(UroToday.com) There is variability in the evaluation, treatment, and referral patterns for recurrent urinary tract infections (rUTI). This group sought to analyze patterns in the workup and surgical management of rUTI at their institution. Data collected included demographics, provider specialty, and workup, including the performance of genitourinary exam, urodynamic evaluation, cystoscopy, and imaging and if the patient underwent a surgical procedure and type.
A total of 1340 predominantly female (77%) patients are included in this analysis. Majority were evaluated by urology (83%) compared with urogynecology (17%). 68% underwent genitourinary exam, 69% underwent cystoscopy, and 72% received imaging. The most common imaging modality employed was CT (54%) followed by ultrasound (39%). 77% underwent urodynamics of which 20% evaluated with post-void residual, 28% with uroflow, and 40% with complete urodynamic testing. It was the urologist who pursued urodynamics for 81% of patients compared with 12% among urogynecologists. They also more frequently ordered cystoscopies (73% versus 53%) and imaging (75% versus 57%) than urogynecologists. A minority of patients underwent a surgical procedure for rUTI (304, 23%), the most common was the female sling placement or removal (n=52), followed by cystoscopy biopsy fulguration (n=38), and ureteroscopy with or without laser lithotripsy or stone basketing (n=30). Rate of surgical management was fairly comparable between urologists (22%) and urogynecologists (25%). The authors note that despite receiving this extensive workup, the majority of patients seen for rUTI at their institution are ultimately managed medically rather than surgically.
Written by: Diane K. Newman, DNP, ANP-BC, FAAN, Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health during the 2021 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting