Antibiotics and HoLEP
Reviewed by Arun K Sharma

Holmium laser enucleation of the prostate (HoLEP) is an increasingly done size-independent surgical treatment for benign prostatic hypertrophy. There is currently a lack of data on perioperative antibiotic prescribing patterns for HoLEP and thus, no consensus on optimal practices. This interesting study comes from Ohio, USA. Members of the Endourological Society (EUS) were invited by email to complete a REDCap survey. The survey inquired about surgeons’ practice setting, training, surgical volume, antibiotic prescribing practices, and explored different factors that might affect antibiotic choice and duration. A total of 70 urologists (66 male, 4 female) responded, who performed an average of 108 HoLEPs per year with a mean clinical experience of 11 years. HoLEP was learned by fellowship (39%), self-training (33%), course-based training (17%), others 11%. Group 1 – in the case of a negative preoperative urine culture with a patient who is not catheterised / intermittently self-catheterising (C/ISC), 96% of urologists would only give a single perioperative dose of antibiotic. If the patient is C/ISC then 49% of urologists would give more than a single dose of perioperative antibiotic when the urine culture is negative. Group 2 – if the preoperative urine culture is negative, 39% of surgeons would prescribe postoperative antibiotics even when the patient is not C/ISC and this increased to 64% if the patient is C/ISC. Group 3 – if there is preoperative urine mixed flora 34% will repeat mid-stream urine (MSU), 42% will treat with antibiotics. Fifty-eight percent prescribed single dose per operative. Group 4 – For positive cultures, most will give antibiotics prior to HoLEP with days ranging from three to fourteen. Forty-three percent will give for seven days. The most common factors urologists considered when prescribing antibiotic prophylaxis / therapy were positive urine culture, catheterisation status, and a history of recurrent urinary tract infection (UTI). Private sector urologists administered postoperative prophylaxis more often (p<0.05) and urologists with more experience treated a positive urine culture for a shorter period. Urosepsis is a real killer in elderly and frail patients and we should try our best to kill pathogens as far as possible perioperatively. This will avoid morbidity / mortality and admission to intensive care unit etc.

Assessing antibiotics administration practices among urology surgeons performing HoLEP worldwide.
Poor SMM, Asif H, Denis-Diaz D, et al.
WORLD JOURNAL OF UROLOGY
2025;43(1):169.