Do We Need a Urine Culture Before Cystoscopy? Time to Shift Away from Routine Testing

OBJECTIVE To determine if cystoscopy could be safely performed without a urine culture by analyzing 2 pro-spectively cohorts of patients undergoing outpatient cystoscopy, 1 without urine culture and the other cohort screened and treated for ASB as per protocol. We aim to report the rate of symptom-atic UTI and the rate of urinary sepsis within 30 days of cystoscopy.METHODS All patients who underwent cystoscopy between 2021 and 2022 were invited to participate. Patients were prospectively recruited in a 2:1 ratio. Cohort A: patients who did not require urine culture before cystoscopy. Cohort B: patients who were required to have sterile urine before the procedure. Primary endpoint was the occurrence of symptomatic UTI & LE; 30 days after cystoscopy.RESULTS A total of 461 patients were recruited, 316 for cohort A and 145 for cohort B. Fifteen patients had symptomatic UTIs between both groups, 8 in Cohort A and 7 in Cohort B. The overall rate of symptomatic UTI was 3.2%, 2.5% for Cohort A and 4.8% for Cohort B. We had only 1 case of urinary sepsis in Cohort B. The RR for developing UTI in cohort B was 1.91 in the univariate model and 1.74 in the multivariate analysis.CONCLUSION Routine urine culture before outpatient cystoscopy is unnecessary. In asymptomatic patients, sub-sequent UTIs are rare and can be easily treated. Avoiding routine urine culture helps prevent mis -use of antibiotics, reduce cancellation rates, and ease the burden of patients that get cancelled because of ASB. The low risk of symptomatic UTI after the procedure must be discussed with the patient. UROLOGY 172: 13-17, 2023. & COPY; 2022 Elsevier Inc.