Incidence and Predictors of Infection after Robot-Assisted Radical Prostatectomy: The Role of Peri-Operative Urine Culture.

BACKGROUND

Robot-assisted radical prostatectomy (RARP) is a widely used minimally invasive procedure for the treatment of localized prostate cancer. Although pre-operative bacteriuria has been associated with post-operative infections after open prostatectomy, evidence in the RARP era remains limited. The clinical significance of post-operative bacteriuria also remains unclear.

PATIENTS AND

METHODS

We retrospectively reviewed the records of patients who underwent RARP at our institution between 2019 and 2025. Urinalysis and urine cultures were routinely performed pre-operatively and on post-operative day 4. Infectious complications, including surgical site and urinary tract infections, were assessed within 30 days of operation. We analyzed the association between peri-operative urinary findings and post-operative infections.

RESULTS

Among 257 patients, post-operative infections occurred in 11 cases (4.3%). Pre-operative pyuria was significantly more common in the infection group than in the non-infection group (18.2% vs. 3.7%, p = 0.049), whereas pre-operative bacteriuria was not. Post-operative bacteriuria was observed in 45.5% of infected cases compared with 3.3% of non-infected cases (p < 0.001), whereas post-operative pyuria did not differ significantly between the groups. However, severe post-operative pyuria (>50 white blood cells per high-power field) was more frequent in the bacteriuria-positive group than in the bacteriuria-negative group (46.2% vs. 4.1%, p < 0.001).

CONCLUSIONS

Pre-operative bacteriuria was not associated with post-operative infections following RARP. In contrast, post-operative bacteriuria was strongly associated with infectious complications. These findings suggest that routine pre-operative urine cultures may be unnecessary in patients without symptoms. However, post-operative bacteriuria may indicate an increased risk of infection, and urine cultures should be considered, particularly in cases with severe pyuria.