What is included in the preoperative care prior to transurethral resection of bladder tumor (TURBT)?

Updated: Aug 03, 2019
  • Author: Gary David Steinberg, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Answer

Patients scheduled for cystoscopy or anesthetic cystoscopy with transurethral resection of bladder tumor (TURBT) must have sterile urine documented prior to instrumentation. Sterility is usually presumed on the basis of a microscopic urinalysis showing no bacteria or white blood cells (WBCs). A urine culture is ideal but not always feasible for surveillance cystoscopy.

The risk of urinary tract infection with instrumentation is approximately 1%. In the past, a single prophylactic dose of fluoroquinolone was given to patients undergoing cystoscopy. However, American Urological Association guidelines recommend considering an antibiotic from a different class, on a case-by-case basis, in view of the 2016 US Food & Drug Administration (FDA) black box warning on safety issues with fluoroquinolones. In addition, the guidelines suggest considering whether low-risk patients require any antibiotics prior to routine cystoscopy. [8]  

A review of a zero antimicrobial prophylaxis protocol for outpatient cystoscopy concluded that it is safe and can be effective.  The incidence of UTI after cystoscopy rose slightly when the protocol was implemented (from 2.9% to 3.7%), but the difference was not statistically significant. Catheter use (indwelling, suprapubic, or intermittent) was the only risk factor identified for post-cystoscopy infection. [9]

Some patients may need additional antibiotics based on a history of valvular heart disease. The American Heart Association guidelines recommend prophylaxis in these patients to prevent endocarditis.

In moderate-risk patients, administer 2 g of ampicillin intravenously or intramuscularly at least 30 minutes before the procedure (or 2 g of amoxicillin orally at least 1 h before the procedure). In patients allergic to penicillin, vancomycin at a dosage of 1 g intravenously over 1-2 hours, completed at least 30 minutes before the procedure, may be substituted. High-risk patients also receive 120 mg of gentamicin parenterally 30 minutes before the procedure, then a second dose of ampicillin or amoxicillin 6 hours later.

Patients with prosthetics may merit additional antibiotics based on the clinical scenario.


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