In literature there are no guidelines, and well-conducted studies on antibiotic prohylaxis in urogyneoclogical surgery. The main doubt of all urogynecology surgeons is if to use single or multi dose antibiotic prophylaxis, which type of antibiotic to choose. The aim of this study was to evaluate if there is a potential benefit of single or multi-dose antibiotic in antibiotic prophylaxis in prolapse surgery with mesh.

This was a prospective study on consecutive patients with symptomatic stage >II POP according to POP -Q classification, who underwent urogynaecological reconstructive surgery with mesh, through laparoscopic or vaginal approach. Pre-operative evaluation included history, clinical examination, urodynamic testing and transperineal ultrasound, urinalysis and urine culture, vaginal swab. Patients with patients with positive vaginal swabs and or symptomatic urinary tract infections (UTI) and fever were excluded. Pre-operative data regarded age, body mass-index, parity, smoking status, medical co-morbidities, history of recurrent urinary tract infections. The evening before procedure all women used a vaginal egg and vaginal lavender with chlorhexidine to disinfect the vagina. The bowel preparation was not performed. In the operating room the vagina and the surgical site were disinfected with povidone-iodine solution or chlorhexidine solution.
 Patients were divided into 3 groups according to the antibiotic protocol administered: 
•Protocol A: Metronidazole (15 mg/kg), piperacillin tazobactam (2gr) and gentamycin (160 mg) 60 minutes before starting the surgical procedure Metronidazole and Piperacillin-tazobactam have been administered until hospital discharge.
•Protocol  B : Gentamycin and Piperacillin-tazobactam in the same way as for the group A;
•Protocol C:Clindamycin (600 mg) and Gentamycin (160 mg) one shot only during the peri-operative time.
This vaginal pack was removed in the 1st day after laparoscopic sacrocolpopexy, and in the 2nd day after vaginal surgery. The indwelling catheter was removed at the 2nd postoperative day in both approaches. Patients were followed up at 1-12 months after surgery with history, clinical examination, urinalysis and urine culture. The vaginal exposures were clinically documented by the physical examination, they were classified in according to the IUGA/ICS Joint Terminology and Classification of Complications. The study was approved by the ethics committee. Informed consent was obtained from all the patients involved in the study. Statistical analysis: Mann-Whitney U test, the Pearson χ2 test, p<0.05

We included 87 patients of which 57 patients (65%) underwent laparoscopic sacrocolpopexy and 30 (34%) underwent transvaginal sacrospinous ligament suspension with polypropylene mesh. They were divided: 30 (34.5%) patients in the protocol A, 30(34.5%) in the protocol B and 27 (31%) in the protocol C. The choice of the protocol regimen was adopted in a chronological manner. Pre-operative data are recorded in the Table 1. Table 2 showed that there were no statistically significant differences among antibiotic protocols as regards postoperative complications. In each protocol there were no differences between the vaginal and abdominal approach with regard to the rate of postoperative infectious complication, except  for UTIs in protocol A, that it was more in vaginal group (6(54.5) vs1 (5.3),p=0.002) There have been no cases of surgical site or prosthetic infections. The vaginal exposures were only in multi-dose treatment (2AaT3S1), two cases in vaginal group (Protocol B), one case in laparoscopic group in Protocol A and one in Protocol B. They were asymptomatic and were managed by wait and see.

In our single dose group, the rate of UTI was inexplicably higher in laparoscopic group.  However, this result was not clinically significant because only 3 out of 18 women had UTI. The vaginal mesh exposure may not be related to the type of antibiotic therapy, especially if it was not infected, but rather to surgical technical problems

This study showed that antibiotic prophylaxis with a single dose is sufficient to prevent the postoperative infectious complications of prolapse surgery with mesh both by laparoscopic and by vaginal approach.