Practice and Safety of Rigid Cystoscopy Without Prior Urine Culture or Antibiotic Prophylaxis: Observational Analysis in Chad

Introduction: Cystoscopy is a key diagnostic procedure in urology, but the need for prior urine culture and routine antibiotic prophylaxis remains controversial due to the low risk of infection reported in several studies. In resource-limited settings, these practices pose particular challenges. This study evaluates the safety of rigid cystoscopy performed without prior urine culture or antibiotic prophylaxis in a referral center in Chad. Methods: We conducted a retrospective descriptive study at the Urology Department of CHU La Renaissance, Chad, including patients who underwent outpatient rigid cystoscopy without prior urine culture or antibiotic prophylaxis between 2023 and 2025. Patients with active urinary tract infections were excluded. Clinical data, indications, and post-procedural complications were analyzed descriptively. Results: During the study period, 361 patients underwent cystoscopy, of whom the majority were male (n = 329, 91.1%) with a mean age of 46.4 years (range, 14-81). The most common comorbidities were diabetes mellitus (19%) and hypertension (14%). Lower urinary tract symptoms were the leading indication for cystoscopy (n = 157, 43.5%), followed by hematuria (n = 130, 36.0%). Cystoscopy was successfully completed without intraoperative complications in most patients (n = 329, 91.2%). Normal cystoscopic findings were observed in 97 patients (26.9%). Post-procedural complications were generally mild, with pain being the most frequent (n = 69, 19%), and symptomatic urinary tract infections occurring in 14 patients (3.9%) within an average of 48 hours. No severe infectious complications were reported. Additional interventions included urethral dilation/urethrotomy, bladder biopsy, and prostate biopsy. Conclusion: This study in Chad shows that rigid cystoscopy without prior urine culture or routine antibiotic prophylaxis is associated with a low rate of mild infections, with no cases of sepsis or hospitalization. It suggests that a selective approach, based on clinical evaluation and strict aseptic technique, is safe and appropriate in this context.