Holmium Laser Enucleation of the Prostate (HoLEP) as a size-independent surgical treatment; peri-operative antibiotic prophylaxis to reduce risk of urinary tract infection (UTI) and sepsis
Target Population
Patients undergoing HoLEP, including those with and without indwelling or intermittent self-catheterization (C/ISC)
Care Setting
Urologic surgical settings including academic medical centers, private practice, and hospital-employed surgeons
Key Highlights
95.7% of urologists prescribe a single peri-operative antibiotic dose for patients with negative urine culture and no catheterization.
For catheterized or intermittently self-catheterizing patients with negative urine culture, nearly half of surgeons prescribe extended pre- or post-operative antibiotics.
Practice setting influences antibiotic prescribing patterns, with private practice surgeons more likely to prescribe extended antibiotic courses.
Guideline-Based Recommendations
Diagnosis
Preoperative urine culture to identify infection status prior to HoLEP.
Management
Single-dose peri-operative antibiotic prophylaxis recommended for patients with negative urine culture and no catheterization.
Antibiotic treatment of positive preoperative urine cultures prior to HoLEP, commonly for 7 days.
Consider extended antibiotic prophylaxis (pre- and/or post-operative) for patients with indwelling or intermittent self-catheterization, though consensus is lacking.
Monitoring & Follow-up
Monitor for urinary tract infection and sepsis post-operatively.
Adjust antibiotic duration based on surgeon experience and patient catheterization status.
Risks
Potential increased risk of infection in catheterized patients if prophylaxis is inadequate.
Risks of extended antibiotic use include antibiotic resistance and adverse effects.
Patient & Prescribing Data
Patients undergoing HoLEP with varying catheterization status and urine culture results.
Surgeons predominantly use single-dose prophylaxis for non-catheterized patients with negative cultures; extended antibiotic courses are more common in catheterized patients and those with positive cultures. More experienced surgeons tend to prescribe shorter antibiotic durations.
Clinical Best Practices
Obtain preoperative urine culture to guide antibiotic use.
Administer single-dose peri-operative antibiotic prophylaxis for patients without catheterization and negative urine culture.
Treat positive urine cultures with appropriate antibiotics prior to surgery, commonly for 7 days.
Consider extended antibiotic prophylaxis in patients with indwelling or intermittent self-catheterization, balancing infection risk and antibiotic stewardship.
Tailor antibiotic choice and duration based on patient catheterization status and surgeon experience.
Recognize practice setting influences prescribing patterns and aim for evidence-based standardization.
by Seyed Mohammad Mohaghegh Poor, Hafsa Asif, Darion Denis-Diaz, Eric Riedinger, Tasha Posid, Maxwell Newton, Michael Sourial, Mark Assmus, Amy Krambeck, Bodo Knudsen, Matthew Lee
