Do Prophylactic Antibiotics Decrease the Rate of Urinary Tract Infections After Robot-Assisted Radical Cystectomy? A Randomized Controlled Trial

Abstract

Purpose:

The purpose of this article was to investigate the role of prophylactic antibiotics after robot-assisted radical cystectomy (RARC) in the prevention of 90-day UTIs.

Materials and Methods:

Patients who underwent RARC with urinary diversion were randomized to standard of care (SOC) vs receiving prophylactic antibiotics (nitrofurantoin 100 mg daily or trimethoprim/sulfamethoxazole 160/800 mg daily) for 30 days after discharge. The primary end point was 90-day UTIs (defined as positive urine culture with >10⁵ cfu/mL associated with clinical symptoms, such as fever, chills, or flank pain). Secondary end points included adverse events, 90-day infectious complications, UTI-related readmissions, and cost.

Results:

The final cohort included 40 in the SOC and 37 patients in the study arm, with follow-up ≥90 days. Median age was 69 years (IQR, 65-76), 19 (25%) were female, and 28 (36%) received neoadjuvant chemotherapy. Ten patients (25%) developed UTIs in the SOC vs 0% in the study arm (P = .001). There was no significant difference in complications or high-grade complications. Ninety-day infectious complications were 43% in the SOC arm vs 14% in the study arm (P = .006), and 90-day infection-related readmissions were 30% in the SOC vs 5% in the study arm (P = .007). The mean postcystectomy cost was $9074 lower in the treatment arm compared with the SOC (P = .007). The number needed to treat to prevent a single UTI was 4.0 (95% CI, 2.5-7.0).

Conclusions:

Prophylactic antibiotics for 30 days after RARC were associated with lower 90-day UTIs, infectious complications, UTI-related readmissions, and costs without an increase in adverse events.

Hussein AA, Mahmood AW, Ahmad A, Houenstein H, Harrington G, Khan M, et al. Do Prophylactic Antibiotics Decrease the Rate of Urinary Tract Infections After Robot-Assisted Radical Cystectomy? A Randomized Controlled Trial. Journal of Urology [Internet]. 2025 Aug 1 [cited 2025 Sep 23];214(2):147–55.