Should We Always Use Antibiotics after Urodynamic Studies in High-Risk Patients?


P. Miotla
S. Wawrysiuk
K. Naber
E. Markut-Miotla
P. Skorupski
K. Skorupska
T. Rechberge


Aim. The aim of this observational study was to evaluate the effectiveness of a phytotherapic drug (Canephron N) in preventing urinary tract infection (UTI) in high-risk women undergoing urodynamic studies (UDS).

Methods. The study protocol was approved by the local institutional ethical committee. Adult women with at least one risk factor for acquiring UTI (defined as: age over 70, elevated postvoid residual urine>100 ml, recurrent UTI, pelvic organ prolapse (POP) ≥II in POP-Q scale, and neurogenic bladder) had received after UDS either a single oral dose of fosfomycin trometamol (FT) (3 grams) or a phytodrug containing centaury herb, lovage root, and rosemary leaves (5 ml taken orally three times daily for one week). All patients included in the study had no pyuria according to urine dipstick (nitrite and/or blood and/or leukocyte esterase) and negative urine culture (CFU < 103/ml) before UDS. Urine samples were also tested 7 days after UDS.

Results. Seventy-two high-risk participants completed the study. Seven days after urodynamic studies UTI symptoms, pyuria (nitrite and/or blood and/or leukocyte esterase) and bacteriuria with E. coli occurred in two patients (one (2.8 %) in the FT and one (2.7 %) in the phytodrug group, respectively). No statistical differences in UTI incidence were found between both treatment groups.We did not observe any additional adverse events in both groups. The major disadvantage of prophylaxis with the phytodrug as compared to FT was the necessity of continuing therapy for 7 days.

Conclusion. Prophylaxis of UTI with a phytodrug (Canephron N) may be considered a good alternative to antibiotic prophylaxis use after UDS in high-risk female patients.


How to Cite
Miotla, P., Wawrysiuk, S., Naber, K., Markut-Miotla, E., Skorupski, P., Skorupska, K., & Rechberge, T. (2020). Should We Always Use Antibiotics after Urodynamic Studies in High-Risk Patients?. Health of Man, (2), 17–21.
For practicing physicians
Author Biographies

P. Miotla, Medical University of Lublin

Pawel Miotla,

2nd Department of Gynaecology

S. Wawrysiuk, Medical University of Lublin

Sara Wawrysiuk,

2nd Department of Gynaecology

K. Naber, Technical University of Munich

Kurt Naber,

Department of Urology

E. Markut-Miotla, Medical University of Lublin

Ewa Markut-Miotla,

Department of Paediatric Pulmonology and Rheumatology

P. Skorupski, Medical University of Lublin

Pawel Skorupski,

2nd Department of Gynaecology

K. Skorupska, Medical University of Lublin

Katarzyna Skorupska,

2nd Department of Gynaecology

T. Rechberge, Medical University of Lublin

Tomasz Rechberge,

2nd Department of Gynaecology


C. Gürbüz, B. Güner, G. Atış, L. Canat, and T. Caşkurlu, “Are prophylactic antibiotics necessary for urodynamic study?” Kaohsiung Journal of Medical Sciences, vol. 29, no. 6, pp. 325–329, 2013.

A. M. Suskind, L. Cox, J. Q. Clemens et al., “The Value of Urodynamics in an Academic Specialty Referral Practice,” Urology, vol. 105, pp. 48–53, 2017.

T. Magari, Y. Fukabori, H. Ogura, and K. Suzuki, “Lower urinary tract symptoms of neurological origin in urological practice,” Clinical Autonomic Research, vol. 23, no. 2, pp. 67–72, 2013.

F. Aoun, A. Peltier, and R. Van Velthoven, “Lower urinary tract dysfunction in pelvic gynecologic cancer: The role of urodynamics,” Advances in Urology, vol. 2014, 2014.

E. Hirakauva, A. Bianchi-Ferraro, E. Zucchi et al., “Incidence of Bacteriuria after Urodynamic Study with or without Antibiotic Prophylaxis in Women with Urinary Incontinence,” Revista Brasileira de Ginecologia e Obstetrícia, vol. 39, no. 10, pp. 534–540, 2017.

G. W. Cundiff, M. T. McLennan, and A. E. Bent, “Randomized Trial of Antibiotic Prophylaxis for Combined Urodynamics and Cystourethroscopy,” Obstetrics & Gynecology, vol. 93, no. 5, pp. 749–752, 1999.

P. M. Latthe, R. Foon, and P. Toozs-Hobson, “Prophylactic antibiotics in urodynamics: A systematic review of effectiveness and safety,” Neurourology and Urodynamics, vol. 27, no. 3, pp. 167–173, 2008.

F. Wagenlehner, C. Wagenlehner, S. Schinzel, and K. Naber, “Prospective, Randomized, Multicentric, Open, Comparative Study on the Efficacy of a Prophylactic Single Dose of 500 mg Levofloxacin versus 1920 mg Trimethoprim/Sulfamethoxazole versus a Control Group in Patients Undergoing TUR of the Prostate,” European Urology, vol. 47, no. 4, pp. 549–556, 2005.

S.-W. Tsai, F.-T. Kung, F.-C. Chuang, Y.-C. Ou, C.-J. Wu, and K.-H. Huang, “Evaluation of the relationship between urodynamic examination and urinary tract infection based on urinalysis results,” Taiwanese Journal of Obstetrics and Gynecology, vol. 52, no. 4, pp. 493–497, 2013.

M. Nadeem, M. I. Sheikh, M. S. Sait, N. Emmanuel, M. K. M. Sheriff, and S. Masood, “Is urinary tract infection after urodynamic study predictable?” Urological Science, vol. 28, no. 4, pp. 240–242, 2017.

M. M. Nóbrega, A. P. F. Auge, L. G. M. De Toledo, S. Da Silva Carramão, A. B. Frade, and M. J. C. Salles, “Bacteriuria and urinary tract infection after female urodynamic studies: Risk factors and microbiological analysis,” American Journal of Infection Control, vol. 43, no. 10, pp. 1035–1039, 2015.

A. P. Cameron, L. Campeau, B. M. Brucker et al., “Best practice policy statement on urodynamic antibiotic prophylaxis in the non-index patient,” Neurourology and Urodynamics, vol. 36, no. 4, pp. 915–926, 2017.

R. Foon, P. Toozs-Hobson, and P. Latthe, “Prophylactic antibiotics to reduce the risk of urinary tract infections after urodynamic studies.,” Cochrane Database of Systematic Reviews (Online), vol. 10, p. CD008224, 2012.

K. G. Naber, “Efficacy and safety of the phytotherapeutic drug Canephron® N in prevention and treatment of urogenital and gestational disease: Review of clinical experience in Eastern Europe and Central Asia,” Research and Reports in Urology, vol. 5, pp. 39–46, 2013.

R. C. Bump, A. Mattiasson, K. Bo et al., “The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction,” American Journal of Obstetrics & Gynecology, vol. 175, no. 1, pp. 10–17, 1996.

L. Bombieri, D. A. B. Dance, G. W. Rienhardt, A. Waterfield, and R. M. Freeman, “Urinary tract infection after urodynamic studies in women: Incidence and natural history,” BJU International, vol. 83, no. 4, pp. 392–395, 1999.

Y. Z. Almallah, C. D. Rennie, J. Stone, and M. J. R. Lancashire, “Urinary tract infection and patient satisfaction after flexible cystoscopy and urodynamic evaluation,” Urology, vol. 56, no. 1, pp. 37–39, 2000.

J. H. Ku, S. W. Kim, H. H. Kim, J.-S. Paick, H. Son, and S.-J. Oh, “Patient experience with a urodynamic study: A prospective study in 208 patients,” The Journal of Urology, vol. 171, no. 6 I, pp. 2307–2310, 2004.

J. Subramaniam, “Association of Urinary Tract Infection in Married Women Presenting with Urinary Incontinence in a Hospital based Population,” Journal of Clinical and Diagnostic Research, 2016.

P. Miotla, K. Romanek-Piva, M. Bogusiewicz et al., “Antimicrobial Resistance Patterns in Women with Positive Urine Culture: Does Menopausal Status Make a Significant Difference?” BioMed Research International, vol. 2017, 2017.

K. G. Naber, G. Schito, H. Botto, J. Palou, and T. Mazzei, “Surveillance study in europe and brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy,” European Urology, vol. 54, no. 5, pp. 1164–1178, 2008.

F. M. E. Wagenlehner, U. Hoyme, M. Kaase, R. Fünfstück, K. G. Naber, and G. Schmiemann, “Uncomplicated urinary tract infections,” Deutsches Ärzteblatt International, vol. 108, no. 24, pp. 415–423, 2011.

J. L. Lowder, L. J. Burrows, N. L. S. Howden, and A. M. Weber, “Prophylactic antibiotics after urodynamics in women: A decision analysis,” International Urogynecology Journal, vol. 18, no. 2, pp. 159–164, 2007.

U. M. Peschers, V. Kempf, K. Jundt, I. Autenrieth, and T. Dimpfl, “Antibiotic treatment to prevent urinary tract infections after urodynamic evaluation,” International Urogynecology Journal, vol. 12, no. 4, pp. 254–257, 2001.

M. Sundqvist, P. Geli, D. I. Andersson et al., “Little evidence for reversibility of trimethoprim resistance after a drastic reduction in trimethoprim use,” Journal of Antimicrobial Chemotherapy, vol. 65, no. 2, pp. 350–360, 2009.

B. R. Levin, “Minimizing potential resistance: A population dynamics view,” Clinical Infectious Diseases, vol. 33, no. 3, pp. S161–S169, 2001.

A. K. Shepherd and P. S. Pottinger, “Management of Urinary Tract Infections in the Era of Increasing Antimicrobial Resistance,” Medical Clinics of North America, vol. 97, no. 4, pp. 737–757, 2013.