtained. The existence of “honeymoon cystitis” is well known even in the mature or infirmed population.

Dr. Steven P. Petrou
Associate Professor of Urology
Chief of Surgery, St. Luke’s Hospital
Associate Dean, Mayo School of Medical Education
Jacksonville, Florida, USA