Symptomatic Urinary Tract Infection Following Single-Dose Prophylactic Antibiotic Administration in Patients Undergoing Cystoscopic DJ Stent Removal

Abstract

Background: Symptomatic urinary tract infection (UTI) is a known complication following cystoscopic double-J (DJ) stent removal, often mitigated with prophylactic antibiotics. However, the necessity and efficacy of single-dose antibiotic prophylaxis remain unclear, especially in general surgical populations, highlighting a gap in evidence-based recommendations for standardized protocols. Objective: To evaluate the frequency of symptomatic UTI and its association with age, gender, stent duration, and laterality in patients undergoing cystoscopic DJ stent removal after receiving a single preoperative dose of intravenous Sulzone. Methods: This descriptive case series was conducted at Qazi Hussain Ahmad Medical Complex, Nowshera, from November 2024 to May 2025. A total of 190 patients aged 18–80 years undergoing elective DJ stent removal were enrolled using purposive sampling. Patients with recent antibiotic use, active UTI, immunocompromised status, or indwelling urinary devices were excluded. Each received 2g Sulzone (1g cefoperazone + 1g sulbactam) intravenously one hour before the procedure. Patients were monitored for four weeks postoperatively for UTI symptoms; urine cultures were performed when indicated. Data were analyzed using SPSS v25. Ethical approval was obtained per the Declaration of Helsinki. Results: Symptomatic UTI developed in 13.7% of patients. No statistically significant associations were found with age (p=0.62), gender (p=0.68), stent duration (p=0.80), or procedure side (p=0.17). Odds ratios and 95% confidence intervals confirmed no predictive relationship. Conclusion: Single-dose prophylactic Sulzone is associated with a low incidence of symptomatic UTI post-DJ stent removal, suggesting clinical safety and antibiotic stewardship benefits. Broader trials are recommended for protocol optimization.