Development and psychometric validation of a patient-reported outcome measure of recurrent urinary tract infection impact: the Recurrent UTI Impact Questionnaire

Evaluating the use of Uromune® autovaccine in recurrent urinary tract infections: a pilot unicenter retrospective study in Reus, Spain

BACKGROUND

Urinary tract infections (UTIs) are a significant global health issue, especially among women, with growing concerns related to antibiotic resistance and adverse effects. The Uromune®, a sublingual, heat-inactivated, polybacterial vaccine, represents a promising therapeutic alternative by enhancing immune responses against uropathogens.

METHODS

This pilot retrospective study, conducted at Hospital Universitari de Sant Joan de Reus from January 2018 to August 2022, assessed the association between Uromune® administration and changes in recurrent UTIs. Patients received personalized autovaccines administered as two sublingual puffs daily for three months. Clinical, microbiological, and demographic data were analyzed to assess treatment outcomes and identify recurrence-associated factors.

RESULTS

Forty-nine patients (mean age, 61 years, and 59.2% women) were included in the study. Uromune® treatment decreased UTI episodes from 3.73 ± 0.97 the year before to 0.98 ± 1.36 (p < 0.001) the year after its administration. The number of patients who suffered three or more episodes per year dropped from 43 (87.7%) before the intervention to 7 (14.3%) afterwards. The maximum effectiveness of the autovaccine was observed three months post-administration, with 44 patients not experiencing any UTI episodes. Regression analysis identified having had a urostomy, chronic kidney disease, and being immunosuppressed as predictors of recurrence.

CONCLUSION

Uromune® autovaccine was associated with a significant reduction in the frequency of recurrent UTIs and related hospitalizations, offering substantial relief to patients. These findings suggest that Uromune® may be a promising option for managing recurrent UTIs, though controlled studies are needed to confirm its efficacy compared to standard treatments.

Assessing the influence of recurrent urinary tract infections on sexual function: a case-control study

BACKGROUND

Urinary tract infections (UTIs) significantly impact quality of life and can also lead to changes in sexual function.

AIM

This study aims to assess the symptoms associated with recurrent urinary tract infections (rUTIs) and their influence on both quality of life and sexual activity.

METHODS

A case-control study was conducted, involving 383 patients with rUTIs and 161 healthy controls. The Acute Cystitis Symptom Score (ACSS) and Female Sexual Function Index (FSFI) questionnaires were utilized, with all surveys completed online through Google Forms.

OUTCOMES

The ACSS and FSFI were collected using online surveys designed through Google Forms.

RESULTS

A higher prevalence of constipation was observed in the rUTI group compared to controls (37.6% vs 31.7%). rUTIs caused moderate to severe interference with work activities in 55.5% of cases, while 59% reported interference with social life. Sexual life assessment revealed that all FSFI domains were significantly affected in patients with rUTIs. Sexual desire was rated as low or very low in 61.9% of rUTI cases compared to 48.1% of controls (P < .001). Additionally, 35.3% of rUTI patients reported low or very low confidence in becoming sexually aroused, compared to 7.5% of controls (P < .001). Difficulty reaching orgasm was reported by 29.6% of rUTI patients versus 20.7% of controls (P < .001). Pain or discomfort following vaginal penetration was reported more than half the time by 43.9% of rUTI patients, compared to 19.6% of controls (P < .001). Dissatisfaction with sexual intercourse was noted in 53.6% of rUTI patients versus 15.8% of controls (P < .001).

CLINICAL IMPLICATIONS

The assessment of sexual health should be integrated into the management of patients with rUTIs. Interventions targeting UTI management must also address strategies to improve sexual function and satisfaction.

STRENGTHS AND LIMITATIONS

This study provides insight into the impact of rUTIs on sexual function across both pre- and post-menopausal women, allowing for an evaluation of how sexual perceptions evolve with age. However, the study's limitations include the lack of assessment of sexual practices, which may influence the risk of rUTIs and affect FSFI results.

CONCLUSIONS

Women with rUTIs report significantly lower sexual satisfaction and higher rates of sexual dysfunction. It is essential to evaluate the sexual function of patients with rUTIs, and management strategies must consider ways to improve sexual health as part of the overall treatment plan.

The mediating role of coping in the relationship between perceived health and psychological wellbeing in recurrent urinary tract infection: the rUTI Illness Process Model

Background: Recurrent urinary tract infection (rUTI) is associated with significant symptom and quality of life burden. Given the unique challenges in diagnostics and management, healthcare disillusionment and stigmatisation which distinguish rUTI from other urological conditions, specific identification of the key illness processes experienced by this patient population is required. This study aimed to identify the unique illness processes and perceptions that contribute to quality of life in rUTI, through perceived health status, psychological wellbeing, and coping. Methods: An international sample of adults living with rUTI (N = 389, 96.9% female) completed a cross-sectional survey comprising the following standardised questionnaires: the EuroQoL EQ-5D-5L, Patient Health Questionnaire 9 (PHQ-9), Generalised Anxiety Disorder 7 (GAD-7), Connor-Davidson Resilience Scale-10 (CD-RISC-10), Pain Catastrophising Scale (PCS). Sociodemographic characteristics were also assessed. Structural equation modelling was conducted to identify the underlying constructs which contributed to psychological wellbeing in rUTI, establishing the 'rUTI Illness Process Model'. Results: The positive relationship between 'perceived health status' and 'psychological wellbeing' was partially mediated by 'rUTI coping', after controlling for the impact of household income and age (p < .001). The model demonstrated a large effect size (R 2 = .81) and good local and global fit. Overall, rUTI coping skills, boosted by resilience and weakened by pain catastrophising, contribute to a significant proportion of the positive relationship between perceived health status and psychological wellbeing in rUTI. A uniquely vulnerable patient phenotype emerges from this new research, with patients who are younger and/or of lower socioeconomic status at greater risk of poorer rUTI health outcomes and psychological wellbeing, potentially requiring further support. Conclusions: The rUTI Illness Process Model establishes the crucial need to clinically characterise the individualised illness perceptions and metacognitive strategies held by people living with rUTI, revealing that patient-centred interventions targeting illness perceptions and coping strategies require prioritisation to enhance patient outcomes and the patient experience of living with rUTI.

Gaps in knowledge and recurrent urinary tract infections in women

PURPOSE OF REVIEW

The focus of this review is to present recent literature and gaps in knowledge (GIKs) surrounding the current and future treatment and prevention of uncomplicated recurrent urinary tract infections (rUTIs) in women.

RECENT FINDINGS

Recurrent urinary tract infections are common, significantly reduce quality of life, and create a substantial economic burden to the healthcare system. They are disproportionately affecting the postmenopausal women. Antibiotics, which are used for the treatment and prophylaxis of uncomplicated rUTI, have become problematic, as there is a global rise in allergy and resistance to these agents and their use is associated with further antimicrobial resistance. Thus, in recent decades, several alternative, nonantibiotic approaches have been evaluated.

SUMMARY

There is a critical need for a concerted and standardized methodology for diagnosing, treating, and monitoring women with rUTIs. Additionally, novel nonantibiotic alternative treatment and preventive measures for UTIs are desperately required to address the global issue of antibiotic recalcitrance in all age groups, and specifically older women. Research efforts have sought to develop alternative and more effective techniques; many of which appear to be promising, but require additional evaluation and validation through clinical trials.

From Awareness to Action: Pioneering Solutions for Women's UTI Challenges in the Era of Precision Medicine

This article aims to bring clinicians' awareness to the widespread impact of urinary tract infection (UTI) on the lives of women and to the advances that offer hope for future improvements in the diagnosis and management of UTI. Thanks to physiological, anatomical, and lifestyle factor differences, women face heightened vulnerability to UTIs compared to men. In fact, women are four times more likely than men to develop a UTI and around half of these women encounter UTI recurrence, which is a significant source of both physical and psychosocial burdens. Despite the current shortcomings in diagnosis and management, emerging diagnostic technologies promise to identify UTIs more accurately and rapidly, offering women hope for a revolution in UTI management. Meanwhile, clinicians have the opportunity to reduce the psychosocial burden by recognizing the value of patients' lived experiences and ensuring their care plan is in alignment with their patients' goals and expectations for medical care.

Evaluating the quality of life impact of recurrent urinary tract infection: Validation and refinement of the Recurrent UTI Impact Questionnaire (RUTIIQ)

BACKGROUND AND AIMS

Recurrent urinary tract infection (rUTI) has significant negative consequences for a wide variety of quality of life (QoL) domains. Without adequate validation and assessment of the unique insights of people living with rUTI, clinical results cannot be fully understood. The Recurrent UTI Impact Questionnaire (RUTIIQ), a novel patient-reported outcome measure of rUTI psychosocial impact, has been robustly developed with extensive patient and clinician input to facilitate enhanced rUTI management and research. This study aimed to confirm the structural validity of the RUTIIQ, assessing its strength and bifactor model fit.

METHODS

A sample of 389 adults experiencing rUTI (96.9% female, aged 18-87 years) completed an online cross-sectional survey comprising a demographic questionnaire and the RUTIIQ. A bifactor graded response model was fitted to the data, optimizing the questionnaire structure based on item fit, discrimination capability, local dependence, and differential item functioning.

RESULTS

The final RUTIIQ demonstrated excellent bifactor model fit (RMSEA = 0.054, CFI = 0.99, SRMSR = 0.052), and mean-square fit indices indicated that all included items were productive for measurement (MNSQ = 0.52-1.41). The final questionnaire comprised an 18-item general "rUTI QoL impact" factor, and five subfactor domains measuring "personal wellbeing" (three items), "social wellbeing" (four items), "work and activity interference" (four items), "patient satisfaction" (four items), and "sexual wellbeing" (three items). Together, the general factor and five subfactors explained 81.6% of the common model variance. All factor loadings were greater than 0.30 and communalities greater than 0.60, indicating good model fit and structural validity.

CONCLUSIONS

The 18-item RUTIIQ is a robust, patient-tested questionnaire with excellent psychometric properties, which capably assesses the patient experience of rUTI-related impact to QoL and healthcare satisfaction. Facilitating standardized patient monitoring and improved shared decision-making, the RUTIIQ delivers the unique opportunity to improve patient-centered care.

GSM and Quality of Life Measures

The impact of bothersome vulvovaginal symptoms related to hypoestrogenism on quality of life (QOL) has been evaluated in large international surveys and qualitative studies of vulvovaginal atrophy, most of which were completed before the introduction of the term genitourinary syndrome of menopause (GSM) and focus primarily on vulvovaginal atrophy. The QOL domain most affected in these studies is sexual function, although women also report impacts on self-confidence, self-esteem, sleep, and general enjoyment of life. Health-related QOL measures are available that evaluate the impact of some symptoms associated with GSM on QOL; new measures are in development that assess the full range of symptoms associated with GSM.

Confirmatory structural validation and refinement of the Recurrent Urinary Tract Infection Symptom Scale

Objectives

To confirm the structural validity of the Recurrent Urinary Tract Infection Symptom Scale (RUTISS), determining whether a bifactor model appropriately fits the questionnaire's structure and identifying areas for refinement. Used in conjunction with established clinical testing methods, this patient-reported outcome measure addresses the urgent need to validate the patient perspective.

Patients and methods

A clinically and demographically diverse sample of 389 people experiencing recurrent UTI across 37 countries (96.9% female biological sex, aged 18-87 years) completed the RUTISS online. A bifactor graded response model was fitted to the data, identifying potential items for deletion if they indicated significant differential item functioning (DIF) based on sociodemographic characteristics, contributed to local item dependence or demonstrated poor fit or discrimination capability.

Results

The final RUTISS comprised a 3-item symptom frequency section, a 1-item global rating of change scale and an 11-item general 'rUTI symptom and pain severity' subscale with four sub-factor domains measuring 'urinary symptoms', 'urinary presentation', 'UTI pain and discomfort' and 'bodily sensations'. The bifactor model fit indices were excellent (root mean square error of approximation [RMSEA] = 0.041, comparative fit index [CFI] = 0.995, standardised root mean square residual [SRMSR] = 0.047), and the mean-square fit statistics indicated that all items were productive for measurement (mean square fit indices [MNSQ] = 0.64 - 1.29). Eighty-one per cent of the common model variance was accounted for by the general factor and sub-factors collectively, and all factor loadings were greater than 0.30 and communalities greater than 0.60. Items indicated high discrimination capability (slope parameters > 1.35).

Conclusion

The 15-item RUTISS is a patient-generated, psychometrically robust questionnaire that dynamically assesses the patient experience of recurrent UTI symptoms and pain. This brief tool offers the unique opportunity to enhance patient-centred care by supporting shared decision-making and patient monitoring.

Recurrent urinary tract infection management and prevention techniques among a population-based cohort of women

INTRODUCTION

Recurrent urinary tract infection (rUTI), defined as three or more UTIs in 12 months, has psychological, physical, and financial burden. Many women with rUTI are not satisfied with care and report only starting preventative measures after several infections. The goal of this study is to elucidate current UTI management trends and the implementation of UTI prevention strategies.

METHODS

A web-based study was sent to a national sample of adult women enrolled in ResearchMatch.org. Women were recruited to participate if they had a self-reported UTI in the past 12 months.

RESULTS

Of the 755 subjects, nearly 30% reported rUTI. Among women with rUTI, more than 50% reported being peri- or postmenopausal, and two-thirds reported vaginal symptoms. 15.8% of women with rUTI reported dissatisfaction with care versus 7.9% of women without rUTI. Most women see their primary care physician for UTI management and only 26% of women with rUTI follow with a urologist. More than 65% of women increase their fluid intake, wipe from front to back, and urinate after sexual activity to prevent UTIs. Significantly more women with rUTI use transvaginal estrogen, cranberry extract, and low-dose prophylactic antibiotics. These interventions appear to be driven by urologists.

CONCLUSION

Most women who have had a UTI in the last 12 months implement lifestyle changes to prevent future infections. Most women see their PCP for UTI management and women with rUTI are twice as likely to report dissatisfaction with care. Despite urologists optimizing medical rUTI prevention, they appear to be underutilized.