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Procedure

Prophylaxis recommendation

Details

Diagnosis procedures (cystoscopy, urodynamics, retrograde pyelography, etc.)

High-risk

• Pre-procedural antibiotics show a strong trend towards reducing the risk of UTI, but not fever, after endoscopic urologic procedures

TRUS biopsy

All

• High risk of adverse infection-related events in patients undergoing transrectal prostate biopsy.  
  
• Insufficient evidence for efficacy of pre-procedural enemas to recommend their routine use.
  
• In patients at increased risk of harboring resistant organisms (previous history of urosepsis, or multiple treatments with antibiotics, perirectal culture swabs prior to transrectal prostate biopsy should be considered.

TURP

All

• Pre-procedural antibiotics reduce the risk of febrile UTI after TURP

TURBT

High-risk

ESWL

High-risk

• Pre-procedural antibiotics do not significantly reduce the risk of UTI and fever in patients undergoing ESWL but should be considered in patients at high risk of infectious complications.
  
• Patients with large stone burden, associated pyuria, history of pyelonephritis, and adjunctive operative procedure including stent, nephrostomy insertion, PCNL or ureteroscopy are at a higher risk of developing pyelonephritis post-ESWL.

Stone manipulation procedures (URS, PCNL)

All

• Antibiotics reduce the risk of UTI following non-ESWL stone manipulation procedures, and there is a trend towards a reduction in the incidence of fever.