Preoperative Laboratory Testing for Penile Implant Surgery
Routine preoperative laboratory testing, including urinalysis, is not recommended for asymptomatic patients undergoing penile prosthesis implantation. 1
Urine Culture and Urinalysis
Do not routinely screen for or treat asymptomatic bacteriuria (ASB) prior to penile prosthesis implantation (weak recommendation, very low-quality evidence). 1
All patients should receive standard perioperative antimicrobial prophylaxis regardless of bacteriuria screening status. 1
A retrospective study of 721 penile prosthesis procedures found no difference in infection rates between patients with untreated ASB and those with negative preoperative cultures when broad-spectrum perioperative prophylaxis was administered. 1
Routine urinalysis in asymptomatic patients has poor predictive value for postoperative complications and rarely changes management (less than 1% complication rate even when abnormalities are found). 1
Prosthetic device infections are typically caused by biofilm-producing skin flora rather than urinary pathogens, making preoperative urine screening of questionable benefit. 1
Other Laboratory Testing
Electrolytes and Renal Function:
- Do not obtain routine electrolyte panels or creatinine measurements based on age alone. 1
- Consider testing only if compelling historical findings exist (hypertension, heart failure, chronic kidney disease, complicated diabetes, liver disease) or if the patient takes specific medications (diuretics, ACE inhibitors, ARBs, NSAIDs, digoxin). 1
Glucose Testing:
- Consider preoperative glucose assessment only when results would alter perioperative management. 1
- For patients with known diabetes, HbA1c is more useful than random glucose if results would change perioperative management. 1
- Random glucose testing could be considered in patients at very high risk of undiagnosed diabetes. 1
Coagulation Studies:
- Not routinely indicated unless specific bleeding risk factors are present based on history and physical examination. 1
Essential Preoperative Requirements
Infection Screening (Clinical, Not Laboratory):
- Patient must be free of urinary tract infection, systemic infection, and cutaneous lesions in the operative area. 2
- This determination should be made clinically rather than through routine laboratory screening. 1
Medical Optimization:
- Optimize pre-existing medical comorbidities, particularly diabetes, as diabetic patients have nearly double the infection risk. 3
- Patients with immunosuppression or prior pelvic radiotherapy require heightened surveillance but not necessarily additional laboratory testing. 3
Critical Caveat
The most important pitfall is ordering unnecessary screening tests that do not improve outcomes. The evidence consistently shows that routine preoperative urinalysis and urine cultures do not reduce infection rates when appropriate perioperative antibiotic prophylaxis is administered. 1 Focus instead on clinical assessment for active infection and optimization of medical comorbidities. 2, 3