No. 250-Recurrent Urinary Tract Infection

Urinary Tract Infections in Pregnant Individuals

SUMMARY

Urinary tract infection (UTI) is one of the more common perinatal complications, affecting approximately 8% of pregnancies (1, 2). These infections represent a spectrum, from asymptomatic bacteriuria, to symptomatic acute cystitis, to the most serious, pyelonephritis. The presence of UTIs has been associated with adverse pregnancy outcomes, including increased rates of preterm delivery and low birth weight. Screening for and treating asymptomatic bacteriuria have been shown in multiple studies to reduce the incidence of pyelonephritis in pregnancy (3-5). Given the frequency at which UTIs are encountered in pregnancy, the ability to recognize, diagnose, and treat them is essential for those providing care to pregnant individuals. This Clinical Consensus document was developed using an established protocol in conjunction with the authors listed.

Use of Prophylactic Antibiotics to Prevent Urinary Tract Infection After Urodynamic Testing and Cystoscopy in Women: A Practice Pattern Study

OBJECTIVES

To determine practice patterns of prescribing prophylactic antibiotics against urinary tract infection (UTI) for urodynamic studies (UDS) and outpatient cystoscopy in women.

DESIGN

A cross-sectional survey study was conducted of North American female pelvic medicine and reconstructive specialists (FPMRS).

METHODS

An online survey was used to assess prophylactic prescribing patterns of FPMRS specialists that perform UDS and outpatient cystoscopy. This survey was developed and then electronically disseminated through the American Urogynecologic Society to 699 eligible physicians.

RESULTS

A total of 138 surveys were completed. Approximately half of physicians did not prescribe any antibiotic prophylaxis for UDS or for cystoscopy (54% and 43%, respectively). For patients with perceived risk factors (recurrent urinary tract infections, immunosuppression, known neurogenic lower urinary tract dysfunction, indwelling catheter use, elevated post void residual/bladder outlet obstruction, genitourinary anomalies, and diabetes), 32% and 41% of physicians prescribed antibiotic prophylaxis for UDS and cystoscopy, respectively. A minority of physicians always prescribed antibiotics for UDS and cystoscopy (13% and 17%, respectively).

LIMITATIONS

The response rate was a limitation of the study, however, this rate is in keeping with other physician survey studies published within this subspecialty. Selection and response biases may have contributed to the results of this survey study.

CONCLUSION

There was no uniform approach to urinary tract infection prophylaxis for UDS and outpatient cystoscopy in women which reflects the lack of current guidelines and the low level of evidence on which they are based. This non-uniform practice calls for more research to better define an evidence-based standard of care.

Increasing the usefulness of acupuncture guideline recommendations

Yu-Qing Zhang and colleagues examine the progress and pitfalls in guideline recommendations for acupuncture and provide suggestions for improvement

Are We Sentenced to Pharmacotherapy? Promising Role of Lycopene and Vitamin A in Benign Urologic Conditions

Benign prostatic hyperplasia, urolithiasis, recurrent urinary tract infections, and chronic prostatitis are diseases that are commonly diagnosed worldwide. Carotenoids, including lycopene, are widely available in fruits and vegetables, and it is postulated that they can be used in the prevention and treatment of benign urological conditions. The aim of this review is to familiarize doctors and their patients with the current knowledge on carotenoids and their conversion products in selected urological diseases. Most of the experimental and clinical trials show a moderate effect of lycopene and vitamin A on studied parameters. Lycopene was shown to improve the IPSS score in BPH patients, and alleviate symptoms in those with chronic prostatitis. Intake of Vitamin A was associated with decrease of urinary tract reinfection rates. In studied rat models retinol also decreased urolithiasis formation. Although the results of the cited studies are generally promising, it is evident that more detailed and extensive research must be done in this field of medicine.

Recurrent Urinary Tract Infections and Asymptomatic Bacteriuria in Adults

Purpose of review

Our goal was to summarize recent evidence regarding recurrent urinary tract infections and asymptomatic bacteriuria in different adult populations.

Recent findings

Several research groups are focused on the description of resident bacterial flora in the bladder and urinary dysbiosis in the microbiome era. Even the definitions might change in light of these discoveries. However, the role of urinary microbiome and bacterial interference has still to be determined.

Summary

Systematic treatment of asymptomatic bacteriuria is not recommended and even classic indications such as asymptomatic bacteriuria in pregnant women are controversial. In fact, its treatment is associated with a higher probability of symptomatic UTI and a higher prevalence of antibiotic-resistant bacteria. Improving the diagnosis of asymptomatic bacteriuria and optimizing the management of recurrent urinary tract infections, especially through non-antibiotics measures, are needed in order to minimise antimicrobial resistance.

Could sublingual vaccination be a viable option for the prevention of recurrent urinary tract infection in Canada? A systematic review of the current literature and plans for the future

INTRODUCTION

We conducted a systematic review to examine the role of a novel sublingual vaccine - Uromune - for prevention of recurrent urinary tract infection (rUTI) to understand its potential role for Canadian women suffering from rUTI.

METHODS

Databases were searched for studies published from 2010-2020 that investigated use of Uromune in the management of rUTI. Only original clinical studies that included use of Uromune as prophylaxis for uncomplicated rUTI in women that included UTI-free rate following initiation of vaccine as an outcome were included.

RESULTS

Of 73 publications related to Uromune and UTIs, 19 unique clinical studies were identified evaluating Uromune for prevention of rUTI. Five studies met our inclusion criteria for primary review. These included 1408 women treated with Uromune. In two retrospective comparative studies, subjects treated with Uromune daily for three months (519 women in total) had significantly higher UTI-free rates (35-90%) than subjects treated with six months of antibiotic prophylaxis (0% in 499 women in total) over 15 months (p<0.001 for both studies). In three prospective, uncontrolled studies, UTI-free rates for subjects treated with Uromune ranged from 33-78% over 9-24 months. No major safety issues were identified in these trials. Additional unique studies evaluating Uromune for rUTI that did not meet our criteria added consistent confirmation of the potential effectiveness and safety of Uromune to prevent rUTI.

CONCLUSIONS

Although these findings require confirmation in currently active, prospective clinical studies, including a randomized placebo-controlled trial, Uromune may be an alternative to antibiotics to prevent rUTI in Canadian women.

High incidence of lower urinary tract dysfunction in women with recurrent urinary tract infections

The aim of this study was to evaluate lower urinary tract dysfunction (LUTD) in women with recurrent urinary tract infections (UTIs). One hundred consecutive female patients with recurrent UTIs who underwent videourodynamic study (VUDS) were included. Another 25 women free from recurrent UTIs served as controls. All the underlying diseases, urine analysis and culture results, VUDS findings, and treatment outcomes of voiding dysfunction were carefully reviewed and analyzed. The mean age of the recurrent UTIs patients was 64.0 ± 16.0 years. Storage and voiding dysfunctions were found in 90 (90%) patients, including bladder neck dysfunction in 19 (19%), detrusor hyperactivity with impaired contractility in 6 (6%), detrusor overactivity in 5 (5%), detrusor underactivity in 10 (10%), dysfunctional voiding in 25 (25%), hypersensitive bladder in 6 (6%), and poor relaxation of the pelvic floor muscle in 20 (20%). Only 10 (10%) patients had normal urodynamic tracings. Compared with the controls, the recurrent UTI patients had significantly smaller cystometric bladder capacity, lower maximum flow rate, smaller voided volume, higher detrusor pressure, and larger PVR volume. However, only 6 (11.3%) patients with recurrent UTIs were free from subsequent UTIs following individualized treatment for their voiding dysfunction. A high incidence of vide urodynamic LUTD was identified in women with recurrent UTIs. Despite receiving individualized treatments based on their VUDS findings, only a small portion of these patients were subsequently free from UTIs.