Heterogeneity in the perioperative management of asymptomatic bacteriuria across urological surgery: an international survey by the EAU-YAU Working Group on Infectious Diseases

Purpose: Asymptomatic bacteriuria (ABU) is frequent in patients scheduled for urological surgery, yet the evidence on whether, when and how to manage it perioperatively remains scarce. We aimed to map international practice patterns and identify priorities for future evidence generation. Methods: International, cross-sectional, anonymous, web-based survey developed by the EAU-YAU Working Group on Infectious Diseases. The 16-item questionnaire covered respondent demographics, general ABU management and procedure-specific management for up to three self-selected procedures from a list of nine. Dissemination occurred between March and July 2025 via social media and the EAU Annual Congress. Responses were analysed descriptively; subgroup comparisons by practice setting and experience used the χ² test. Results: Of 123 accessed questionnaires, 101 (82%) were completed by urologists from 28 countries. Only 29% based their decision to obtain a preoperative urine culture on international guidelines. When ABU treatment was considered indicated, all six strategies offered were used, with preoperative initiation ranging from 1 to ≥ 7 days and postoperative extension from none (29%) to ≥ 7 days (18%). Heterogeneity was greatest for procedures carrying the highest infectious risk: 48% used a full pre-, peri- and postoperative regimen for retrograde intrarenal surgery (RIRS), 40% for transurethral prostate resection (TURP) and 43% for radical cystectomy. Respondents with ≤ 10 years of experience more often cited international guidelines (36% vs. 16%, p = 0.048). Conclusions: The observed variability likely reflects a genuine evidence gap. Aggregate antibiotic exposure may exceed what is evidence-based and contribute to antimicrobial resistance. Procedure-specific randomised trials are urgently needed.