Antibiotic Prophylaxis For Urinary Tract Infection After Midurethral Sling: A Randomized Controlled Trial Editorial Comment

Stress urinary incontinence (SUI) is common in adult women and is often treated by the placement of a midurethral sling. Postoperative urinary tract infection (UTI) is a frequent complication of this surgery. Its incidence varies widely (8.9%–34%). Two previous studies reported that the use of prophylactic antibiotics following sling placement decreased the incidence of UTI. The aim of this randomized, double-blinded, placebo-controlled, multicenter trial was to determine whether a 3-day postoperative course of a urinary antibiotic would lower the incidence of UTI in women undergoing outpatient midurethral sling placement for SUI. Adult women with SUI undergoing placement of a midurethral sling were randomized to receive oral doses of nitrofurantoin 100 mg (n = 74) or placebo (n = 75) twice daily for 3 days after surgery. All participants and caregivers were blinded to the randomization. Subjects were observed for signs and symptoms of UTI until 6 weeks after surgery and were evaluated at that time for occurrence of UTI, the primary study outcome. The overall rate of UTI during the study period was 24.8% (n = 37). The incidence of postoperative UTI was significantly lower in the treatment group than in the placebo group (17.6% vs 32%; P = 0.04). These findings show that a 3-day course of nitrofurantoin reduces the risk of postoperative UTI in the first 6 weeks after sling surgery in this study population. The authors recommend that all patients receiving an outpatient miduretheral sling be treated with a course of nitrofurantoin.