Impact of infectious complications in the overall structure of urethroplasty complications, treatment and antibiotic prophylaxis: a systematic review

Introduction. Urethroplasty is a urological operation that is widely used in the management of urethral stricture (US). However, postoperative complications are relatively common in this procedure. In their structure, infection takes the leading position in most cases. Nevertheless, to date the problems of prevention and treatment of infectious complications, be it urinary tract infection (UTI) or wound infection, remain poorly studied.
Objective. To generalise and critically analyse the worldwide literature data on infectious complications in urethroplasty, as well as to study the expediency and validity of infectious conditions treatment before urethroplasty, the efficacy of the protective effect of antibiotic prophylaxis in the aspect of postoperative complications.
Materials & methods. The study was conducted accordance with the recommendations on preferred reporting elements for systematic reviews and meta-analyses. The search was conducted in the PubMed database from 1992 to 2022 by keywords, considering the inclusion and exclusion criteria which led to the selection of twenty papers for further study. 
Results. We have observed the influence of UTI on postoperative complications or recurrence. The presence of infectious postoperative complications, in turn, also has a significant impact on US recurrence. Some authors have drawn attention to the influence of surgical aspects, bed-days and aetiology of US on the incidence of surgical site infection. The studies to date provide little insight into the appropriateness of preurethroplasty infection treatment and antibiotic prophylaxis in the context of their impact on complications and US recurrence which leave these issues open to debate.
Conclusion. Infectious complications are the most frequent hospital-acquired sequela after surgery; consequently, more efforts should be made to eliminate them in patients receiving urethroplasty. The systematic review revealed insufficient study of the issues of complications and US recurrence prevention in urethroplasty, no consensus on the optimal antibiotic prophylaxis regimes and the appropriateness of preoperative UTI treatment.

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