Cystoscopic procedures carry a risk of infection ranging from 4% for simple diagnostic cystoscopy to nearly 20% for certain therapeutic procedures such as botulinum toxin A injections or transurethral resection of the prostate (TURP). A variety of methods have been utilized to reduce the incidence of infection post-operatively, including antimicrobial prophylaxis, pre-operative testing including urinalysis and/or culture with subsequent treatment of urinary tract infections prior to the procedure, as well as skin preparation with betadine or aqueous-based cleansing solution. Despite these methods, concerns about increasing multidrug resistant organisms prompt interest in developing additional ways to reduce infection associated with cystoscopy. Studies of intravesical treatments including antibiotic solutions have not shown differences in infection outcomes, however historically there were clinical studies dating back to the 1980’s showing an improvement in postoperative infection with intravesical betadine solution in prostatectomy patients given this treatment pre-operatively. We therefore sought to evaluate the efficacy of using a dilute betadine solution intra-operatively in patients undergoing cystoscopic procedures by a single surgeon. We hypothesized that patients receiving betadine solution would have a lower rate of infection than patients receiving standard of care infection prevention methods.

Permission for chart review was obtained through our local institutional review board (IRB). Electronic medical records were reviewed between the years 2019-2021 for a single surgeon who utilized intraoperative betadine lavage on patients who had a history of multidrug resistant organisms in their urine culture. Patients were excluded if they did not have documented follow-up of at least 30 days after the index procedure. The betadine procedure was as follows: after entering the bladder with the cystoscope, lavage of a 0.38% betadine solution x 180-240 cc was performed. Dilute betadine solution was created by mixed 50 cc of 8% betadine with 1,000 cc of warm saline. The lavage was then performed with a 60 cc syringe through the cystoscope side port. Betadine was irrigated clear using saline or water irrigation and the procedure continued as planned. Data was collected including demographic information, pre and post-operative urine culture, adverse reactions, hospital readmissions, documented urinary tract infections, and rates of sepsis.

There were n=30 betadine cases reviewed and, thus far, n=20 control cases, from the same surgeon. Comparison was made among all procedures in the same time frame. Baseline characteristics are recorded in Table 1. They indicate that both populations had similar demographics and procedure type. Of note, there were more males in the betadine group (66.7 versus 40%, respectively). Table 2 summarizes the main outcomes of the study, which are post-operative rates of urinary tract infection, hospital readmission, and sepsis. In the experimental group, betadine lavage at the beginning of cystoscopy did not result in any immediate adverse reactions. Patients receiving betadine lavage had zero infectious complications including urinary tract infection, hospital readmission, and sepsis. In the control group there was a urinary tract infection rate of 10%, and 0% rate of hospital readmission and sepsis.

In this retrospective review of patients undergoing cystoscopic procedures, intra-operative betadine lavage was associated with no adverse events and resulted in a lower rate of urinary tract infection when compared to patients who did not undergo betadine lavage. There were lower numbers of controls, however this may be due to the limited range of years selected for review. The betadine group had more males in this population, which may be due to a larger percentage of patients undergoing TURP in this group.

Betadine lavage may be a useful tool for the prevention of infection associated with cystoscopic lower urinary tract procedures. Future efforts may be aimed at increasing the sample size, as well as obtaining prospectively collected data.