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Corse TD, Rahmani LD, Hasley HL, Kim K, Harrison R, Fromer DL. New avenue of diagnostic stewardship: procedural stewardship for recurrent urinary tract infections in female patients. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e231. [PMID: 38156218 PMCID: PMC10753495 DOI: 10.1017/ash.2023.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 12/30/2023]
Abstract
Introduction Societal guidelines offer a weak recommendation to perform cystoscopy for female patients with recurrent urinary tract infections (rUTI) of advanced age and/or with high-risk features. These guidelines lack the support of robust data and are instead based on expert opinion. In this retrospective cohort study, we aim to determine the utility of cystoscopy in patients with and without high-risk features for rUTI. Materials and methods We identified 476 women who underwent cystoscopy for the evaluation of rUTI at a single tertiary academic medical center from May 1, 2015 and March 15, 2021. Patients were excluded if they had a competing indication for cystoscopy. Risk factors, demographic information, cystoscopic findings, and patient outcomes were analyzed. Results 192 (41.1%) were classified as having complicated UTI. We identified six patients (1.3%) with findings that prompted management to significantly impact patient outcomes. All six patients had high-risk features. 14 patients (3.0%) were found to have mucosal abnormalities prompting biopsy, three of which required general anesthesia. All 14 biopsies were ultimately benign. Conclusions Our findings demonstrate a low diagnostic yield and increased risk exposure for women undergoing cystoscopy for the evaluation of complicated rUTI. Additionally, our observations support prior studies indicating that cystoscopy has limited utility in the evaluation of rUTI without high-risk features.
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Affiliation(s)
- Tanner D. Corse
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Linda Dayan Rahmani
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Hunter L. Hasley
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Katherine Kim
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Robert Harrison
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Debra L. Fromer
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
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Deb A, Gogoi M, Mandal TK, Sinha S, Pattader PSG. Specific Instantaneous Detection of Klebsiella pneumoniae for UTI Diagnosis with a Plasmonic Gold Nanoparticle Conjugated Aptasensor. ACS APPLIED BIO MATERIALS 2023; 6:3309-3318. [PMID: 37437266 DOI: 10.1021/acsabm.3c00369] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Urinary tract infection (UTI), which can be caused by various pathogens, if not detected at an early stage can be fatal. It is essential to identify the specific pathogen responsible for UTI for appropriate treatment. This study describes a generic approach to the fabrication of a prototype for the noninvasive detection of a specific pathogen using a tailor-made plasmonic aptamer-gold nanoparticle (AuNP) assay. The assay is advantageous because the adsorbed specific aptamers passivate the nanoparticle surfaces and reduce and/or eliminate false-positive responses to nontarget analytes. Based on the localized surface plasmon resonance (LSPR) phenomena of AuNP, a point-of-care aptasensor was designed that shows specific changes in the absorbance in the visible spectra in the presence of a target pathogen for robust and fast screening of UTI samples. In this study, we demonstrate the specific detection of Klebsiella pneumoniae bacteria with LoD as low as 3.4 × 103 CFU/mL.
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Affiliation(s)
- Aniruddha Deb
- Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
| | - Mousumi Gogoi
- Altanostics Lab Private Limited, IIT Research Park, IIT Guwahati, Guwahati, Assam 781039, India
| | - Tapas K Mandal
- Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
- Jyoti and Bhupat Mehta School of Health Science & Technology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
| | - Swapnil Sinha
- Altanostics Lab Private Limited, IIT Research Park, IIT Guwahati, Guwahati, Assam 781039, India
| | - Partho Sarathi Gooh Pattader
- Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
- Jyoti and Bhupat Mehta School of Health Science & Technology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
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Basak M, Mitra S, Gogoi M, Sinha S, Nemade HB, Bandyopadhyay D. Point-of-Care Biosensing of Urinary Tract Infections Employing Optoplasmonic Surfaces Embedded with Metal Nanotwins. ACS APPLIED BIO MATERIALS 2022; 5:5321-5332. [PMID: 36222059 DOI: 10.1021/acsabm.2c00720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We report the synthesis of gold nanotwins (Au NTs) on a solid and transparent glass substrate which in turn has been employed for the selective optoplasmonic detection of Escherichia coli (EC) bacteria in human urine for the point-of-care diagnosis of urinary tract infections (UTIs). As compared to the single nanoparticle systems (Au NPs), the Au NTs show an enriched localized surface plasmon resonance (LSPR) due to the enhancement of the electric field under electromagnetic irradiation, e.g., photon, which helps in improving the limits of detection. For this purpose, initially a simple glass surface has been coated with Au NPs, with the help of the linker 3-aminopropyl-triethoxysilane - APTES. The surface has been linked further with another Au NP with the help of the 1,10-alkane-dithiol linker with two thiol ends, which eventually leads to the development of the optoplasmonic surface with Au NTs and an enhanced LSPR response. Subsequently, the EC specific aptamer has been chemically immobilized on the surface of Au NTs with the blocking of free sites via bovine serum albumin (BSA). Remarkably, Raman spectroscopy unfolds a 7-fold increase in the peak intensities with the Au NTs on the glass surface as compared to the surface coated with isolated Au NPs. The enhancement in the LSPR response of glass substrates coated with Au NTs and the EC specific aptamer has been further utilized for the selective and sensitive detection of UTIs. The results have been verified with the help of UV-visible spectroscopy to establish the utility of the proposed sensing methodology. An extensive interference study with other bacterial species unveils the selectivity and specificity of the proposed optoplasmonic sensors toward EC with a detection range of 5 × 103 to 107 CFU/mL. Intuitively, the method is more versatile in a sense that the sensor can be made specific to any other pathogens by simply changing the design of the aptamer. Finally, a low-cost, portable, and point-of-care optoplasmonic transduction setup is designed with a laser light illumination source, a sample holder, and a sensitive photodetector for the detection of UTIs in human urine.
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Affiliation(s)
- Mitali Basak
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam781039, India
| | - Shirsendu Mitra
- Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati, Assam781039, India
| | - Mousumi Gogoi
- Altanostics Laboratories Private Limited, Indian Institute of Technology Guwahati, Guwahati, Assam781039, India
| | - Swapnil Sinha
- Altanostics Laboratories Private Limited, Indian Institute of Technology Guwahati, Guwahati, Assam781039, India
| | - Harshal B Nemade
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam781039, India
| | - Dipankar Bandyopadhyay
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam781039, India.,Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati, Assam781039, India.,School of Health Sciences and Technology, Indian Institute of Technology Guwahati, Guwahati, Assam781039, India
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4
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Hsieh ES, Palm C, Segev G, Johnson EG, Leung K, Westropp JL. Diagnostic yield of uroendoscopy compared to ultrasonography for evaluating lower urinary tract disorders in dogs. Vet Med (Auckl) 2022; 36:1700-1707. [PMID: 35986564 PMCID: PMC9511071 DOI: 10.1111/jvim.16501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/14/2022] [Indexed: 11/29/2022]
Abstract
Background Cystourethroscopy and vaginoscopy (uroendoscopy) is often used in the diagnostic evaluation of dogs with lower urinary tract disorders (LUTD). Objective/Hypothesis To evaluate if uroendoscopy is warranted in dogs with various LUTD, the agreement between uroendoscopic and ultrasonographic diagnoses were compared. Dogs with recurrent urinary tract infections (rUTI) will have the highest diagnostic agreement between uroendoscopy and ultrasonography (US) compared to dogs presenting for other LUTD. Animals Two hundred thirty‐seven dogs presenting between 2014 and 2019 with lower urinary tract signs (LUTS) that had US within 60 days preceding uroendoscopy. Methods Retrospective study. Dogs were categorized by primary indication for ultrasound. Pertinent uroendoscopic findings were recorded and agreements (κ analysis) between the final uroendoscopic diagnosis were compared with the final ultrasonographic diagnosis. Results Pertinent uroendoscopic findings were recorded for 69/237 (29%) cases. For dogs presenting primarily for urinary incontinence (UI), agreement between uroendoscopy and US was 71% (46/65; κ = 0.47, 95% CI 0.28‐0.66), for dogs with stranguria, 58% (29/50; κ = 0.47, 95% CI 0.31‐0.62) and for dogs with rUTI the agreement was substantial at 87% (26/30; κ = 0.70, 95% CI 0.43‐0.98). Urethral strictures were the majority (14/21; 67%) of pertinent uroendoscopic findings for dogs with stranguria, of which 12 were male dogs. Conclusions and Clinical Importance Agreement between uroendoscopy and US was moderate for all dogs. Based on these data, recommendation for uroendoscopy should be tailored to individual clinical presentation and signalment; transabdominal US is not the preferred modality for urethral lesions.
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Affiliation(s)
- Emmelyn S. Hsieh
- William R. Pritchard Veterinary Medical Teaching Hospital University of California Davis California USA
| | - Carrie Palm
- Department of Veterinary Medicine and Epidemiology University of California Davis California USA
| | - Gilad Segev
- Koret School of Veterinary Medicine The Hebrew University of Jerusalem Rehovot Israel
| | - Eric G. Johnson
- Department of Surgical & Radiological Sciences University of California Davis California USA
| | - Kaitlin Leung
- William R. Pritchard Veterinary Medical Teaching Hospital University of California Davis California USA
| | - Jodi L. Westropp
- Department of Veterinary Medicine and Epidemiology University of California Davis California USA
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Role of Flexible Cystoscopy in the Management of Postmenopausal Women with Recurrent Urinary Tract Infections. Urology 2022; 169:65-69. [DOI: 10.1016/j.urology.2022.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/19/2022]
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Khalid F, Bushra R, Ghayas S, Mushtaque M. Case Report: Urinary Tract Infection in a Diabetic Postmenopausal Woman With Multiple Episodes of Recurrence: An Antimicrobial Susceptibility dispute. Clin Med Insights Case Rep 2022; 15:11795476221112819. [PMID: 35898804 PMCID: PMC9309758 DOI: 10.1177/11795476221112819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
Urinary tract infection (UTI) is caused by bacteria growing in urine and affect
kidneys, bladder, ureters, and urethra. Women with diabetes are at high risk of
developing UTI. This is a case of a 60-year-old postmenopausal woman with
uncontrolled type-I diabetes mellitus and hypertension, who presented with an
acute onset of dysuria, burning micturition, and increased frequency. This case
highlights the shortfall in the preliminary management plan of performing
imperative clinical laboratory investigations including urine detailed report
(DR), urine culture and sensitivity(C/S), and plasma glucose testing to initiate
antimicrobial treatment. UTI requires to be treated precisely in diabetic
patients with the help of a comprehensive diagnosis for signs of dysuria,
frequent urination, and pelvic pain. The treatment of UTIs should always begin
with culture and sensitivity analysis while the patient is symptomatic, to
initiate antimicrobial treatment. Comorbidities should be managed appropriately
during treatment to achieve desired therapeutic outcomes.
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Affiliation(s)
- Farah Khalid
- Department of Pharmacy Practice, Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Rabia Bushra
- Department of Pharmaceutics, Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Sana Ghayas
- Department of Pharmaceutics, Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Madiha Mushtaque
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
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Sorić Hosman I, Cvitković Roić A, Lamot L. A Systematic Review of the (Un)known Host Immune Response Biomarkers for Predicting Recurrence of Urinary Tract Infection. Front Med (Lausanne) 2022; 9:931717. [PMID: 35860746 PMCID: PMC9289160 DOI: 10.3389/fmed.2022.931717] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022] Open
Abstract
Recurrent urinary tract infections (rUTI) represent a major healthcare and economic burden along with a significant impact on patient’s morbidity and quality of life, even in the absence of well-known risk factors, such as vesicoureteral reflux. Despite numerous attempts to find a suitable therapeutic option, there is no clear benefit of any currently available intervention for prevention of UTI recurrence and its long-term consequences such as hypertension, renal scarring and/or insufficiency. The common treatment practice in many centers around the globe involves the use of continuous low-dose antibiotic prophylaxis, irrespective of various studies indicating increased microbial resistance against the prophylactic drug, leading to prolonged duration and escalating the cost of UTI treatment. Moreover, the rapid appearance of multi-drug resistant uropathogens is threatening to transform UTI to untreatable disease, while impaired host-microbiota homeostasis induced by a long-term use of antibiotics predisposes patients for various autoimmune and infectious diseases. New biomarkers of the increased risk of UTI recurrence could therefore assist in avoiding such outcomes by revealing more specific patient population which could benefit from additional interventions. In this light, the recent findings suggesting a crucial role of urothelial innate immunity mechanisms in protection of urinary tract from invading uropathogens might offer new diagnostic, prognostic and even therapeutic opportunities. Uroepithelial cells detect uropathogens via pattern recognition receptors, resulting in activation of intracellular signaling cascade and transcription factors, which ultimately leads to an increased production and secretion of chemokines, cytokines and antimicrobial peptides into the urinary stream. Emerging evidence suggest that the disturbance of a single component of the urinary tract innate immunity system might increase susceptibility for rUTI. The aim of the current review is to update clinicians and researchers on potential biomarkers of host immune response alterations predisposing for rUTI and propose those well worth exploring further. For this purpose, over a hundred original papers were identified through an extensive PubMed and Scopus databases search. This comprehensive review might enrich the current clinical practice and fill the unmet clinical needs, but also encourage the development of therapeutic agents that would facilitate urinary bacterial clearance by enhancing the host immune response.
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Affiliation(s)
- Iva Sorić Hosman
- Department of Pediatrics, Zadar General Hospital, Zadar, Croatia
| | - Andrea Cvitković Roić
- Department of Nephrology and Urology, Clinic for Pediatric Medicine Helena, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Lovro Lamot
- Division of Nephrology, Dialysis and Transplantation, Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
- Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
- *Correspondence: Lovro Lamot,
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8
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Pat JJ, Steffens MG, Witte LPW, Marcelissen TAT, Blanker MH. Comparison of the diagnostic yield of routine versus indicated flowmetry, ultrasound and cystoscopy in women with recurrent urinary tract infections. Int Urogynecol J 2021; 33:2283-2289. [PMID: 34125244 PMCID: PMC9343267 DOI: 10.1007/s00192-021-04871-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/19/2021] [Indexed: 11/27/2022]
Abstract
Introduction and hypothesis To quantify and compare the outcomes of routine vs. urologist-requested diagnostic testing for recurrent urinary tract infections (rUTI). Methods A retrospective cohort study of patients with rUTI referred to a large non-academic teaching hospital between 2016 and 2018 (Hospital A) and a university hospital between 2014 and 2016 (Hospital B). Electronic medical records were reviewed for baseline and diagnostic data. Women underwent the following assessments routinely: urinalysis, voiding diary, flowmetry in Hospital A and urinalysis, voiding diary, flowmetry, ultrasound, abdominal x-ray and cystoscopy in Hospital B. All other diagnostics were performed by indication in each hospital. Results We included 295 women from Hospital A and 298 from Hospital B, among whom the mean age (57.6 years) and mean UTI frequency (5.6/year) were comparable, though more were postmenopausal in Hospital A. We identified abnormalities by flowmetry or post-void residual volumes in 134 patients (Hospital A: 79; Hospital B: 55), cystoscopy in 14 patients (Hospital A: 6; Hospital B: 8) and ultrasound in 42 patients (Hospital A: 16; Hospital B: 26), but these differences were not significant. Diagnostics altered treatment in 117 patients (e.g., pelvic floor muscle training, referral to another specialist, surgical intervention), mostly due to flowmetry and post-void residual volume measurement. The retrospective design and absence of follow-up data limit these results. Conclusions The routine use of cystoscopy and ultrasound in female patients with rUTIs should not be recommended as they yield few abnormalities and lead to additional costs.
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Affiliation(s)
- Jorik J Pat
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands.
- Department of Urology, Isala Clinics, Zwolle, The Netherlands.
| | | | | | - Tom A T Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
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9
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Dokubo II, Reeves F, Cashman S, Gnanapragasam VJ. Rationalising the use of investigation for urinary tract infections: Analysis of 700 patients and proposal for a diagnostic algorithm. Int J Clin Pract 2021; 75:e13977. [PMID: 33369808 DOI: 10.1111/ijcp.13977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS To evaluate the diagnostic yield of investigations performed on patients with a history of urinary tract infections (UTI). METHODS A retrospective review was conducted on patients who underwent cystoscopy and imaging for a history of UTI between 2014 and 2019 in a single UK teaching hospital. Data were collected on demographics, cystoscopy and radiological findings requiring further management. The cohort was stratified by age, gender and a confirmed history of recurrent UTI (rUTI). The subsequent algorithm was re-tested in a second cohort to validate its use. RESULTS Seven hundred patients were included in the primary analysis-427 female and 273 males. Three hundred and thirty-one met the criteria of rUTI. The median age was 64 years (18-97). Imaging abnormalities were equally frequent in men 6.3% (15/241) and women 8% (30/380) and the majority noted in patients aged ≥55 years, 30/45 (66.7%). Amongst those who did not meet the definition of rUTI, abnormal imaging was identified in 5%-7% regardless of age group and gender. Cystoscopy abnormalities (n = 24) were twice more likely in males, 5.5%(15/273) than females, 2%(9/427). About 88%(21/24) were identified in patients ≥55 years. There were no positive findings in women <55 years. Applying baseline imaging but confining cystoscopy to those aged ≥55 years and men with a confirmed history of rUTI would have saved 44% of procedures, missed no abnormalities with an overall diagnosis detection rate of 9.8% (69/700). This algorithm was validated in a separate cohort of 63 patients; applying it would have saved 46% (29/63) of cystoscopies with a positive diagnostic rate of 9.5% and no missed findings. CONCLUSION To our knowledge this is one of the largest studies reporting the outcomes of investigations for UTI and rUTI. Our result suggests that imaging is a useful baseline assessment, but cystoscopy should be limited to specific subgroups. We propose and validate a simple decision algorithm to manage investigations for referrals for UTI in secondary care.
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Affiliation(s)
- Ibifuro I Dokubo
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK
| | - Felicity Reeves
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK
| | - Sophia Cashman
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK
| | - Vincent J Gnanapragasam
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK
- Division of Urology, Department of Surgery, University of Cambridge, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Cambridge, UK
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10
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Venkatesan AM, Oto A, Allen BC, Akin O, Alexander LF, Chong J, Froemming AT, Fulgham PF, Goldfarb S, Gettle LM, Maranchie JK, Patel BN, Schieda N, Schuster DM, Turkbey IB, Lockhart ME. ACR Appropriateness Criteria® Recurrent Lower Urinary Tract Infections in Females. J Am Coll Radiol 2020; 17:S487-S496. [PMID: 33153559 DOI: 10.1016/j.jacr.2020.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
Urinary tract infections (UTIs) in women are common, with an overall lifetime risk over >50%. UTIs are considered recurrent when they follow complete clinical resolution of a previous UTI and are usually defined as at least three episodes of infection within the preceding 12 months. An uncomplicated UTI is classified as a UTI without structural or functional abnormalities of the urinary tract and without relevant comorbidities. Complicated UTIs are those occurring in patients with underlying structural or medical problems. In women with recurrent uncomplicated UTIs, cystoscopy and imaging are not routinely used. In women suspected of having a recurrent complicated UTI, cystoscopy and imaging should be considered. CT urography or MR urography are usually appropriate for the evaluation of recurrent complicated lower urinary tract infections or for women who are nonresponders to conventional therapy, develop frequent reinfections or relapses, or have known underlying risk factors. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Aytekin Oto
- Panel Chair, University of Chicago, Chicago, Illinois
| | - Brian C Allen
- Panel Vice-Chair, Duke University Medical Center, Durham, North Carolina
| | - Oguz Akin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Pat F Fulgham
- Urology Clinics of North Texas, Dallas, Texas; American Urological Association
| | - Stanley Goldfarb
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; American Society of Nephrology
| | | | | | - Bhavik N Patel
- Stanford University Medical Center, Stanford, California
| | - Nicola Schieda
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama
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11
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Habib A, Noel J, Batura D, Hellawell G. Guideline-based flexible cystoscopy safely improves capacity, avoiding unnecessary intervention with cost savings. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415819900112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Flexible cystoscopy (FC) is a common and useful diagnostic tool. Because of its broader applications, availability and simplicity, there has been criticism of its overuse with accompanying financial burden to the health system and unnecessary invasive intervention to the patient. Therefore, we reviewed our local practice against current guidelines to evaluate compliance, enhance patient safety and capacity utilisation. Patients and methodology: Data were collected retrospectively on all patients having FC over two months. The indications and findings of FC were gathered from the hospital electronic patient record system. Results: A total of 413 FCs were carried out over the study period. The most common indications were cancer surveillance 116 (28%) and visible haematuria 76 (18.4%). A total of 152 (37%) FCs were performed for non-recommended indications. The most common conditions that deviated from guidelines were lower urinary tract symptoms (LUTS) (72, 17.4%), urinary tract infection (UTI) (41, 9.9%) and asymptomatic non-visible haematuria (35, 8.5%). In all non-visible haematuria cases, 65 (90%) of LUTS and 39 (95%) of UTI patients, FC was non-contributory. Adherence to guidelines would have yielded 37% of FC slots. Based on current UK National Tariffs, cost savings would have been £352,032 annually in this trust. Conclusions: FC is a frequent investigation within urology departments for which referral guidelines exist. Protocol-driven practice enables appropriate use, ensures patient safety and leads to efficient utilisation of capacity with substantial cost savings. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
- A Habib
- Urology, London North West University Healthcare NHS Trust, UK
| | - J Noel
- Urology, London North West University Healthcare NHS Trust, UK
| | - D Batura
- Urology, London North West University Healthcare NHS Trust, UK
| | - G Hellawell
- Urology, London North West University Healthcare NHS Trust, UK
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12
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Hostetter O, Hemal K, Hines KN, Matthews CA. Is a pelvic examination contributory in the initial evaluation of women with recurrent urinary tract infections? Int Urogynecol J 2019; 31:1209-1214. [PMID: 31832717 DOI: 10.1007/s00192-019-04198-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/21/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Recurrent urinary tract infections (rUTIs) affect up to 44% of women; evidenced-based guidelines regarding the contributory role of a pelvic examination in these women are lacking. We hypothesize that routine pelvic examination has a limited role in evaluation and management of women with rUTI when appropriate symptoms-based screening is performed and normal post-void residual volume (PVR) is confirmed. METHODS We performed a retrospective chart review of women ages 18-85 years presenting to Wake Forest Pelvic Health Center with two culture-proven UTIs in 6 months or three UTIs in 12 months with a documented pelvic examination. Pregnant women were excluded. Data extraction included demographics, medical history, screening assessment of vaginal bulge symptoms, urine culture results, imaging, physical/pelvic examination findings, PVR, treatment recommendations and outcomes within 1 year of initial assessment. Descriptive statistics and Fisher's exact test were performed. RESULTS Of 160 charts screened, 91 met the inclusion criteria. Nineteen (21%) had symptoms of vaginal bulge, and 14 (17%) had PVR > 100 ml. Pelvic examination provided new/contributory information in eight (8.8%) of women. The negative predictive value of absence of bulge symptoms and normal PVR was 89%. Within 1 year, 41 (46%) reported symptom resolution with rUTI treatment with no difference between those with or without a contributory pelvic examination (p value = 0.64). CONCLUSIONS In women with rUTI who report absence of vaginal bulge symptoms and have a PVR < 100 ml, a pelvic examination provides contributory information in < 10% of women and did not change treatment outcomes.
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Affiliation(s)
- Olivia Hostetter
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston Salem, NC, USA
| | - Kshipra Hemal
- Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Katherine N Hines
- Department of Urology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC, 27101, USA
| | - Catherine A Matthews
- Department of Urology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC, 27101, USA.
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Jung C, Brubaker L. The etiology and management of recurrent urinary tract infections in postmenopausal women. Climacteric 2019; 22:242-249. [PMID: 30624087 PMCID: PMC6629580 DOI: 10.1080/13697137.2018.1551871] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/17/2018] [Indexed: 01/17/2023]
Abstract
Urinary tract infections (UTIs) are one of the most common infections and affect up to 50% of women in their lifetime, with almost half of these women experiencing a recurrence in 6-12 months. Menopause predisposes women to recurrent UTI (rUTI), as normally lower levels of estrogen lead to changes in the urogenital epithelium and subsequently urogenital microbiome. The recently discovered urobiome is now known to have different compositions in both healthy and unhealthy bladders, including a role in the pathophysiology of rUTI, and may be a therapeutic target for prevention and treatment options for rUTI. In postmenopausal women with frequent UTI, the diagnosis of acute UTI should be made using a combination of the symptom assessment and urine diagnostic studies. The choice of UTI antibiotic should include consideration of efficacy, collateral effects, and side-effects. Some women may be candidates for self-start therapy, in which the patient accurately recognizes her UTI symptoms and then starts previously prescribed antibiotics. A large component of the management of women with rUTI is prevention. Urobiome research for bladder health and disease is a young field of investigation with significant potential to improve care for postmenopausal women affected by rUTI through novel, evidence-based prevention and treatment strategies.
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Affiliation(s)
- Carrie Jung
- a Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Female Pelvic Medicine and Reconstructive Surgery , University of California San Diego , La Jolla , CA , USA
| | - Linda Brubaker
- a Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Female Pelvic Medicine and Reconstructive Surgery , University of California San Diego , La Jolla , CA , USA
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International Society for Companion Animal Infectious Diseases (ISCAID) guidelines for the diagnosis and management of bacterial urinary tract infections in dogs and cats. Vet J 2019; 247:8-25. [PMID: 30971357 DOI: 10.1016/j.tvjl.2019.02.008] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 02/08/2023]
Abstract
Urinary tract disease is a common clinical presentation in dogs and cats, and a common reason for antimicrobial prescription. This document is a revision and expansion on the 2011 Antimicrobial Use Guidelines for Treatment of Urinary Tract Disease in Dogs and Cats, providing recommendations for diagnosis and management of sporadic bacterial cystitis, recurrent bacterial cystitis, pyelonephritis, bacterial prostatitis, and subclinical bacteriuria. Issues pertaining to urinary catheters, medical dissolution of uroliths and prophylaxis for urological procedures are also addressed.
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15
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Cystoscopy Findings in Females with Recurrent Urinary Tract Infection. Nephrourol Mon 2018. [DOI: 10.5812/numonthly.61829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Burge F, Kockelbergh R. Closing the Gender Gap: Can We Improve Bladder Cancer Survival in Women? - A Systematic Review of Diagnosis, Treatment and Outcomes. Urol Int 2016; 97:373-379. [PMID: 27595416 DOI: 10.1159/000449256] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 08/19/2016] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Despite recent attention, there are no gender specific guidelines to address the disparity in bladder cancer survival between the sexes. The focus of this review was to identify areas of clinical practice that may influence bladder cancer outcomes and to provide evidence-based recommendations to improve bladder cancer survival in women. METHOD A systematic search of MEDLINE was conducted to identify studies related to referral, diagnosis, treatment and outcomes of patients with bladder cancer with particular reference to gender differences. RESULTS Patients' knowledge of key signs and symptoms of bladder cancer is poor. There is evidence that there is a gender difference in referral patterns both at patient and primary care level. The presence of cystits, in particular, delays referral. Treatment and surveillance of high-risk non-muscle invasive cancers is variable and non-urothelial bladder cancer, which has higher incidence in women is more likely to be treated non-operatively than urothelial bladder cancer. CONCLUSION We have offered recommendations to improve patient education and streamline referrals and suggested considerations for treatment of high-risk cancers to help improve survival in female bladder cancer patients.
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Affiliation(s)
- Frances Burge
- Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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17
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Wu Y(R, Rego LL, Christie AL, Lavelle RS, Alhalabi F, Zimmern PE. Recurrent Urinary Tract Infections Due to Bacterial Persistence or Reinfection in Women—Does This Factor Impact Upper Tract Imaging Findings? J Urol 2016; 196:422-8. [DOI: 10.1016/j.juro.2016.01.111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
Affiliation(s)
| | - Lauren L. Rego
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alana L. Christie
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rebecca S. Lavelle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Feras Alhalabi
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Philippe E. Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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Pagano MJ, Barbalat Y, Theofanides MC, Edokpolo L, James MB, Cooper KL. Diagnostic yield of cystoscopy in the evaluation of recurrent urinary tract infection in women. Neurourol Urodyn 2016; 36:692-696. [DOI: 10.1002/nau.22998] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 03/04/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Matthew J. Pagano
- Department of Urology; Columbia University Medical Center; New York New York
| | - Yanina Barbalat
- Department of Urology; Columbia University Medical Center; New York New York
| | | | - Leonard Edokpolo
- Department of Urology; Columbia University Medical Center; New York New York
| | - Maxwell B. James
- Department of Urology; Columbia University Medical Center; New York New York
| | - Kimberly L. Cooper
- Department of Urology; Columbia University Medical Center; New York New York
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19
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Abstract
Background: Recurrent urinary tract infections (UTIs) in women are common despite anatomically normal urinary tracts and are frequently referred to secondary care for further assessment. Patients and methods: Clinic letters and pathology reports of 244 women referred to our centre over a 2-year period with uncomplicated recurrent UTIs were reviewed to determine the investigations they underwent in both primary and secondary care. Results: A significant proportion of women do not meet the criteria for recurrent UTIs as their infections are not proven on culture. The majority of women undergo both renal tract ultrasound scan (USS) and flexible cystoscopy. Though USS was found to demonstrate relevant pathology, flexible cystoscopy, however, did not reveal any relevant pathology. Conclusion: Investigation of women with recurrent uncomplicated UTIs should be done with adequate cultures and renal tract USS.
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Salinas J, Virseda M, Méndez S, Menéndez P, Esteban M, Moreno J. Abdominal strength in voiding cystometry: a risk factor for recurrent urinary tract infections in women. Int Urogynecol J 2015; 26:1861-5. [PMID: 26001361 DOI: 10.1007/s00192-015-2737-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 05/05/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Recurrent urinary tract infections are a common condition in women. The aim of this study is the evaluation of lower urinary tract dysfunctions that are risk factors for recurrent urinary tract infections in women. METHODS We conducted a case-control study in 49 women with recurrent urinary tract infections (rUTIs) and 49 control women without rUTIs, comparing the urinary symptoms and urodynamic data of both groups. RESULTS The main significant differences between these groups were age (the women were older in the control group) and the value of abdominal pressure during voiding cystometry (this was higher in the group with rUTIs). After controlling age as a confounding factor, it was confirmed that the value of maximum abdominal pressure during voiding was the only factor to facilitate the rUTIs and the ideal cut-off was 28 cm H(2)O. CONCLUSIONS Abdominal strength in the voiding phase constitutes a risk factor for recurrent urinary tract infections in women.
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Affiliation(s)
- Jesus Salinas
- Urology Department, San Carlos Clinico Hospital, Complutense University, Madrid, Spain.
| | - Miguel Virseda
- Urology Department, Paraplegics National Hospital, Toledo, Spain
| | - Santiago Méndez
- Urology Department, Hospital Sanitas La Moraleja, Madrid, Spain
| | - Pablo Menéndez
- General Surgery Department, Gutierrez Ortega Hospital, Ciudad Real, Spain
| | - Manuel Esteban
- Urology Department, Paraplegics National Hospital, Toledo, Spain
| | - Jesus Moreno
- Urology Department, San Carlos Clinico Hospital, Complutense University, Madrid, Spain
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22
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Sengupta N, Hillard T. Urogynecological risk assessment in postmenopausal women. EXPERT REVIEW OF OBSTETRICS & GYNECOLOGY 2013; 8:625-637. [DOI: 10.1586/17474108.2013.851847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
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23
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Al-Badr A, Al-Shaikh G. Recurrent Urinary Tract Infections Management in Women: A review. Sultan Qaboos Univ Med J 2013; 13:359-67. [PMID: 23984019 PMCID: PMC3749018 DOI: 10.12816/0003256] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 02/23/2013] [Accepted: 03/27/2013] [Indexed: 11/27/2022] Open
Abstract
Urinary tract infections (UTIs) are one of the most frequent clinical bacterial infections in women, accounting for nearly 25% of all infections. Around 50-60% of women will develop UTIs in their lifetimes. Escherichia coli is the organism that causes UTIs in most patients. Recurrent UTIs (RUTI) are mainly caused by reinfection by the same pathogen. Having frequent sexual intercourse is one of the greatest risk factors for RUTIs. In a subgroup of individuals with coexisting morbid conditions, complicated RUTIs can lead to upper tract infections or urosepsis. Although the initial treatment is antimicrobial therapy, use of different prophylactic regimens and alternative strategies are available to reduce exposure to antibiotics.
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Affiliation(s)
| | - Ghadeer Al-Shaikh
- King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
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24
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Shepherd AK, Pottinger PS. Management of urinary tract infections in the era of increasing antimicrobial resistance. Med Clin North Am 2013; 97:737-57, xii. [PMID: 23809723 DOI: 10.1016/j.mcna.2013.03.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Antimicrobial resistance of urinary pathogens is increasing. Most urinary tract infections (UTIs) should still be treated empirically. However, patients with recurrence or other risk factors for resistance may benefit from urine culture. Patients with recurrent UTI often resort to antibiotic prevention, a risky proposition in terms of resistance. Non-antimicrobial preventative methods should be considered first. If preventative antibiotics must be used, postcoital patient-initiated protocols are effective and reduce overall antibiotic exposure compared with continuous prophylaxis. Consider referring patients for urologic evaluation when at risk for complicated UTIs or when recurrence continues despite conservative interventions.
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Affiliation(s)
- Amanda Kay Shepherd
- Department of Medicine, University of Washington, 1959 Northeast Pacific Street, Box #356421, Seattle, WA 98195, USA.
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25
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Affiliation(s)
- Kalpana Gupta
- Department of Medicine, VA Boston Healthcare System and Boston University School of Medicine, Boston, MA 02132, USA.
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26
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Howles S, Tempest H, Doolub G, Bryant RJ, Hamdy FC, Noble JG, Larré S. Flexible cystoscopy findings in patients investigated for profound lower urinary tract symptoms, recurrent urinary tract infection, and pain. J Endourol 2012; 26:1468-72. [PMID: 22612791 DOI: 10.1089/end.2012.0139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The National Institute of Clinical Excellence published guidelines in 2010 recommending the use of cystoscopy to investigate profound lower urinary tract symptoms (pLUTS), recurrent urinary tract infection (rUTI), and pain in men. Currently, there are no equivalent guidelines for women. We aimed to examine the diagnostic performance of flexible cystoscopy (FC) when it is used in this context in both men and women. PATIENTS AND METHODS Results of all outpatient FCs undertaken in our department between April 2009 and March 2010 were examined retrospectively. Patients undergoing FC for the investigation of pLUTS, rUTI, or pain were included. Diagnostic performance was calculated, which was defined as the number of patients receiving a diagnosis of a clinically relevant abnormality at FC divided by the total number of patients undergoing FC for this indication. RESULTS Of the 1809 patients who underwent FC during the study period, 113 underwent FC to investigate pLUTS, rUTI, or pain. Diagnostic performance was 11.5% (n=13), being 11.4%, 19.2%, and 0% in those with pLUTS, rUTI, and pain, respectively. Bladder cancer was diagnosed in one (0.9%) patient who underwent FC to investigate pLUTS but also had nonvisible hematuria. Urethral stricture was diagnosed in nine (8.0%) cases and intravesical calculi in four (3.5%) cases. CONCLUSION Clinically relevant abnormalities were found in 11.5% of patients with pLUTS, rUTI, or pain, supporting recently published NICE guidelines recommending cystoscopy in patients with pLUTS or rUTI. Of the 17 patients who were investigated for pain, none was found to have clinically relevant abnormalities; further studies are needed to define the clinical utility of FC in these cases.
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Affiliation(s)
- Sarah Howles
- Department of Urology, Nuffield Department of Surgical Sciences, Churchill Hospital, Oxford, United Kingdom.
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27
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Recurrent Urinary Tract Infections Associated with Gynecological Disorders. CURRENT BLADDER DYSFUNCTION REPORTS 2012. [DOI: 10.1007/s11884-012-0124-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Dason S, Dason JT, Kapoor A. Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Can Urol Assoc J 2011; 5:316-22. [PMID: 22031610 PMCID: PMC3202002 DOI: 10.5489/cuaj.11214] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Shawn Dason
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON
| | | | - Anil Kapoor
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON
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Ying T, Li Q, Shao C, Zhu Z, Feng L, Hu B. Value of transrectal ultrasonography in female traumatic urethral injuries. Urology 2010; 76:319-22. [PMID: 20156650 DOI: 10.1016/j.urology.2009.11.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Revised: 11/20/2009] [Accepted: 11/24/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To estimate the value of transrectal ultrasonography (TRUS) in traumatic urethral injuries of various types in females. METHODS A total of 30 female patients with symptoms of urethral injuries after trauma underwent TRUS between January 2005 and July 2008. Of them, 28 patients with operative indications undertook operation; the other 2 received conservative management and then a follow-up ultrasonography. All outcomes were used to validate the results of TRUS. RESULTS Urethral injuries were clearly observed in 30 cases with TRUS. The continuity of urethral wall, unblocking of urethral lumen, and homogeneous echo of surrounding structures had been changed. Urethral injuries varied in types, including urethrovaginal fistula, urethral stricture, urethral rupture, and urethral hematoma. It was common to find several injury patterns simultaneously in 1 patient. The outcomes in 28 cases with operative indications were consistent with results of surgery. The other 2 cases were diagnosed as urethral hematoma by TRUS which disappeared in a follow-up sonography after 3 months' conservative management. CONCLUSIONS TRUS is a reliable technique to exhibit abnormalities in injured urethra associated with trauma in female.
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Affiliation(s)
- Tao Ying
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University affiliated Sixth People's Hospital, Shanghai, People's Republic of China
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