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Falkensammer E, Erenler E, Johansen TEB, Tzelves L, Schneidewind L, Yuan Y, Cai T, Koves B, Tandogdu Z. Antimicrobial Prophylaxis in Robot-Assisted Laparoscopic Radical Prostatectomy: A Systematic Review. Antibiotics (Basel) 2023; 12:1744. [PMID: 38136777 PMCID: PMC10740870 DOI: 10.3390/antibiotics12121744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
It remains unclear whether antibiotic prophylaxis (AP) should be recommended or discouraged in robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer (PCa). The development of microbial resistance and side effects are risks of antibiotic use. This systematic review (SR) investigates the evidence base for AP in RALP. A systematic literature search was conducted until 12 January 2023, using Embase, MEDLINE, Cochrane CENTRAL, Cochrane CDSR (via Ovid) and CINAHL for studies reporting the effect of AP on postoperative infectious complications in RALP. Of 436 screened publications, 8 studies comprising 6378 RALP procedures met the inclusion criteria. There was no evidence of a difference in the rate and severity of infective complications within 30 days after RALP surgery between different AP protocols. No studies omitted AP. For patients who received AP, the overall occurrence of postoperative infectious complications varied between 0.6% and 6.6%. The reported urinary tract infection (UTI) rates varied from 0.16% (4/2500) to 8.9% (15/169). Wound infections were reported in 0.46% (4/865) to 1.12% (1/89). Sepsis/bacteraemia and hyperpyrexia were registered in 0.1% (1/1084) and 1.6% (5/317), respectively. Infected lymphoceles (iLC) rates were 0.9% (3 of 317) in a RALP cohort that included 88.6% pelvic lymph node dissections (PLND), and 3% (26 of 865) in a RALP cohort where all patients underwent PLND. Our findings underscore that AP is being administered in RALP procedures without scientifically proven evidence. Prospective studies that apply consistent and uniform criteria for measuring infectious complications and antibiotic-related side effects are needed to ensure the comparability of results and guidance on AP in RALP.
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Affiliation(s)
- Eva Falkensammer
- Department of Urology, Klinikum Wels-Grieskirchen, 4600 Wels, Austria
- Department of Pediatric Surgery, University Hospital Salzburg, 5020 Salzburg, Austria
| | - Ece Erenler
- School of Medicine, Koc University, Istanbul 34450, Turkey;
| | - Truls E. Bjerklund Johansen
- Department of Urology, Oslo University Hospital, 0424 Oslo, Norway;
- Institute of Clinical Medicine, University of Aarhus, 8000 Aarhus, Denmark
| | - Lazaros Tzelves
- Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, 11527 Athens, Greece
| | - Laila Schneidewind
- Department of Urology, University Greifswald, 17487 Greifswald, Germany;
| | - Yuhong Yuan
- Department of Medicine, London Health Science Centre, London, ON N6A 5W9, Canada;
- Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, ON N6A 5W9, Canada
| | - Tommaso Cai
- Department of Urology, Santa Chiara Hospital, 38123 Trento, Italy;
- Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Bela Koves
- Department of Urology, South-Pest Teaching Hospital, 1097 Budapest, Hungary
| | - Zafer Tandogdu
- Department of Urology, University College London Hospitals, London NW1 2BU, UK;
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Maffucci F, Chang C, Simhan J, Cohn JA. Is There Any Benefit to the Use of Antibiotics with Indwelling Catheters after Urologic Surgery in Adults. Antibiotics (Basel) 2023; 12:156. [PMID: 36671357 PMCID: PMC9854512 DOI: 10.3390/antibiotics12010156] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
Antibiotic stewardship in urologic reconstruction is critically important, as many patients will require indwelling catheters for days to weeks following surgery and thus are at risk of both developing catheter-associated urinary tract infections (CAUTI) as well as multi-drug resistant (MDR) uropathogens. Accordingly, limiting antibiotic use, when safe, should help reduce antibiotic resistance and the prevalence of MDR organisms. However, there is significant heterogeneity in how antibiotics are prescribed to patients who need indwelling urethral catheters post-operatively. We performed a literature review to determine if there are benefits in the use of antibiotics for various clinical scenarios that require post-operative indwelling catheters for greater than 24 h. In general, for patients undergoing prostatectomy, transurethral resection of the prostate, and/or urethroplasty, antibiotic administration may be limited without increased risk of CAUTI. However, more work is needed to identify optimal antibiotic regimens for these and alternative urologic procedures, whether certain sub-populations benefit from longer courses of antibiotics, and effective non-antibiotic or non-systemic therapies.
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Affiliation(s)
- Fenizia Maffucci
- Department of Urology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111, USA
| | | | | | - Joshua A. Cohn
- Department of Urology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111, USA
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Comparison of enhanced recovery after surgery protocol and conventional approach after laparoscopic transperitoneal radical prostatectomy: a retrospective analysis. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00233-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Abstract
Background
Although open radical prostatectomy has been used in the treatment of localized prostate cancer for a long time, minimally invasive surgical approaches such as laparoscopic radical prostatectomy and robot-assisted radical prostatectomy have recently gained importance in order to improve postoperative results and shorten hospital stay. Although the enhanced recovery after surgery (ERAS) protocol was first defined for gastrointestinal surgeries in 2001, it has now been used in gynecological, orthopedic, thoracic and urological surgeries. In our study, we aimed to compare the results of the ERAS protocol with the conventional approach in patients who underwent laparoscopic radical prostatectomy.
Methods
There is a retrospective analysis of 70 patients who underwent laparoscopic radical prostatectomy at Kayseri City Hospital between May 2018 and January 2021. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) for Windows, version 25.0 (IBM SPSS, Armonk, NY, USA). Seventy patients were included in the study. While 48 patients who underwent perioperative care with the traditional approach were included in the conventional group, 22 patients were included in the ERAS group. Age, comorbidities, preoperative PSA level, digital rectal examination findings, preoperative imaging, extra prostatic spread and lymph node involvement, location of tumors, time between biopsy and surgery, lymphadenectomy status, and histopathological findings of transrectal ultrasound biopsy and prostatectomy specimens were recorded for each patient. Initiation of enteral feeding, time to first defecation, duration of antibiotic use, ileus development rate and length of hospital stay (LOS) were compared for both groups.
Results
The mean age of 48 patients in the conventional group was 63.37 ± 7.01 years, while the mean age of 22 patients in the ERAS group was 66.36 ± 5.31 years (p = 0.080). Although the first defecation time was shorter in the ERAS group (4.75 ± 3.21 vs. 3.73 ± 2.12 days, p = 0.179), there was no statistically significant difference. Ileus developed in 10 (20.8%) patients in the conventional group and 2 (9.1%) in the ERAS group. Use of antibiotics in the postoperative period in the conventional group (5.83 ± 3.62 vs. 3.18 ± 2.42 days, p = 0.003) and LOS (7.92 ± 3.26 vs. 5.91 ± 2, 15 days, p = 0.011) were statistically significantly longer.
Conclusion
In summary, ERAS protocol is associated with short LOS, time to initiation of enteral feeding and duration of antibiotics use. There was no statistically significant difference in the rate of ileus and time to first defecation between the two groups. Randomized prospective studies on heterogeneous and larger patient groups are needed to confirm our findings.
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Roadman D, Helm M, Goldblatt MI, Kastenmeier A, Kindel TL, Gould JC, Higgins RM. Postoperative urinary retention after laparoscopic total extraperitoneal inguinal hernia repair. J Surg Res 2018; 231:309-315. [DOI: 10.1016/j.jss.2018.05.052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/30/2018] [Accepted: 05/24/2018] [Indexed: 11/30/2022]
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