Q. Many patients require an indwelling urinary catheter after surgery. Does the surgeon have a role in encouraging strategies to reduce risk of UTIs in these patients?

A. Of course, the surgeon should be concerned about all aspects of preoperative and postoperative care that has a potential impact on outcome, but increasing emphasis on quality of care documentation is requiring even more attention to complications such as UTIs. For surgeons and hospitals to lower their complication rate, it is essential that everyone get on board with protocols, care pathways, and other strategies that increase the rigor with which preventive steps are implemented. Surgeons should be aware of which patients have been catheterized and to understand the protocols being employed to reduce the high risk of UTIs in these individuals.

Q.  Clearly, sterile technique is important for reducing UTI in anyone undergoing an endourethral procedure, not just catheterization, but is there a rationale for reducing UTI risk by adding antimicrobial and anesthetic properties to lubricating gels?

A. It is not surprising that introducing a catheter or any other foreign body into the urethral canal is associated with a high rate of infection. Foreign bodies provide a ready vector for facilitating transport or migration of the bacteria and other microbes that commonly colonize the perigenital area to mucosal membranes of the urinary tract. Lubricating gels are often used to reduce discomfort and reduce trauma from endourethral procedures. Adding a mild anesthetic is conceptually attractive. First of all, it may further reduce discomfort relative to lubrication alone. In addition, a reduction in pain may avoid upregulation of inflammatory mediators involved in tissue irritation that may contribute to susceptibility for infection. However, from my perspective, the two most important steps to reduce UTIs in patients who require a catheter is rigorous sterile technique and early removal.

Q.  In surgical patients, do you feel that prevention of nosocomial UTIs should be the focus of a multidisciplinary approach that involves not only surgeons but urologists, nurses and other healthcare personnel who employ care pathways that encourage risk reduction? 

A. For rigorously reducing the risk of UTIs, I think the challenge for surgeons and perhaps for others involved in the care of the surgical patient is not accepting that some proportion of infections are inevitable. Surgeons should not only be involved in making sure that urinary catheterization is necessary, which may be one of the most important steps for reducing UTI risk, but, as stated in the answer to the first question, verify that steps are being taken to reduce infection risk when a catheter is placed. For surgical patients, preventing UTIs is traditionally left to nursing staff or urologist consults, but optimal outcomes depends on collaboration that ensures that everyone is rowing in the same direction.