Value of urinary prophylaxis with methenamine in gynecologic surgery.

Abstract

BACKGROUND:

There is a high risk of postoperative bacteriuria and urinary tract infection after gynecologic surgery. Postoperative asymptomatic bacteriuria often disappears without treatment, but 15-20% of patients still require treatment for postoperative urinary tract infection. This study was carried out to assess the value of prophylactic treatment with methenamine hippurate after routine gynecologic surgery.

METHODS:

This was a prospective, randomized, double-blind, placebo-controlled clinical trial comprising 145 patients undergoing routine gynecologic laparotomy or vaginal plastic surgery using a Foley catheter for 24 h. Antibiotics were not used. Subjects received 1 g Hiprex or placebo twice daily for 5 days. Urine was cultured preoperatively, at catheter removal, and 2 days later. Patients with positive cultures were not given antibiotics unless they were symptomatic. The follow-up period was 1 month.

STATISTICS:

The chi-square test, Fisher exact test, and t-test were used with level of significance at 0.05, and odds ratios with 95% confidence intervals were calculated.

RESULTS:

Asymptomatic bacteriuria was diagnosed in 36 cases (50.0%) in the placebo group and 22 cases (30.1%) in the methenamine group (p = 0.02). Urinary tract infection was diagnosed in 10 cases (13.9%) in the placebo group and two cases (2.7%) in the methenamine group (p = 0.03). There were few adverse events.

CONCLUSIONS:

Prophylactic treatment with methenamine hippurate significantly reduces the incidence of postoperative bacteriuria and urinary tract infection.

• Authors: Hjalmar A Schiøtz, Kristian Guttu
• Journal: Acta obstetricia et gynecologica Scandinavica (Acta Obstet Gynecol Scand) Vol. 81 Issue 8 Pg. 743-6 (Aug 2002) ISSN: 0001-6349 [Print] United States
• PMID: 12174159 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Anti-Infective Agents, Urinary
• Methenamine

Topics

• Administration, Oral
• Adult
• Aged
• Aged, 80 and over
• Anti-Infective Agents, Urinary (administration & dosage, therapeutic use)
• Antibiotic Prophylaxis
• Bacteriuria (etiology, microbiology, prevention & control)
• Double-Blind Method
• Female
• Gynecologic Surgical Procedures
• Humans
• Laparotomy
• Methenamine (administration & dosage, therapeutic use)
• Middle Aged
• Postoperative Complications (etiology, prevention & control)
• Prospective Studies
• Treatment Outcome
• Urinary Catheterization (adverse effects)
• Vagina (surgery)