number of vaginal examinations. As exclusion factors, the
authors considered all cases that had proceeded to taking
antibiotic in the previous week and all who had bacteriuria
in the first urine culture. Two urine cultures were taken; the
first when inserting the catheter and the second after its
removal 24 hours after surgery(5).
The study carried out in 2002(11) examined whether the
effect of saline solution and povidone iodine applied to the
canal, as well as administration of 1g of antibiotic, prevent
UTI after transurethral resection of the prostate. A total of
167 participants with benign prostatic hyperplasia were
randomized into three groups: in group A (n=66) it was applied
a compress soaked in saline at the meatus; in group B
(n=64) it was applied a compress soaked in povidone iodine
at the meatus; and in group C (n=37) it was administered 1g
of antibiotic. The inclusion criteria were men with benign
prostatic hyperplasia with an average age of 66.5 years. The
exclusion criteria were the presence of pyuria and bacteriuria
in the month prior to surgery, history of prostate cancer,
the presence of urinary calculi, antibiotic therapy, hepatic
or renal impairment and immunosuppression. The presence
of UTI was assessed at the intraoperative moment when
removing the bladder catheter and in the first consultation
after discharge from hospital(11).
The study from 2001(12) carried out between October
1999 and April 2000, included 436 pregnant women who
were randomly divided into two groups: the experimental
group (n=217), in which was performed disinfection of
the urinary meatus with chlorhexidine gluconate 0 1%
and the control group (n=219), in which the urinary canal
cleaning was done with water. The inclusion criteria were:
age, parity, previous number of UTI and number of vaginal
examinations during delivery. The urinary colonization was
done through a urine culture, collected 24 h after insertion
of the urinary catheter(12).
With regard to the hierarchy of evidence and for
having adopted the classification proposed by the
Evidence-Based On-Call (http://www.eboncall.org, accessed
in Viseu, January 2013) we can say that we have a level
1b, which is related to randomized and controlled clinical
trials (RCT) because four of the included studies(4-5,11-12)
are RCT. The study by Fernandes(1) presents a level 2b
because it is not a randomized clinical trial (uncontrolled
or unblinded).
As we are conducting a systematic review of the literature
with meta-analysis of randomized and controlled clinical
trials, we will reach the first level of evidence (1a) and the
established recommendations will be of level A.