Editorial Comment of Antibiotic Prophylaxis in Men Undergoing Transurethral Resection of Prostate: A Systematic Review and Network Meta‐Analysis

In recent years, surgical procedures for benign prostatic hyperplasia (BPH) have evolved to include enucleation and vaporization techniques, and minimally invasive surgical therapies (MIST) have become increasingly common. However, a 2022 survey examining the implementation status of various BPH surgical procedures in Japan reported that transurethral resection of the prostate (TURP) remained the most commonly performed procedure, accounting for 45%, followed by holmium laser enucleation of the prostate (HoLEP) at 24.3%, transurethral enucleation with bipolar (TUEB) at 12.2%, and photoselective vaporization of the prostate (PVP)/contact laser vaporization (CVP) at 8.3% [1]. Among perioperative complications, postoperative infection is a major concern that can significantly impair patients' quality of life. The administration of prophylactic antibiotics plays an important role in preventing perioperative infections; however, inappropriate long-term use not only increases the risk of adverse drug events but also promotes the development of drug-resistant bacteria. Therefore, the selection of appropriate agents and optimal administration methods is of paramount importance. According to the aforementioned survey, the duration of prophylactic antibiotic administration for TURP varied among institutions: a single dose in 38.3%, within 24 h in 20.4%, within 48 h in 27.2%, and within 72 h in 12.3%. The Japanese guidelines recommend a single-dose regimen for antibiotic prophylaxis in TURP [2]. Although adherence to these guidelines has been improving, some facilities continue to use prolonged regimens. These results indicate that compliance with the guidelines remains suboptimal, and further efforts are required to promote the appropriate use of antibiotics. A systematic review of 39 randomized controlled trials reported that prophylactic antibiotics reduced the incidence of sepsis from 3.4% to 1.4% (a 51% relative risk reduction) and decreased the rates of postoperative fever and bacteriuria by 36% and 63%, respectively [3]. These findings support the necessity of prophylactic antibiotic use in TURP. Thre present study, which demonstrated through systematic review and network meta-analysis that a single-dose regimen is sufficient, provides highly valuable evidence for clinical practice [4]. On the other hand, few studies have evaluated the effectiveness of prophylactic antibiotics in BPH surgeries other than TURP. To determine the optimal duration of antibiotic administration for patients undergoing transurethral enucleation of the prostate, a multicenter prospective RCT was conducted by the Japanese Research Group for Urinary Tract Infection (JRGU). The incidence of postoperative genitourinary tract infections did not differ significantly between patients who received a single dose of cefazolin and those who received a 3-day regimen, indicating that a single dose is sufficient for prophylaxis in patients without preoperative pyuria or bacteriuria [5]. In the future, further reports, systematic reviews, and meta-analyses are expected to clarify the necessity and optimal duration of prophylactic antibiotic administration in surgical procedures such as enucleation (e.g., HoLEP, TUEB), vaporization (e.g., PVP, CVP), and minimally invasive therapies (e.g., water vapor energy therapy [WAVE], prostatic urethral lift [PUL]), which have become increasingly popular in recent years. Moreover, the optimal duration of prophylactic antibiotic administration in high-risk cases, such as those with preoperative bacteriuria, remains uncertain and should be established through future studies. Yoshikazu Togo: writing – original draft, review, and editing. The author declares no conflicts of interest. Alessandro V. Oliveira et al. Antibiotic Prophylaxis in Men Undergoing Transurethral Resection of Prostate: A Systematic Review and Network Meta-Analysis. Doi: https://doi.org/10.1111/iju.70276.