The Risk of Urinary Tract Infection after Flexible Cystoscopy in Patients with Bladder Tumor Who Did Not Receive Prophylactic Antibiotics

Purpose: The frequency of febrile urinary tract infection was determined after outpatient flexible cystoscopy in antibiotic naive patients with bladder tumor. Materials and Methods: A total of 3,108 outpatient cystoscopies were performed in 1,110 patients with bladder tumor. Immediately before cystoscopy patients submitted a voided urine sample for culture. Significant bacteriuria was defined as greater than 10(4) cfu/ml of a single organism. Patients received no antibiotics immediately before or after cystoscopy. They were followed for 30 days for onset of febrile urinary tract infection. Results: Of the 3,108 patient cystoscopies 673 (22%) had asymptomatic bacteriuria and 2,435 (78%) had sterile urine. A febrile urinary tract infection developed within 30 days of cystoscopy in 59 patients (1.9%), including in 3.7% of infected and 1.4% of uninfected patients (p = 0.01). All cases resolved within 12 to 24 hours with oral antibiotics. No patient was hospitalized for bacterial sepsis. Conclusions: Antibacterial therapy before outpatient flexible cystoscopy does not appear necessary in patients who have no clinical signs or symptoms of acute urinary tract infection, including bacteriuria.