SCOTTSDALE, AZ USA (UroToday.com) - Dr. Karyn Eilber moderated a panel of clinicians with expertise in treating urinary tract infections.
Dr. Duane Hickling presented “Pathophysiology of recurrent UTI’s – Why patients with “normal” urinary tracts get bladder infections.” He reviewed the data regarding risk factors and prevention for recurrent UTIs in women. Historically recommended behavioral modifications of promoting fluid intake, post-coital voiding, front-to-back wiping, avoiding tampon use, hot tub use, and douching have all been shown to be ineffective. Conversely, a positive family history of UTI, short urethral length, and various genetic alleles have been shown to be significant risk factors. In premenopausal women, increasing sexual activity has been shown to increase the risk 10-fold in women reporting intercourse frequency more than 9-times a month. In postmenopausal women, incontinence, elevated post void residual, vaginal atrophy/genitourinary syndrome of menopause, and cystocele have been shown to be significant risk factors for recurrent UTI.
Dr. Kimberly Cooper presented “Evaluation and treatment of recurrent UTIs in Women: Who needs treatment and how should we be treating?” She reviewed uncomplicated recurrent cystitis. Recurrent UTI was defined as 3 culture positive UTIs in a 12-month period or 2 culture positive UTIs within 6 months. Data suggests that gram positive organisms rarely cause symptomatic acute cystitis and caution should be exercised prior to giving antibiotics for gram positive organisms on culture. The Infectious Diseases Society of America recommendation of not treating asymptomatic bacteriuria was stressed. This recommendation is based upon data showing a low progression from asymptomatic bacteria to acute cystitis and a very low risk of resulting upper tract deterioration. Nitrofurantoin and sulfa/trimethoprim are recommended first-line treatments. Ciprofloxacin is no longer recommended as a first-line agent. While self-start antibiotics are commonly utilized, Dr. Cooper expressed concern that patients often start treatment when no UTI exists. There is controversy regarding the efficacy of cranberry extract for prophylaxis. Methenamine/Vitamin C was recommended as it does not induce microbial resistance and has few side effects. Vaccines for UTI prevention are currently being studied in European trials.
Dr. Michel Pontari presented “Evaluation and treatment of UTIs and prostatitis in Men.” He focused upon post prostate biopsy infections. He noted the post biopsy risk of prostatitis is ~7%. A review of 2 studies suggests that transurethral procedures and transrectal procedures have very different bacteria which should play a role in antibiotic management while cultures are pending. Carbapenem was advocated for transrectal empiric treatment whereas a third generation cephalosporin plus an aminoglycoside was recommended for transurethral procedures. Dr. Pontari discussed methods to prevent post transrectal biopsy infection. Rectal culture guided perioperative antibiotics were shown in one study to decrease infection rates from 3.3% to 0.3%. Provodine rectal swabbing was not shown to be effective. In regards to the evaluation of non-febrile UTI in men. One study demonstrated a post void residual of > 180 mL in affected men, but the data trying to demonstrate a goal PVR in patients without UTI was inconclusive. Refractory chronic bacterial prostatitis treatment options are,
- Daily low dose antibiotics,
- TURP, which has only a 30% success as bacterial tend to pool in peripheral zones, and
- Dutasteride which in an ad hoc analysis of one study showed a potential benefit.
Moderated by Karyn S. Eilber, MD at the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) Winter Meeting - February 24 - 28, 2015 - JW Marriott Camelback Inn Resort & Spa - Scottsdale, AZ USA
Pathophysiology of recurrent UTI’s – Why patients with “normal” urinary tracts get bladder infections: Duane Hickling, MD
Evaluation and treatment of recurrent UTIs in Women: Who needs treatment and how should we be treating?: Kimberly Cooper, MD
Evaluation and treatment of UTI’s and prostatitis in Men: Michel A. Pontari, MD
Reported for UroToday by Drew Freilich, MD. Dr. Freilich is a graduate of the University of Massachusetts Medical School and completed his urology residency at New York Medical College/Westchester Medical Center. He is currently a fellow in Female Urology, Neurourology and Reconstructive Urology at Medical University of South Carolina. He has authored more than 40 peer-reviewed articles, monographs, abstracts, and book chapters and abstracts. Dr. Freilich is a member of the American Urological Association and the Society for Urodynamics and Female Urology.