title: Safety and tolerability of sedation-free flexible cystoscopy for intradetrusor botulinum toxin-A injection. Is antibiotic prophylaxis required for flexible cystoscopy? A truncated randomized double-blind controlled trial. Randomized trial of antibiotic prophylaxis for combined urodynamics and cystourethroscopy. Efficacy of antibiotic prophylaxis in patients undergoing cystoscopy: a randomized clinical trial Randomized clinical trial on antimicrobial prophylaxis for flexible urethrocystoscopy. Urinary tract infection and patient satisfaction after flexible cystoscopy and urodynamic evaluation. Oral ciprofloxacin or trimethoprim reduces bacteriuria after flexible cystoscopy [Antimicrobial prophylaxis in urethrocystoscopy. Comparative study]. The Issue of Prophylactic Antibiotics prior to Flexible Cystoscopy
abstract: PURPOSE Intradetrusor botulinum toxin-A injection is a promising emerging therapy for neurogenic and idiopathic overactive bladder that is refractory to current antimuscarinic agents . We evaluated a sedation-free procedure using flexible endoscopy to perform intradetrusor botulinum toxin-A injection using a vali date d pain score to assess the tolerability of this technique . MATERIAL S AND METHODS Five men and 22 women with idiopathic overactive bladder refractory to antimuscarinics were prospect ively evaluated and r and omized to 100 U ( 14 ) or 150 U botulinum toxin-A ( 13 ) . Subjects underwent BTA injection with intravesical lidocaine using a 14Fr Olympus flexible cystoscope , which accommo date s a 27 gauge flexible Olympus injection needle . Patients were evaluated with the visual analog scale to evaluate discomfort during and 15 minutes after the procedure . Procedure time was recorded . RESULTS In 22 female patients the mean pain score was 3.1 ( range 0 to 10 ) during the procedure and 0.7 ( range 0 to 7 ) 15 minutes after the procedure . In 5 male patients the mean pain score was 1.6 ( range 0 to 3.5 ) during the procedure and 0.0 with all reporting no pain 15 minutes after the procedure . Mean procedure time was 4.5 minutes ( range 4 to 6 ) . Only 1 of the 27 patients requested sedation before any subsequent injections . CONCLUSIONS Sedation-free intradetrusor botulinum toxin-A injection using intravesical lidocaine and flexible endoscopy is a well tolerated and safe procedure to perform in an office setting PURPOSE To examine the incidence of  urinary tract infection ( UTI ) after flexible cystoscopy ( FC ) and determine whether prophylactic norfloxacin reduces this incidence compared with placebo . PATIENTS AND METHODS A double-blind trial was performed , r and omizing 234 patients to either 400 mg of norfloxacin or placebo prior to FC . All patients provided a midstream urine specimen ( MSU ) before the procedure , as well as at day 3 and day 7 after FC . In addition , a telephone question naire was performed to correlate the nature and severity of any symptoms associated with UTI . RESULTS Interim analysis was performed because of the low recruitment rate , and a significantly lower infection rate than expected meant that the trial was discontinued . There was one symptomatic UTI in the placebo group ( 0.82 % ) and one in the norfloxacin group ( 0.89 % ) . The UTI in the placebo group was de novo , while the infection in the norfloxacin group was secondary to pre-FC bacteriuria . There was no difference in the infection rates in the two groups . The overall infection rate ( de novo and secondary to existing bacteruria ) after FC was 0.85 % . CONCLUSION Infection after flexible cystoscopy is rare and not associated with significant morbidity . A much larger study would be required to determine whether antibiotic prophylaxis significantly reduces the rate of postprocedure UTI OBJECTIVE To determine the efficacy of prophylactic nitrofurantoin in preventing bacteriuria after urodynamics and cystourethroscopy . METHODS We assumed that nitrofurantoin prophylaxis would decrease the rate of infection after urodynamics and cystourethroscopy from 19 % to 5 % . All women presenting for urodynamics and cystourethroscopy during a 27-month period were offered enrollment , and 142 were r and omly assigned to receive two doses of long-acting nitrofurantoin 100 mg ( n = 74 ) , or two doses of placebo ( n = 68 ) . Nitrofurantoin and placebo capsules were identical , and subjects and physicians were masked to group assignment . Differences were assessed using Student t test for continuous data and chi2 analysis for dichotomous data . RESULTS There were no statistical differences in demographic characteristics or final diagnoses between groups . Seven women ( 5 % ) who had bacteriuria on initial urine culture were not included in the final analysis . The frequency of bacteriuria in the postinstrumentation urine cultures was 6 % overall , 7 % in the treatment group , and 5 % in the controls , a nonsignificant difference ( [ relative risk ] 1.49 , [ confidence interval ] 0.37 , 5.95 ) . The power of the study was 33 % to detect a significant difference . CONCLUSION Bacteriuria after combined urodynamics and cystourethroscopy was not improved by a 1-day course of nitrofurantoin Objective To establish the efficacy of antibiotic prophylaxis prior to cystoscopy in out patients in decreasing the incidence of post-procedure urinary tract infection . Study design and setting A r and omized clinical trial in patients ( men and women ) older than 18 who underwent cystoscopy for any non-urgent indication . The intervention was Levofloxacin 500 mg single dose , and the control was placebo 500 mg single dose made with similar characteristics . The primary outcome was urinary tract infection ( UTI ) measured 3–10 days after the procedure . It was performed as per protocol analysis . Results Hundred and thirty-eight patients in each study arm completed the trial . The incidence of UTI in the intervention group was 0.7 % and in the placebo group was 3 % ( p = 0.17 ) , and no significant differences were found . The incidence of asymptomatic bacteriuria in the intervention group was 5.8 % and in the control group was 14.5 % ( p = 0.01 ) . Conclusions No significant differences were found in the use of prophylactic antibiotic compared to placebo to reduce the incidence of UTI in patients who undergo cystoscopy as an outpatient procedure with sterile urine demonstrated by urine culture OBJECTIVES One of the main drawbacks of flexible urethrocystoscopy is the risk of urinary tract infection ( UTI ) . In order to reduce this risk , antimicrobial prophylaxis has been considered , however there is not a unanimous view regarding indications , dosage , type of antibiotic , and so on . To clarify this uncertainty , we practice d a pilot and experimental study aim ed at assessing the effectiveness of chemoprophylaxis with 3 grams of fosfomycin trometamol in the prevention of UTI after urethrocystoscopy . METHODS Sixty patients were entered into a pilot r and omized clinical trial between March and August 2011 . Thirty patients were assigned to a control group without receiving any antibiotic dose , and the intervention group ( 30 patients ) received 3 g fosfomycin trometamol . Ten days later urine culture and sediment analysis were performed in all patients . Significant bacteriuria was considered from > 105 CFU /ml . One month later a telephone survey was developed to assess urinary symptoms , and assistance to the family doctor . We estimated the cumulative incidence of bacteriuria , pyuria and microhematuria in both groups , and we compared the results using a strategy of analysis per protocol and intention to treat . RESULTS The incidence of bacteriuria , pyuria and microhematuria in the control group was 10 % , 23.3 % and 26.7 % respectively and in the intervention groups the values differed depending on the type of analysis . Considering only the 27 patients ( per protocol analysis ) , the incidence would be 11.1 % , 37.0 % and 29.6 % respectively . If we include the three patients who did not completed the study ( per intention to treat analysis ) and considering their results as negative , the results were 10 % , 33.3 % and 26.7 % respectively . Finally , in the case the three cultures not performed in this group had produced a positive result , the impact would have been 20.0 % , 43.3 % and 36.7 % . In any of the three cases , the differences with the control group were not statistically significant . CONCLUSIONS In a selected population and with appropriate aseptic measures , antibiotic chemoprophylaxis does not appear to show a clinical ly relevant reduction in the incidence of UTI in patients undergoing flexible urethrocystoscopy OBJECTIVES To investigate the incidence of symptomatic and asymptomatic bacteriuria and to assess patient satisfaction after flexible cystoscopy  ( FC ) and  urodynamic ( UD ) evaluation in a prospect i ve survey . The incidence of urinary tract infection after FC and UD studies and the use of prophylactic antibiotics are issues of debate . The tolerability and acceptance of FC and UD studies by patients have not been thoroughly documented . It would be helpful to be able to give such information to patients before performing these procedures . METHODS A total of 215 nonconsecutive patients seen as out patients for FC and UD studies to evaluate various indications were studied . A midstream urine sample was taken before and 48 hours after the procedures . Patients were given a question naire that inquired about the presence of lower urinary tract symptoms before and 48 hours after the procedures . The self-administered question naire included questions to assess patients ' tolerance of the procedures and how it compared with their expectations . RESULTS Of the 201 patients analyzed ( FC 103 , UD studies 98 ) , 9 patients ( 4 . 5 % ) developed significant bacteriuria within 48 hours of FC and UD studies . Only 2 patients with significant bacteriuria reported newly developed symptoms within 48 hours . In a subgroup of 25 patients who were given prophylactic antibiotics for various reasons , 6 ( 24 % ) reported new symptoms , although none developed significant bacteriuria . The association between patients who had preprocedure pyuria ( n = 7 ) and the development of significant growth after the procedure ( n = 6 ) was significant ( P < 0.01 ) . In response to the patient-satisfaction question naire , 166 ( 82.5 % ) reported that the procedure was not as bad as they expected , and 200 ( 99.5 % ) said that they would undergo the test again if necessary . CONCLUSIONS FC and UD studies are safe , well-tolerated procedures . The addition of prophylactic antibiotics in these procedures is unnecessary , unless specific indications are present To report a large prospect i ve , pragmatic , double‐blind r and omized controlled trial to determine whether oral prophylactic antibiotics reduce the risk of bacteriuria  after flexible cystoscopy ( FC ) , as up to 10 % of patients develop urinary infection afterwards , with significant morbidity and costs for health services Instrumentation of lower urinary tract is a predisposing factor for the development of  urinary infection .  Incidence of infective complications following urethrocystoscopy has been evaluated in a multicenter , prospect i ve , comparative and r and omized study in 2,284 patients , who had a previous negative urine culture . Patients were r and omized into two groups : one to be used as control and the other one to received antimicrobial prophylaxis prior to instrumentation ( ceftriazone , 1 gr intramuscular ) . Clinical and microbiological responses were evaluated at 48 - 72 hours and 4 weeks after cystoscopy . Symptomatic bacteriuria was observed in 10.2 % of patients in the control group and in 2.5 % in the prophylaxis group ( p < 0.000 ) ; asymptomatic bacteriuria in 3.02 % and 1.52 % ( p > 0.05 ) and irritative syndrome with sterile urine in 2.93 % and 2.60 % ( p > 0.05 ) , respectively . Thus , the use of prophylaxis reduced the incidence of infective complications in these patients Objective : The aim of this study was to determine whether single – dose parenteral antibacterial therapy significantly alters the rate of infection in patients undergoing flexible cystourethroscopy . Patients and Methods : 162 patients were studied prospect ively having either received parenteral antibacterial chemoprophylaxis prior to flexible cystourethroscopy or not . Pre– and postprocedure mid stream sample s of urine ( MSSU ) were obtained to objective ly evaluate the presence of infection . Results : Gentamicin prophylaxis reduced the rate of post – cystoscopy – positive MSSUs from 21 to 5 % . Conclusion : The surprisingly high rate of infection after flexible cystoscopy was significantly reduced by a single dose of gentamicin
target: Conclusions : Antibiotic prophylaxis did confer a reduction in cases of symptomatic and asymptomatic bacteriuria but the NNT were high .
background: Introduction : The role of antibiotic prophylaxis for routine flexible cystoscopy ( FC ) is not clear due to the varying practice s of individual clinicians .
  There are no formal guidelines , and this may be due to a lack of formal summary of the data .