Urological Infections

For the 2021 Urological Infections Guidelines, new and relevant evidence was identified, collated and appraised through a structured assessment of the literature. Broad and comprehensive literature searches, covering these sections were performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. The number of unique records identified, retrieved and screened for relevance for each section were:

  • 3.8 Catheter-associated UTI: 1,253 unique abstracts; 83 full texts; 25 included.
  • 3.14 Human papillomavirus management in males: 1,148 unique abstracts; 86 full texts; 33 included.

Specific changes include:

  • 3.8 Catheter-associated UTI - The section and recommendations have been comprehensively updated as outlined above.
  • 3.14 Human papillomavirus management in males - The section is a new edition to the EAU Urological Infections Guidelines and includes practical recommendations for urologists as well as a new diagnostic and treatment algorithm.
  • Prostate biopsy - The section and recommendations have been updated to reflect the results of two systematic reviews undertaken by the panel. A recommendation for transperineal prostate biopsy has been made.


Summary of evidenceLE
A meta-analysis of seven studies including 1,330 patients showed significantly reduced infectious complications in patients undergoing transperineal biopsy as compared to transrectal biopsy.1a
A meta-analysis of eight RCTs including 1,786 men showed that use of a rectal povidone-iodine preparation before transrectal biopsy, in addition to antimicrobial prophylaxis, resulted in a significantly lower rate of infectious complications.1a


RecommendationsStrength rating
Perform prostate biopsy using the transperineal approach due to the lower risk of infectious complications.Strong
Use routine surgical disinfection of the perineal skin for transperineal biopsy.Strong