Urological Surgery

Antibiotic prophylaxis is NOT indicated for the following procedures:- 

• Flexible cystoscopy (unless under GA)
• Extracorporeal shockwave lithotripsy (ESWL)
• Diagnostic cystoscopy, cup bladder biopsy & Cystodiathermy
• Trans-perineal prostate biopsy
• Circumcision
• Scrotal/inguinal surgery (where mesh is not used)
• Open upper tract surgery
• Laparoscopic upper tract surgery
• Nephrectomy (low risk cases)

NB: selected cases may be given prophylaxis, either because of infected urine which cannot be treated pre-operatively, or because the patient is at particularly high risk of post-operative infection.

For the following procedures:-

• Prostate Surgery, including:-
  • Transurethral resection of the prostate (TURP) 
  • Holmium laser enucleation or vapourisation of the prostate (HoLEP)
  • Radical or Millin's prostatectomy (open or robotic)
  • Prostatic High intensity focused ultrasound HIFU
• Cystectomy
• Bladder neck incision (BNI)
• Urethrotomy/ uretheral dilatation
• Transurethral resection of bladder tumor (TURBT)
• Cystolitholopaxy
• Ureteroscopy
• Nephrectomy (high risk cases - eg live transplant donor, chronically infected kidney, immunosuppressed host)

Preferred: (including for penicillin allergy (non-severe and severe) or MRSA positive patients):

gentamicin 3mg/kg iv

See Interventional Radiology - Genitourinary

No antibiotics are required UNLESS

• there is a history of symptomatic UTI after catheter change 
• OR following traumatic catheterisation

Note: In the setting of acute urinary infection see "Empiric Treatment:  Urinary Tract and Renal Medicine".

Prophylactic dose is not required if patients are already on UTI treatment antibiotics. 

Preferred: nitrofurantoin 100mg po single dose (Adverse effects have been reported with nitrofurantoin see Nitrofurantoin MHRA drug safety updates)

For renal impairment (eGFR less than 45mL/min/1.73m²): gentamicin 3mg/kg iv single dose. Suggest consult ID/Micro if no intravenous access possible. 

• Includes Fiducial Prostatic Implants

Preferred:  

ciprofloxacin 500mg po bd +  metronidazole 400mg po tds 

Give antibiotics 40-60 minutes pre-biopsy and for 48 hours post-biopsy.

Known ciprofloxacin resistance or contra-indications to ciprofloxacin:

fosfomycin 3g po single dose 2-3 hours before biopsy

+

metronidazole 400mg po tds.

Give antibiotics 40-60 minutes pre-biopsy and for 48 hours post-biopsy. 

For MRSA positive patients:

co-trimoxazole 960mg po bd + metronidazole   400mg po tds 

Give antibiotics 40- 60 minutes pre-biopsy and for 48 hours post-biopsy.

Includes

• Ileal conduit formation/ manipulation
• Prostate brachytherapy

Preferred (including for penicillin allergy (non-severe)): cefazolin iv (see dosing table below)

For penicillin allergy (severe) or MRSA positive patients: gentamicin 3mg/kg iv

metronidazole 500mg iv can be added if peritoneal contamination occurs.

Preferred (including for penicillin allergy (non-severe): cefazolin iv (see dosing table below) + gentamicin 3mg/kg

Severe penicillin allergy or MRSA positive patients: teicoplanin 800mg iv + gentamicin 3mg/kg iv

Post-operative: gentamicin 3mg/kg iv (single dose at 24 hours after surgery)

Intra- operative antibiotic soaking of device has not been ratified by ASG

Antibiotic prophylaxis depends on the clinical situation:

• For cases where pre-admission clinic urine shows infection or where infected nephrolithiasis is suspected (non-spinal case), then oral antibiotics (according to susceptibility of urine MCS) will be given for 7 days before same-day admission
• For cases of nephrolithiasis where there is a pre-existing spinal injury, admission is on the day prior to the PCNL procedure and iv antibiotics are commenced at admission

Preferred (including for penicillin allergy (non-severe and severe) or MRSA positive patients):  gentamicin 3mg/kg iv 

*in the setting of resistant organisms, prophylaxis may need to be tailored to the microbiology. Always discuss with Micro/ID.