Postoperative Urinary Tract Infection Following Water Vapor Thermal Therapy

Abstract Purpose Urinary tract infection (UTI) is frequently reported after water vapor thermal therapy (WVTT), but its true rate remains uncertain because expected postoperative irritative symptoms may mimic infection and standardized definitions have been lacking. We evaluated postoperative infectious complications after WVTT using a recently established international consensus definition of UTI. Methods This international multicentre cohort study included consecutive patients undergoing WVTT between January 2020 and December 2025. Prospectively collected clinical data were retrospectively analysed. Postoperative episodes considered clinically suspicious for infection were classified according to the consensus definition proposed by Bilsen et al. as confirmed, probable, possible, or no UTI. The primary endpoint was confirmed/probable UTI within 30 days. Results Among 278 patients, 58 (21%) experienced a postoperative episode considered clinically suspicious for infection. Application of the consensus definition identified 26 confirmed and three probable UTIs, corresponding to a 30-day confirmed/probable UTI rate of 10%. Postoperative antibiotics were prescribed in 61 patients (22%), of whom 33 (54%) did not fulfil criteria for confirmed/probable UTI. No statistically significant association was observed between preoperative bacteriuria and confirmed/probable postoperative UTI. Conclusion Standardized assessment identified confirmed/probable UTI in 10% of patients after WVTT, substantially fewer than clinically suspected infections. These findings highlight the value of standardized definitions for reporting postoperative UTI and guiding antibiotic use.