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Antibiotic Prophylaxis for Urinary Tract Infection After Midurethral Sling: A Randomized Controlled Trial

Jackson, Daniel MD*; Higgins, Edmund MD; Bracken, Jessica MD; Yandell, Paul M. MD; Shull, Bob MD; Foster, Raymond T. Sr MD, MS, MHSc*

Female Pelvic Medicine & Reconstructive Surgery: May/June 2013 - Volume 19 - Issue 3 - p 137–141
doi: 10.1097/SPV.0b013e318285ba53
Original Articles
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Objective: Because of the reported high percentage of bladder infections after placement of a midurethral sling (8.9%–34%), this study was undertaken to determine if a 3-day postoperative course of a urinary antibiotic would significantly lower the incidence of urinary tract infection (UTI) among treated women.

Methods: Women who were planning outpatient vaginal surgery for stress incontinence were enrolled, after informed consent, and randomized to receive placebo or nitrofurantoin (100 mg 2 times a day) for 3 days after surgery. Research subjects and investigators were blinded to the randomization. Women were observed for signs and symptoms of UTI until 6 weeks after surgery. Sample size was calculated to have 80% power to detect a 15% difference in the primary outcome (α = 0.05). The primary outcome was analyzed using a χ2 analysis.

Results: Data were analyzed from 149 subjects (placebo, n = 75; drug, n = 74). Overall, 37 women (24.8%) were diagnosed with a UTI during the study period. The incidence of postoperative UTI was significantly lower in the treatment arm (17.6%) then in the placebo arm (32%; P = 0.04).

Conclusions: A short (3-day) course of nitrofurantoin after outpatient sling surgery significantly reduces the incidence of postoperative bladder infection in the first 6 weeks after sling surgery. ( registration number: NCT00734968).

Postoperative prophylaxis with nitrofurantoin significantly reduces the risk of postoperative urinary tract infection after placement of a midurethral sling.

From the *Department of Obstetrics, Gynecology, and Women’s Health, School of Medicine, University of Missouri, Columbia, MO; and †Department of Obstetrics and Gynecology, Scott and White Hospital, Texas A&M University System Health Sciences Center, Temple, TX.

Reprints: Raymond T. Foster Sr, MD, MS, MHSc, 500 Keene St, Suite 306, Columbia, MO 65201. E-mail:

This project was supported with faculty research start-up funds by Dr Raymond Foster.

The authors have declared they have no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins