The state of antimicrobial prophylaxis for holmium laser enucleation of the prostate: HoLEP and the results of a questionnaire survey

Holmium laser enucleation of the prostate (HoLEP) has been established as a procedure for the treatment of patients with benign prostate hyperplasia, instead of transurethral resection of prostate (TURP). To determine the appropriate antimicrobial prophylaxis for the prevention of perioperative urinary tract infection following HoLEP we sent a questionnaire to 79 institutes belonging to the Japanese Urological Association. We surveyed 1) the performance of HoLEP, 2) number of HoLEP performed in 2009, 3) antimicrobial agents and the term of the administration for prophylaxis, 4) rate of perioperative infections, and 5) usage of other antimicrobial prophylaxis in HoLEP, as compared with in TUR-P. We received answers from 59 institutes (74.9%). We examined 43 responses, which were obtained from executive members who performed more than eleven cases of HoLEP in 2009. Thirty-one of these institutes (72.1%) indicated parenteral antibiotics ; three of them adopted oral antibiotics, and nine of them added oral antibiotics following parenteral antibiotics. In 40 of them (93.0%), the rate of perioperative infections was reported to be fewer than 5%. Twenty-seven of them (62. 7%) adopted the same schedule for the prophylaxis in both HoLEP and TUR-P. Eleven of them indicated shorter antimicrobial usage in HoLEP than in TUR-P. Ten of the eleven institutes reported that the rate of perioperative infections in HoLEP had been lower than in TUR-P. Our questionnaire survey demonstrated that shorter antimicrobial prophylaxis might be possible in HoLEP than in TUR-P.