BACKGROUND AND OBJECTIVE:Urological infections significantly impact individuals' well-being and quality of life due to their widespread occurrence and diverse clinical manifestations. This work aims to provide evidence-based guidance on diagnosing, treating, and preventing urinary tract infections (UTIs) and male accessory gland infections, while addressing crucial public health aspects related to infection control and antimicrobial stewardship. METHODS:For the 2026 Urological Infections Guidelines, new and relevant evidence was identified, collated, and appraised through a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Library. Recommendations within the Guidelines were developed by the panels to prioritise clinically important care decisions. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including certainty of estimates), and the nature and variability of patient values and preferences. KEY FINDINGS AND LIMITATIONS:Key recommendations emphasise the importance of thorough medical history and physical examination for patients with urological infections. The guidelines stress the role of antimicrobial stewardship to combat the rising threat of antimicrobial resistance, providing recommendations for antibiotic selection, dosing, and duration based on the latest evidence. Key updates in the 2026 Urological Infections Guidelines summary include: comprehensive restructuring of the guideline framework in alignment with the new classification system for UTIs; the addition of a new chapter on the diagnosis and management of Herpes simplex virus; the addition of a new chapter on the diagnosis and treatment of fungal UTIs; and an update of the evidence and recommendations on periprocedural antibiotic prophylaxis for prostate biopsy. CONCLUSIONS AND CLINICAL IMPLICATIONS:This overview of the 2026 European Association of Urology (EAU) guidelines offers valuable insights into the classification, diagnosis, and treatment of urological infections and is designed to be effectively integrated into clinical practice.

The detection of fungi in urine is common, particularly in nosocomial settings. Nevertheless, diagnostic and treatment approaches are often associated with uncertainty. Accordingly, this review aimed to give a concise overview of fungal urinary tract infection (UTI) as a supplement to the more comprehensive update of the European Association of Urology 2026 Guidelines on Urological Infections.Only 2–11% of fungal isolates in urine are associated with symptoms, and a fungal UTI should only be assumed in such cases. Candida albicans is the most frequently identified pathogen. Diagnosis should include a urine culture with susceptibility testing, especially in non-albicans Candida UTI. Nonantimicrobial measures such as catheter replacement should always be part of the treatment. First-line antimicrobial treatment is fluconazole. In cases of localized bladder infections, intravesical amphotericin B may be considered. Asymptomatic funguria should only be treated in exceptional cases. Urologists should play a key role in treatment decision-making for patients with fungal UTIs.

DEEP-URO RA/LP (DE-Escalation of antibiotic Prophylaxis in UROlogical Procedures in Robot Assisted or Laparoscopic Prostatectomy) establishes a scalable audit for antimicrobial stewardship in RA/LP, generating multicenter evidence linking antibiotic prophylaxis practices to verifiable 30-day infection outcomes. This initiative identifies de-escalation opportunities by benchmarking against European Centers for Disease Control definitions and World Health Organization AWaRe classification, informing guideline updates, risk-stratified protocols, and institutional quality improvement amid the global antimicrobial resistance crisis. The adaptable DEEP-URO framework enables future modules across urologic and surgical specialties, advancing data-driven patient safety while curbing unnecessary antibiotic exposure.

Introduction: The appropriate use of antibiotic prophylaxis (AP) in surgical procedures is an ongoing debate. There is a lack of evidence, and urological guidelines provide limited, procedure-specific recommendations. Our aim was to develop a generic model of an audit to define the need for AP in urological procedures, as well as in other surgical specialties. Material and Methods: Based on our experience with the Global Prevalence of Infections in Urology (GPIU) study and a literature review, we defined benchmark standards for 30-day infection rates, including sepsis, and estimated the number of patients needed to be included in a comparative study of AP versus no AP for a surgical procedure within one year. The generic study model was developed during a modified consensus process within the UTISOLVE research group. Urology departments giving and not giving AP were invited to join our development project as an extension of GPIU. Results: Radical prostatectomy was used as a model procedure. Ca. 60 urology centers performing more than 50 radical prostatectomies per year signed up. There was variation in AP practice among sites. Our own review showed that infection rates were ca. 5%, with severe infections, including sepsis, occurring in <0.5% of cases. A sample of 1825 patients would be required to achieve a 95% confidence interval half-width of ±1.0% for general infections. For sepsis, assuming an incidence of 0.5%, a sample of 2124 patients would be needed to reach a 95% confidence interval precision of ±0.30%. Enrollment of 2070 consecutive procedures would be needed to yield precisions of ±0.94% for infection and ±0.30% for sepsis. Based on the number of procedures performed and the number of interested study sites, we agreed on a prospective, multi-center, non-interventional service evaluation, expected to collect standardized data over a 3-month period. The primary outcome was defined as the 30-day incidence of infectious complications. All patients will undergo 30-day post-procedure follow-up through routine clinical care pathways. Conclusions: Our audit model is based on benchmarking of relevant outcomes. It defines how to assess AP in surgical procedures and clarifies a series of issues necessary to defend the status of a generic study model. We regard DEEP-URO to be a comprehensive, multi-center-based initiative that will help balance infection prevention with antimicrobial stewardship and improve the quality of clinical practice and personalized medicine.

Widespread antibiotic use has promoted a concerning rise in bacterial resistance. To counteract this trend and improve the effectiveness of antibiotic treatments, implementing antibiotic stewardship and an active surveillance system is crucial. Our primary aim was to analyze the local urinary bacterial spectrum and antibiotic resistance trends. All positive urine culture results (9423) obtained between January 1, 2012 and December 31, 2023 at the Urology Department, University of Szeged were analyzed. Spearman’s rank correlation test was then used to examine changes in bacterial spectrum, resistance trends of the five most common bacteria, and incidences of multidrug-resistant strains and nosocomial Clostridioides difficile infections. The proportion of Escherichia coli decreased significantly from 53 to 40

Genital herpes (GH) is a prevalent, lifelong, sexually transmitted infection caused by herpes simplex virus types 1 and 2. Although traditionally managed by dermatologists and infectious disease specialists, GH is increasingly relevant to urologists owing to its clinical complexity and psychosocial impact. This mini-review by the European Association of Urology Guidelines Panel for Urological Infections summarizes updated evidence on GH epidemiology, diagnosis, treatment, and prevention strategies. Diagnosis remains challenging because of atypical presentations; polymerase chain reaction is the preferred diagnostic test. Management mainly relies on nucleoside analogs, with new therapies under investigation. Suppressive treatment reduces recurrences and transmission. Routine screening of asymptomatic individuals is not recommended. Effective counseling and partner notification are critical components of care. PATIENT SUMMARY: Patients with genital herpes should receive clear information on the nature of the infection, the diagnostic process, and treatment options and preventive strategies. Urologists must play a key role in managing symptoms, reducing the risk of transmission, and supporting patients through education and counseling.

Background: Transrectal prostate biopsy is a commonly performed urological procedure in which antibiotic prophylaxis is recommended. Fluoroquinolone-type antibiotics are no longer acceptable in the EU. Fosfomycin-trometamol may be used, but there is no evidence regarding its ideal dose and administration time. Methods: Patients who underwent prostate biopsy between 2021 and 2023 were evaluated prospectively. 204 patients were randomized into two arms: 102 patients (Arm A) received a single-dose of fosfomycin-trometamol one hour before surgery, and 102 patients (Arm B) received one additional dose of fosfomycin-trometamol 48 hours after the first dose. Urine tests and questionnaires were administered during the postoperative period and the subsequent four weeks to identify any symptoms, infectious, or other complications. Results: There was no statistical difference in the rate of asymptomatic bacteriuria (4.90% (5) vs. 8.82% (9), P = 0.27) symptomatic urinary tract infection (0% (0) vs. 1.96% (2), P = 0.50), or febrile urinary tract infection (0% (0) vs. 0.98% (1), P = 1) between the groups. Only hematuria was significantly more common in Arm B (6.86% (7) vs. 16.67% (17), P = 0.03), whereas other complications did not differ significantly. There was no statistical difference in hospitalization (0.98% (1) vs. 2.94 (3), P = 0.62) or mortality rate (0 % (0) vs. 0.98% (1), P = 1). Sub-group analysis of previous antibiotic users showed no difference in terms of complications. Conclusion: There is no significant difference in infectious complications between single-dose and prolonged prophylaxis of fosfomycin-trometamol for transrectal prostate biopsy. A single-dose of fosfomycin one hour before biopsy is an ideal choice with a better ecological impact compared with prolonged antibiotic prophylaxis for transrectal prostate biopsy. (c) 2025 The Asian Pacific Prostate Society. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

BACKGROUND AND OBJECTIVE:Prostate biopsies remain a key step in the diagnosis of prostate cancer and are performed either via a transrectal (TR) or a transperineal (TP) route. In general, the approaches are considered to provide similar diagnostic power. However, infectious complications appear to differ in favour of the TP approach. Furthermore, antibiotic prophylaxis is felt to have limited additional value in a TP biopsy, which aligns with antimicrobial stewardship principles. Urology association guidelines have provided conflicting recommendations on the best approach for a prostate biopsy. This systematic review aims to compare the infectious complications and antibiotic usage of the two approaches. METHODS:A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines after registration with PROSPERO (CRD42024513309). MEDLINE, Embase, Scopus, and Web of Science were searched for articles published until April 1, 2025. Randomised controlled trials (RCTs) assessing infectious complications (fever, urinary tract infection, and hospitalisation with infectious complications) following a prostate biopsy were included. The risk of bias was assessed with the RoB 2 tool, and statistical analyses included visualisation through funnel and forest plots and assessing the publication bias via Egger's regression test. KEY FINDINGS AND LIMITATIONS:Ten RCTs were included in the analysis, encompassing 4188 prostate biopsies. Of seven studies reporting hospitalisation for infectious complications, the TP route showed significantly lower odds (odds ratio 0.23, 95% confidence interval [CI] 0.10-0.54; graphical abstract), reducing hospitalisation risk by 77% compared with the TR route. Postinterventional fever occurred less frequently, with an odds ratio of 0.68 (95% CI 0.52-0.89). There was no statistically significant difference in infectious complications after a TP biopsy with or without antibiotics. All TR route biopsies utilised antibiotic prophylaxis. The small number of eligible studies and the high risk of bias, as well as sparse data on bias in most studies, limit the power of our manuscript. CONCLUSIONS AND CLINICAL IMPLICATIONS:TP biopsy is associated with a lower admission risk due to postprocedural infection compared with TR biopsy. TP biopsy seems to be a safe procedure without antibiotics in patients without risk factors, advocating for enhanced antimicrobial stewardship in urology.

Complicated urinary tract infections denote an important research field for new antibiotics against Gram-negative pathogens. There is, however, increasing concern that this disease entity is too vaguely defined, leading to heterogeneous study populations and risk of bias. We analysed researchers' adherence to the US Food and Drug Administration (FDA) guidance on complicated urinary tract infection and assessed risk of bias using a three-step procedure: literature review of full-text articles on complicated urinary tract infection; assessment of the importance of risk factors for treatment failure, including statistical evaluation of how patients with risk factors might skew treatment effects; and a Delphi consensus process in a multidisciplinary group. Our evaluation showed poor adherence to FDA guidance on complicated urinary tract infection and significant heterogeneity in the reporting of study, patient, and pathogen characteristics, leading to a high risk of bias when interpreting and comparing study findings. We therefore question the concept of complicated urinary tract infection as a meaningful entity with its own study guidance.

A radikális cystectomián áteső betegek vezetése továbbra is a nagy kihívást jelent az urológiai ellátásban, tekintettel a műtéti indikációt képző betegség, és a komplex műtéti ellátásból fakadó magas perioperatív, posztoperatív mortalitásra, morbiditásra, és az ellátás során megjelenő pszichés hatásokra. Osztályunkon egyre inkább felmerülő kérdéskör az, hogy a korrekt onkosebészeti megoldáson felül létre tudjon jönni egy komplexebb ellátási protokoll, amely a daganatos gyógyulás elősegítése mellett megoldási lehetőséget kínál azokra a problémákra, amik a radikális cystectomián áteső páciensek ellátása során szembesülünk. Így jött létre a Cystectomia Életminőség Program (CystoGuide), amellyel reményeink szerint mind a páciens, mind pedig az ellátórendszer fontos előnyökhöz juthat a program igénybevétele esetén. A cikk a programmal kapcsolatos tudnivalókat, és kezdeti tapasztalatainkat foglalja össze.

The absence of a consensus-based reference standard for urinary tract infection (UTI) research adversely affects the internal and external validity of diagnostic and therapeutic studies. This omission hinders the accumulation of evidence for a disease that imposes a substantial burden on patients and society, particularly in an era of increasing antimicrobial resistance. We did a three-round Delphi study involving an international, multidisciplinary panel of UTI experts (n=46) and achieved a high degree of consensus (94%) on the final reference standard. New-onset dysuria, urinary frequency, and urinary urgency were considered major symptoms, and non-specific symptoms in older patients were not deemed indicative of UTI. The reference standard distinguishes between UTI with and without systemic involvement, abandoning the term complicated UTI. Moreover, different levels of pyuria were incorporated in the reference standard, encouraging quantification of pyuria in studies done in all health-care settings. The traditional bacteriuria threshold (105 colony-forming units per mL) was lowered to 104 colony-forming units per mL. This new reference standard can be used for UTI research across many patient populations and has the potential to increase homogeneity between studies.

It remains unclear whether antibiotic prophylaxis (AP) should be recommended or discouraged in robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer (PCa). The development of microbial resistance and side effects are risks of antibiotic use. This systematic review (SR) investigates the evidence base for AP in RALP. A systematic literature search was conducted until 12 January 2023, using Embase, MEDLINE, Cochrane CENTRAL, Cochrane CDSR (via Ovid) and CINAHL for studies reporting the effect of AP on postoperative infectious complications in RALP. Of 436 screened publications, 8 studies comprising 6378 RALP procedures met the inclusion criteria. There was no evidence of a difference in the rate and severity of infective complications within 30 days after RALP surgery between different AP protocols. No studies omitted AP. For patients who received AP, the overall occurrence of postoperative infectious complications varied between 0.6% and 6.6%. The reported urinary tract infection (UTI) rates varied from 0.16% (4/2500) to 8.9% (15/169). Wound infections were reported in 0.46% (4/865) to 1.12% (1/89). Sepsis/bacteraemia and hyperpyrexia were registered in 0.1% (1/1084) and 1.6% (5/317), respectively. Infected lymphoceles (iLC) rates were 0.9% (3 of 317) in a RALP cohort that included 88.6% pelvic lymph node dissections (PLND), and 3% (26 of 865) in a RALP cohort where all patients underwent PLND. Our findings underscore that AP is being administered in RALP procedures without scientifically proven evidence. Prospective studies that apply consistent and uniform criteria for measuring infectious complications and antibiotic-related side effects are needed to ensure the comparability of results and guidance on AP in RALP.

Background and objectiveUrological infections significantly impact the wellbeing and quality of life of individuals owing to their widespread occurrence and diverse clinical manifestations. The objective of the guidelines panel was to provide evidence-based guidance on the diagnosis, treatment, and prevention of urinary tract infections (UTIs) and male accessory-gland infections, while addressing crucial public health aspects related to infection control and antimicrobial stewardship.MethodsFor the 2024 guidelines on urological infections, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences.Key findings and limitationsKey recommendations emphasise the importance of a thorough medical history and physical examination for patients with urological infections. The guidelines stress the role of antimicrobial stewardship to combat the rising threat of antimicrobial resistance, providing recommendations for antibiotic selection, dosing, and duration on the basis of the latest evidence.Conclusions and clinical implicationsThis overview of the 2024 EAU guidelines offers valuable insights into managing urological infections and are designed for effective integration into clinical practice.Patient summaryThe European Association of Urology has issued an updated guideline on urological infections. The guidelines provide recommendations for diagnosis, treatment, and prevention, with a particular focus on minimising antibiotic use because of the increasing global threat of antimicrobial resistance.

(1) Background: Urinary tract infections (UTIs) are among the most frequent complications in kidney transplant (KT) recipients. Asymptomatic bacteriuria (ASB) may be a risk factor for UTIs and graft rejection. We aimed to evaluate available evidence regarding the benefit of screening and treatment of ASB within the first year after KT. (2) Evidence acquisition: A systematic literature search was conducted in MEDLINE, the Cochrane Library CENTRAL and Embase. Inclusion criteria were manuscripts in English addressing the management of ASB after KT. The PICO questions concerned Patients (adults receiving a KT), Intervention (screening, diagnosis and treatment of ASB), Control (screening and no antibiotic treatment) and Outcome (UTIs, sepsis, kidney failure and death). (3) Evidence synthesis: The systematic review identified 151 studies, and 16 full-text articles were evaluated. Seven were excluded because they did not evaluate the effect of treatment of ASB. There was no evidence for a higher incidence of lower UTIs, acute pyelonephritis, graft loss, or mortality in patients not treated with antibiotics for ASB. Analysis of comparative non-randomized and observational studies did not provide supplementary evidence to guide clinical recommendations. We believe this lack of evidence is due to confounding risk factors that are not being considered in the stratification of study patients.

BACKGROUND:Fournier's gangrene (FG) is a life-threatening, necrotizing infection. Due to the rareness of the disease, it is challenging to plan robust prospective studies. This study aims to describe current practice patterns of FG in Europe and identify implications for planning a prospective FG registry.METHODS:Online non-validated 17-items survey among urologists treating FG in in European hospitals. Questionnaires were analyzed with LimeSurvey (LimeSurvey GmbH Hamburg, Germany).RESULTS:229 responses from ten different European countries were submitted, and 117 (51.1%) urologists completed the questionnaire. The departments treat a mean of 4.2 (SD 3.11) patients per year. The urology department mostly takes the lead in treating FG patients (n = 113; 96.6%). The practice in FG is very heterogenic and mostly case-based all over Europe, e.g., vacuum-assisted wound closure (VAC) is mostly used (n = 50; 42.7%) as adjunct wound. The biggest challenges in FG are the short time to diagnosis and treatment, standardization and establishment of guidelines, and disease awareness. Additionally, participants stated that an international registry is an outstanding initiative, and predictive models are needed.CONCLUSIONS:There is no standard of care in the diagnosis, treatment, and long-term care of FG all over Europe. Further research could be conducted with a prospective registry.