To investigate the prevalence and associated risk factors of urinary tract infection (UTI) following total hysterectomy in patients with benign uterine conditions, and to establish a foundation for clinical prevention and management.

A total of 187 patients who underwent total hysterectomy at the Department of Gynecology, First Affiliated Hospital of the University of Science and Technology of China, from January 2024 to December 2024, were prospectively included. A prospective cohort design with a single group was utilized. The occurrence and risk factors of urinary tract infections were assessed with standard urine analyses, ICIQ-FLUTS, and UDI-6 questionnaires prior to and within six weeks post-surgery. Univariate and multivariate logistic regression analyses were employed to examine the associated factors, and a predictive model was developed based on the outcomes of the multivariate regression analysis. The findings were reported as odds ratios (OR), 95% confidence intervals (CI), and receiver operating characteristic (ROC) curves.

Of the 187 patients, 34 experienced urinary tract infections within 6 weeks post-surgery, yielding an incidence rate of 18.2% (95% CI 12.7%-23.7%). Univariate analysis indicated that prior pelvic surgery, a history of UTI, prolonged indwelling urinary catheterization, post-void residual urine volume (PVR) exceeding 0 mL, and intraoperative blood loss greater than 30 mL were risk factors for postoperative UTI. Multivariate logistic regression analysis indicated that intraoperative blood loss exceeding 30 mL (OR = 2.91, 95% CI 1.18-7.19, P = 0.020), postoperative residual urine greater than 0 mL (OR = 4.00, 95% CI 1.60-10.00, P = 0.003), a history of prior pelvic surgery (OR = 3.12, 95% CI 1.21-8.04, P = 0.018), a history of previous urinary tract infections (OR = 3.70, 95% CI 1.47-9.31, P = 0.005), and the duration of indwelling urinary catheterization (OR = 1.34, 95% CI 1.01-1.78, P = 0.048) were identified as independent risk factors for urinary tract infections following total hysterectomy. The outcomes of the AUC and the Hosmer-Lemeshow (H-L) test demonstrated that the model possessed strong discriminatory capability.

Urinary tract infections following complete hysterectomy are prevalent urological consequences post-surgery. Intraoperative blood loss over 30 mL, PVR greater than 0 mL, a history of prior UTI, a history of pelvic surgery, and the length of indwelling urinary catheterization are independent risk factors. The prediction model developed through multivariate regression analysis demonstrates strong performance. Preventive treatments should be implemented clinically to decrease the occurrence of postoperative UTI.