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. 2025 Aug;53(4):1351-1361.
doi: 10.1007/s15010-024-02450-3. Epub 2024 Dec 20.

Transurethral resection of the prostate (TUR-P) and associated risk of infective endocarditis

Emil Loldrup Fosbøl #  1   2 , Anna Stahl #  3 , Andreas Røder  4 , Cecilie Bagi Nordsten  4 , Lauge Østergaard  5 , Thomas S G Sehested  5 , Anders Dahl  6 , Nikolaj Ihlemann  7 , Henning Bundgaard  5   8 , Kasper Iversen  8   6 , Nana Valeur  7 , Gunnar Gislason  6 , Christian Torp-Pedersen  9 , Marianne Voldstedlund  10 , Per Bagi  4 , Lars Køber  5   8
Affiliations

Transurethral resection of the prostate (TUR-P) and associated risk of infective endocarditis

Emil Loldrup Fosbøl et al. Infection. 2025 Aug.

Abstract

Purpose: Bacteremia is a well-known complication to surgery and may result in infective endocarditis (IE). Transurethral resection of the prostate (TUR-P) may give rise to bacteremia, but the associated risk of IE is not well described. We aimed to examine risk of infective endocarditis following TUR-P.

Methods: We examined risk of IE following TUR-P between 2010 and 2020 in comparison with an age-matched (match-ratio 1:1) cohort from the background population. Patients were considered exposed to TUR-P related IE 6 months after TUR-P. Comparisons were estimated using cumulative incidences and multivariable time-dependent Cox regression models.

Results: A total of 25,781 males underwent TUR-P (11.4% diagnosed with prostate cancer). Median age was 70.7 years (25-75 percentiles, 64.9-76.3 years). In the TUR-P group, 901 (3.5%) patients had bacteremia and 44 (0.2%) patients developed IE within 6 months following index. The most common microorganism in IE-cases was Enterococcus faecalis (72.7%). The incidence of IE was higher < 6 months after TUR-P (34.64 (25.78-46.55)) IEs per 10,000 person years) than 6-12 months after TUR-P (8.37 (5.46-12.84) IEs per 10,000 person years). TUR-P was associated with a higher hazard ratio of IE within 6 months (age-adjusted HR 8.16, 95% CI 3.06-21.79), but not 6-12 months after TUR-P (adj. HR 2.15 (0.91-5.07)).

Conclusions: TUR-P was associated with an eight-fold higher risk of IE compared with age-matched controls within 6 months after surgery. Although the absolute risk was low, TUR-P seems to be a significant risk factor for IE and this warrant consideration for development of better prophylactic interventions.

Keywords: Bacteremia; Infective endocarditis; Microbiology; Prostate hyperplasia; TUR-P.

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Conflict of interest statement

Declarations. Conflict of interest: Dr Fosbøl reports an independent research grant from Novo Nordisk Foundation and the Danish Heart Association. Dr Østergaard reports an independent research grant from the Novo Nordisk Foundation for the study of mitral valve regurgitation. Dr Voldstedlund reports a grant from Statens Serum Institute as institution on United4survaeillance – EU commission. Dr Køber reports Speaker’s fee from AstraZeneca, Bayar, Boehringer, Novartis and Novo Nordisk. None above is related to the current study.

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