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Purpose: To determine compliance with the American Urological Association (AUA) antimicrobial prophylaxis best practice statement and whether the use of postoperative antibiotics is associated with lower rates of postoperative urinary tract infection (UTI) in patients with nephroureterolithiasis and a negative preoperative urine culture undergoing ureteroscopy. Materials and Methods: A retrospective review of all adult patients undergoing ureteroscopy from 2013 to 2014 for stone disease with a negative preoperative urine was conducted. Patients who did and did not receive postoperative oral antibiotics beyond 24 hours of surgery were identified. The rates of culture-proven postoperative UTI and unplanned postoperative encounters were determined for both groups. Between-group comparisons were made by using independent t-test and Chi-square analyses. Results: A total of 1068 patients met inclusion criteria and 31.6% were managed in accordance with the AUA best practice statement by not receiving antibiotics beyond 24 hours of surgery. Overall, 33 patients developed a culture-proven UTI within 30 days after surgery, with no difference in UTI rate between patients who did and did not receive home-going antibiotics (2.9% vs 3.6%, respectively; p = 0.5). Rates of unplanned hospital encounters also did not differ between groups (23.7% vs 27.0%, respectively; p = 0.2). On multivariate regression, culture-proven UTI within 1 year before surgery was the only factor associated with postoperative UTI (odds ratio: 10.8, p < 0.0001). Conclusions: Patients who did and did not receive home-going antibiotics after ureteroscopy demonstrated similar rates of postoperative UTI and unplanned hospital encounters. These results suggest that there is no benefit to extended antibiotics after ureteroscopy. The minority of patients managed in accordance with the AUA best practice statement highlights room for quality improvement. [ABSTRACT FROM AUTHOR]

Purpose: To assess factors that affect prostate biopsy results following salvage whole gland cryoablation. Patients and Methods: One hundred seventy-four patients underwent prostate biopsy following salvage whole gland cryoablation of the prostate in the Cryo-OnLine Database registry. Wilcoxon rank-sum and χ2 tests and logistic regression analysis were used to assess predictors of positive biopsy. Prostate specific antigen (PSA) nadir was divided into a statistical tertile for comparisons between different nadir PSA cut points. Results: Fifty-two of 174 (29.9%) of this highly select group of men who underwent biopsy had a posttreatment biopsy demonstrating malignant cancer. Men who had positive biopsy following salvage therapy had significantly higher median nadir PSA, shorter median time to prostate biopsy, and shorter median time to biochemical failure. Compared to the lowest tertile (PSA nadir defined as ≤0.1 ng/mL), PSA in the second tertile (0.11-0.8 ng/mL) and third tertile (>0.8 ng/mL) demonstrated increased odds ratio (OR) for positive biopsy, 4.34 (95% confidence interval [CI] 1.66, 11.4, p = 0.003) and 2.81 (95% CI 1.14, 7.00, p = 0.02), respectively, in adjusted models. In addition, men with a presalvage PSA >20 (OR 7.65; 95% CI 2.03, 28.9; p = 0.003) and Gleason score ≥8 (OR 2.26; 95% CI 0.93, 5.47; p = 0.07) had a higher OR of positive biopsy. Conclusions: Nadir PSA of 0.1 ng/mL or less following salvage cryotherapy is predictive of treatment success. Routine biopsy should be reserved for men with nadir PSA >0.1 ng/mL and patients with high risk features of prostate cancer before salvage cryoablation. [ABSTRACT FROM AUTHOR]