Can a patient with an active urinary tract infection (UTI) undergo mesh hernioplasty?

Management of Mesh Hernioplasty in a Patient with Active UTI

Mesh hernioplasty should be delayed until the urinary tract infection is completely resolved with documented negative urine cultures to minimize the risk of mesh infection and subsequent complications. 1

Risk Assessment and Rationale

• Active infections, including UTIs, create a potentially contaminated surgical field that increases the risk of surgical site infections and subsequent mesh infections 2, 1
• Mesh infection is a devastating complication with reported rates of 1.9-5% that often requires mesh explantation (72.7% of cases), significantly increasing morbidity 1, 3, 4
• The presence of bacteria can lead to biofilm formation on the synthetic mesh material, creating an environment for bacterial proliferation and chronic infection 3, 5

Management Algorithm

Step 1: Treat the UTI Completely

• Complete a full course of appropriate antibiotics based on culture and sensitivity results 1, 6
• Document complete resolution of UTI with negative urine cultures before proceeding with mesh hernioplasty 1
• Minimum treatment duration should be 7-14 days depending on severity and causative organism 1, 6

Step 2: Surgical Decision-Making Based on Urgency

• Non-urgent hernia:

  • Delay mesh hernioplasty until UTI is completely resolved with negative cultures 1
  • Schedule surgery at least 48-72 hours after documented resolution of infection 1

• Urgent/emergent hernia repair needed despite active UTI:

  • For small defects (<3 cm): Consider primary tissue repair without mesh 2, 1
  • For larger defects: Consider biological mesh rather than synthetic mesh if primary repair is not feasible 2, 1

Special Considerations

• CDC wound classification impacts surgical approach:

  • Clean surgical field (CDC class I): Synthetic mesh is safe with low infection risk 2
  • Clean-contaminated (CDC class II): Synthetic mesh can be used with caution 2
  • Contaminated/dirty fields (CDC classes III/IV): Primary repair for small defects or biological mesh for larger defects 2

• If mesh placement is absolutely necessary with active UTI:

  • Consider using macroporous, lightweight mesh which may have lower infection rates 2
  • Ensure meticulous surgical technique and appropriate perioperative antibiotics 4

Complications and Prevention

• Factors increasing mesh infection risk:

  • Prolonged operative time 4
  • Mesh contamination during surgery 4
  • Active infection at time of surgery 1, 3

• Signs of mesh infection to monitor for postoperatively:

  • Local inflammation, pain, erythema, chronic discharging sinus 2, 3
  • Fever, myalgia, abscess formation 3, 4

• Management of mesh infection often requires:

  • Conservative approaches (antibiotics, drainage) initially 2
  • Complete surgical removal of the mesh if conservative treatment fails 2, 5

Key Pitfalls to Avoid

• Do not proceed with mesh placement in the presence of active UTI 1
• Do not rely solely on symptom resolution without documented negative urine cultures 1
• Avoid prolonged operative times which increase infection risk 4
• Do not underestimate indolent signs of deep mesh infection which may present with chronic symptoms 2