Patrick G Rice, Robyn S E Hawkins, Bhaskar K Somani
Screening for asymptomatic bacteriuria did not significantly reduce UTI or hospital admission rates following cystoscopy. Given the associated costs, procedural delays, and antimicrobial stewardship concerns, routine screening before cystoscopy should not be performed.
CONTEXT: Controversy exists regarding whether routine screening of asymptomatic bacteriuria before cystoscopy reduces infectious complications.
OBJECTIVE: To determine whether screening for asymptomatic bacteriuria and treating patients with positive results before cystoscopy reduces infectious complications compared with no screening.
EVIDENCE ACQUI: We conducted a preregistered systematic review and meta-analysis (PROSPERO CRD420251073042) searching MEDLINE, Embase, Scopus, BASE, and the Cochrane Library up to July 16, 2025. Studies were eligible if they compared preprocedural urine culture with treatment of positive results or procedure cancellation against untreated positive urine cultures or unscreened controls in adults undergoing cystoscopy and reported postprocedural infectious outcomes. Risk of bias was assessed using Risk of Bias in Non-randomized Studies of Interventions version 2. Pooled odds ratios (ORs) were derived using a random-effects model with restricted maximum likelihood estimation and Hartung-Knapp adjustment.
EVIDENCE SYNTHESIS: Six studies comprising 6323 patients were included; five contributed to the urinary tract infection (UTI) meta-analysis. The risk of bias was moderate in five studies and serious in one. Preprocedural urine culture did not significantly reduce post-cystoscopy UTI rates (pooled OR = 0.40, 95% confidence interval = 0.11-1.42; p = 0.12), with between-study heterogeneity (prediction interval OR = 0.03-6.03; I2 = 75%). Hospitalisation rates were very low in the intervention (0.05%) and control (0.3%) groups. Grading of Recommendations Assessment, Development and Evaluation certainty was low for UTI and urosepsis and very low for hospitalisation.
CONCLUSIONS: Screening for asymptomatic bacteriuria did not significantly reduce UTI or hospital admission rates following cystoscopy. Given the associated costs, procedural delays, and antimicrobial stewardship concerns, routine screening before cystoscopy should not be performed.