From the Guidelines
Hysterectomy and Urinary Tract Infections
Women who undergo hysterectomies do experience a higher incidence of urinary tract infections (UTIs), as evidenced by the need for antimicrobial prophylaxis to reduce postoperative infections, including UTIs 1.
- The use of single-dose antimicrobial prophylaxis within 1 hour of incision is recommended for patients undergoing vaginal hysterectomy, similar to abdominal hysterectomy, to reduce the risk of UTIs 1.
- A Cochrane review cited in the guidelines for vulvar and vaginal surgery found that women who received antimicrobial prophylaxis for vaginal hysterectomy had a reduction in total postoperative infections, including UTIs 1.
- Although the exact incidence of UTIs in women who have undergone hysterectomies is not specified, the guidelines suggest that antimicrobial prophylaxis is beneficial in reducing the risk of UTIs in this population 1.
- The decision to administer antibiotic prophylaxis in patients undergoing vaginal surgery without hysterectomy is left to the discretion of the surgeon, highlighting the complexity of UTI prevention in this population 1.
From the Research
Incidence of Urinary Tract Infections (UTIs) in Women After Hysterectomies
- The incidence of UTIs in women after hysterectomies is a significant concern, with studies indicating a higher risk of UTIs in this population 2, 3.
- A study published in 2023 found that 12.5% of women who underwent radical hysterectomy for cervical cancer developed catheter-associated UTIs 2.
- Another study published in 2024 reported an incidence rate of 9.76% for catheter-associated UTIs in women who underwent radical hysterectomy for cervical cancer 3.
Risk Factors for UTIs in Women After Hysterectomies
- Current smoking history, minimally invasive surgical approach, estimated surgical blood loss, operative time, and increased duration of catheterization have been identified as risk factors for UTIs in women after hysterectomies 2.
- The duration of urinary catheterization, urinary leukocyte esterase, and positive urine culture have also been found to be independent risk factors for UTIs in this population 3.
- Preoperative bladder microbiome composition, including depletion of Lactobacillus iners and enrichment of uropathogens, may also contribute to the risk of UTIs in women after hysterectomies 4.
Prevention and Management of UTIs in Women After Hysterectomies
- Preoperative smoking cessation interventions and catheter removal within 7 postoperative days may help reduce the risk of UTIs in women after hysterectomies 2.
- Topical estrogens, probiotics, cranberry juice, and d-mannose have been proposed as non-antibiotic methods for preventing UTIs in postmenopausal women 5.
- A nomogram-based model incorporating independent risk factors for UTIs may assist in early clinical diagnosis and decision-making for women after hysterectomies 3.