Post-operative urinary tract infection (UTI) is a common complication following genitourinary (GU) oncologic surgery, however the relationship between preoperative and postoperative UTI status and longer-term postoperative outcomes remains incompletely characterized. We evaluated the association of preoperative and postoperative UTI patterns with development of serious adverse events following prostatectomy, cystectomy, and partial nephrectomy.

We performed an IRB approved, retrospective cohort study within Epic Cosmos of adult patients undergoing GU oncologic surgery between February 2017 and February 2025. Epic Cosmos is a cloud-based research platform developed by Epic Research that aggregates de-identified patient records from Epic Systems electronic health record across participating healthcare organizations. Patients undergoing prostatectomy, cystectomy, or partial nephrectomy were stratified into 3 UTI exposure groups: preoperative UTI without postoperative UTI, both preoperative and postoperative UTI, and postoperative UTI without preoperative UTI. Each group was compared with patients with neither preoperative nor postoperative UTI. Outcomes assessed at 1 month, 6 months, 1 year, and 5 years included death, sepsis, and ED visit. Associations were reported as odds ratios (ORs) with 95% confidence intervals (CIs).

Refer to Table 1 and Table 2 for results.

Patients who developed pre and post-op UTI had generally higher rates of ER visits, sepsis and mortality compared to those without. This pattern was consistent with all 3 types of GU cancer surgeries: prostatectomy, cystectomy, and partial nephrectomy. This trend was seen at the 30 days, 60 days, 1 year and 5 year time point, suggesting that the associated risk with post-op UTI is not limited to the immediate perioperative period. There was increased risk of 30-day mortality with development of UTI after prostatectomy (p<0.001, OR 2.3, ) and partial nephrectomy (p<0.001, OR 1.9). Cystectomy, however, was not associated with increased mortality at 30 days (p=0.50, OR 1.04).
Across all 3 procedures, perioperative UTI was associated with increased odds of adverse postoperative outcomes relative to patients without preoperative or postoperative UTI. The strongest associations were observed after prostatectomy, particularly among patients with both preoperative and postoperative UTI, who had markedly increased odds of sepsis (OR 15.7 at 1 month, 18.4 at 6 months, 18.6 at 1 year, and 17.2 at 5 years), death (OR 5.0, 6.4, 7.1, and 8.3, respectively), and ED visit (OR 11.6, 12.2, 11.5, and 10.6, respectively). In the cystectomy cohort, effect sizes were more modest overall; the most consistent association was observed for sepsis, particularly in patients with both preoperative and postoperative UTI (OR 2.4, 2.5, 2.3, and 2.0 across follow-up intervals). In the partial nephrectomy cohort, adverse outcomes were also increased, with the greatest odds generally observed among patients with both preoperative and postoperative UTI or postoperative UTI alone. Overall, sepsis demonstrated the strongest and most consistent association with perioperative UTI status across all procedure types.

Perioperative UTI is associated with an increased odds of ER visits, sepsis and death at multiple time points, including death within 30-days of GU cancer surgery. These findings support utilization of targeted prevention, such as perioperative antimicrobial stewardship, preventative supplements, safe catheter-related practices, and increased surveillance in high-risk patients.