Vulvar re-antisepsis and urinary tract infection after CO2 cystoscopy in laparoscopic hysterectomy.

OBJECTIVE: To evaluate whether vulvar re-antisepsis before carbon dioxide (CO2) cystoscopy after laparoscopic hysterectomy is associated with a lower incidence of postoperative urinary tract infection (UTI). MATERIALS AND METHODS: This prospective observational study included 98 women who underwent laparoscopic hysterectomy between November 25, 2025, and March 1, 2026. All patients received routine preoperative abdominal and vulvovaginal preparation with 10% povidone-iodine. According to routine intraoperative practice and surgeon preference, 53 patients underwent standard antisepsis alone, and 45 received additional vulvar and periurethral re-antisepsis immediately before CO2 cystoscopy. The primary outcome was a postoperative UTI, defined according to Centers for Disease Control and Prevention/National Healthcare Safety Network criteria. Logistic regression was used to explore factors associated with postoperative UTI. The study was registered at clinicaltrials.gov (NCT07232446). RESULTS: Postoperative UTI occurred in 8 patients (15.1%) in the standard antisepsis group and in 4 patients (8.9%) in the re-antisepsis group (p=0.538). Vulvar re-antisepsis was not associated with postoperative UTI in the exploratory multivariable model [adjusted odds ratio (OR)=0.89, 95% confidence interval (CI): 0.19-4.23; p=0.881]. Delayed catheter removal (>6 hours) was associated with postoperative UTI (adjusted OR=12.87, 95% CI: 2.13-77.62; p=0.005). CONCLUSION: Vulvar re-antisepsis before CO2 cystoscopy did not result in a statistically significant reduction in postoperative UTIs. Given the limited number of events and the non-randomized design, these findings should be interpreted as exploratory.