REVIEW   Free access

Minerva Urology and Nephrology 2021 August;73(4):452-61

DOI: 10.23736/S2724-6051.20.04061-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Evaluating the usefulness of antibiotic prophylaxis prior to ESWL in patients with sterile urine: a systematic review and meta-analysis

Dimitrios MEMMOS ¹, Ioannis MYKONIATIS ¹, Petros SOUNTOULIDES ¹ ✉, Anastasios ANASTASIADIS ¹, Nikolaos PYRGIDIS ¹, Francesco GRECO ², Luca CINDOLO ³, Dimitrios HATZICHRISTOU ¹, Evangelos LIATSIKOS ⁴, Panagiotis KALLIDONIS ⁴

¹ First Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece; ² Department of Urology, Humanitas Gavazzeni, Bergamo, Italy; ³ Department of Urology, Villa Stuart Private Hospital, Rome, Italy; ⁴ Department of Urology, University of Patras, Patras, Greece

INTRODUCTION: The aim of this review is to evaluate the effect of antibiotic prophylaxis (AP) on asymptomatic bacteriuria (AB) and urinary tract infection (UTI) in patients with sterile urine undergoing ESWL.
EVIDENCE ACQUISITION: PubMed, Scopus, Web of Science and Cochrane Registry were searched systematically for randomized clinical trials assessing the effect of AP in patients with sterile urine undergoing SWL up to May 2020. Risk ratios were used to compare dichotomous outcomes. A stratified analysis was performed depending on the risk of bias assessment of the included studies. Subgroup analysis was performed in patients that underwent instrumentation of the urinary tract.
EVIDENCE SYNTHESIS: Sixteen studies were evaluated including 2442 patients. When evaluating all the included studies (regardless of the risk of bias assessment), the risk of AB was RR: 0.88, 95% CI: 0.64-1.21, P=0.42 and the risk of UTI was RR: 0.55, 95% CI: 0.22-1.36, P=0.19. When excluding the high risk of bias studies, the risk for AB was RR: 0.9, 95% CI: 0.63-1.28, P=0.55 and for UTI RR: 1.18, 95% CI: 0.38-3.72, P=0.77. When evaluating patients that underwent instrumentation of the urinary tract the risk for AB was RR: 0.92, 95% CI: 0.66-1.27, P=0.6 and for UTI was RR: 0.69, 95% CI: 0.22-2.22, P=0.54.
CONCLUSIONS: AP is not necessary for patients with sterile urine prior to ESWL for the prevention of UTI. Also, patients that undergo instrumentation of the urinary tract prior to or during ESWL do not benefit from antibiotic prophylaxis but further research is required.

KEY WORDS: Extracorporeal shockwave therapy; Lithotripsy; Antibiotic prophylaxis; Urinary tract infections; Bacteriuria