Bethany Tremain
Transurethral resection of the prostate (TURP) is a day-case surgical procedure for management of lower urinary tract symptoms (LUTS). Using ‘Getting it right first-time’ (GIRFT) criteria all pre-operative assessments should have a mid-stream urine (MSU) sample two weeks before procedure. Rationale was due to recent identification of patients requiring intensive care admission due to post-operative sepsis requiring vasopressors which subsequently resulted in patient death.
Retrospective assessment of data was used, incorporating hospital and GP records from 28 April 2025 to 1 August 2025. All TURPs were done with prophylaxis IV antibiotics; no complications or adverse events were post-operatively recorded.
40 patients were identified with a range of ages (55-83), 23 experienced LUTS and 17 for urinary retention. 2 patients were concurrently treated for cystolitholapaxy. Only 2/40 had an MSU as per GIRFT. 8 patients experienced symptoms of urinary tract infection and treated with antibiotics. 5 confirmed on MSU with different pathogens identified (1 - Klebsiella oxytoca, 1 - Pseudomonas aeruginosa, 1 - Serratia marcescens,1 - Proteus mirabilis and 1 - E.coli). 3/8 were diabetic which can increase infection risk. There was no post-operative sepsis requiring hospital +/- Intensive care admission.
There was a 20% post-operative infection rate for patients undergoing TURPs within the period April-August 2025 with only a 5% adherence to GIRFT criteria. Therefore, recommendations are to increase MSU rates pre-operatively to see if this impacts post-operative infection rates and to standardise post-operative safety netting on discharge summaries. Reaudit is needed to see if infection rates are impacted.
Authors
Bethany Tremain, Mohamed Hassan, James Akman
Kings Mill Hospital, Mansfield, United Kingdom