Should Urine Culture Be Performed Before Diagnostic Cystoscopy? Impact on Post-Procedural Infection Risk

Abstract

Introduction:

Urinary tract infection (UTI) is an infrequent complication of diagnostic cystoscopy, with an incidence below 5%. Current guidelines are unclear and remain silent regarding the necessity of performing a urine bacterial culture (UBC) before cystoscopy. The objective of this study was to evaluate whether asymptomatic bacteriuria before cystoscopy increases the risk of UTI afterward. In addition, we aimed to identify risk factors in patient characteristics.

Patients and Methods:

We included all patients who underwent diagnostic cystoscopy at our center between September 2022 and May 2023 and performed a UBC within the preceding 15 days. Patients were excluded if they had received antibiotic treatment or did not provide UBC. Data on the UTI within four weeks post-cystoscopy were collected via telephone interviews. UTIs were defined on the clinical criteria established by the U.S. Centers for Disease Control and Prevention.

Results:

Six hundred eighteen cystoscopies were analyzed. Twenty-nine cases of UTI were reported, accounting for 4.7% of the procedures. Among these, 24 patients had sterile or polymicrobial UBC, whereas 5 had asymptomatic bacteriuria prior to cystoscopy. There was no significant association between asymptomatic bacteriuria and the occurrence of UTI (OR: 1.385, 95% confidence interval [0.513; 3.739], p = 0.52). In multivariable analysis, age was a protective factor (p = 0.01). There was an increase of UTI when the cystoscopy was performed for a suspected tumor (OR: 4.981, 95% confidence interval [1.122; 22.108], p = 0.035) or for a retention (OR: 7.910, 95% confidence interval [1.329; 47.093], p = 0.023). More UTIs occurred when cystoscopy was performed for suspected tumors (p = 0.035) or urinary retention (p = 0.023). There was a significant correlation between asymptomatic bacteriuria and consultation for urinary symptoms after (p = 0.043).

Conclusion:

We found no correlation between asymptomatic bacteriuria prior to cystoscopy and the subsequent occurrence of UTI. Routine UBC before cystoscopy appears unnecessary. Eliminating this practice could prevent the rescheduling of cystoscopies, which often leads to diagnostic delays. Moreover, it would contribute to reducing antibiotic consumption and combating antibiotic resistance.