Prophylactic Antibiotics for Outpatient Urethral Bulking

Prophylactic Antibiotics for Outpatient Urethral Bulking: Impact on Post-Procedural Urinary Tract Infection Rates

The purpose of this study is to evaluate whether taking prophylactic (preventative) antibiotics at the time of standard of care clinic-based urethral bulking reduces the risk of post-procedural urinary tract infection (UTI).

Inclusion Criteria:

• Women ≥ 18 years of age.
• Patients evaluated by a pelvic floor specialist (either urogynecologist or urologist) at the University of Miami with plans to undergo urethral bulking with Bulkamid for stress urinary incontinence or mixed urinary incontinence (stress predominant).
• Negative testing for UTI in pre-procedural work-up, including either negative urine culture or urine dip negative for infection (infection is defined as the presence of nitrites and/or pyuria with >1+ leukocyte esterase on dipstick or >5 WBC/HPF).
• Post-void residual volume of 150 mL or less (measured by either catheterization or bladder scan) before the procedure
• Fluent in English or Spanish
• Able and willing to provide informed consent

Exclusion Criteria:

• Contraindications to both oral antibiotics including antibiotic allergies or significant renal disease (GFR <30)
• Patient undergoing additional pelvic organ prolapse procedures or other urologic procedures concomitantly that also involve insertion [KB2.1]of a foreign object
• Recurrent UTIs, defined as 3 or more UTIs within the past 12 months or 2 UTIs within the past 6 months
• Patients currently taking daily antibiotic prophylaxis for any reason
• Patients with immunosuppression due to underlying medical conditions
• Patients who are pregnant
• Recent antibiotic treatment within one week of the procedure
• Unable or unwilling to provide informed consent or complete study procedures