The aims of this study were to determine the proportion of women presenting for recurrent urinary tract infections (UTIs) who met the diagnostic criteria (culture-proven UTI ≥3 in 1 year or ≥2 in 6 months) and to assess advanced testing utilization, preventive therapy use, and risk factors.
This is a retrospective chart review of women seen as new urogynecology consults for recurrent UTI (rUTI) between April 1, 2017, and April 1, 2018, followed through April 1, 2019. Exclusion criteria included catheter use, cancer treatment within 2 years, and prior organ transplant, urinary diversion, conduit, or bladder augmentation.
Of 600 women, 71% had follow-up with a median of 179 days. Urinary tract infection symptoms included frequency (50%), dysuria (46%), urgency (43%), and malodorous urine (7%). One third met the rUTI diagnostic criteria. Two hundred thirty-four (39%) underwent advanced testing, and 9% (21/234) of women who underwent advanced testing had a change in clinical care. Preventive therapy use increased after consultation (P < 0.001), with vaginal estrogen (47%) being most common. Compared with women not meeting the rUTI criteria, women meeting the rUTI criteria were more likely to be older (adjusted odds ratio [aOR], 1.03/year; 95% confidence interval [CI], 1.02-1.04), have a prior history of gynecologic cancer (aOR, 4.07; 95% CI, 1.02-16.25), or report UTI symptoms of dysuria (aOR, 2.27; 95% CI, 1.57-3.27), or malodorous urine (aOR, 2.96; 95% CI, 1.47-5.94) and, while equally likely to be receiving preventive treatment prior to consultation, were more likely after consultation (OR, 3.06; 95% CI, 2.05-4.55).
Thirty-seven percent of women seen for rUTI met the diagnostic criteria. Advanced imaging rarely changed care. Education about diagnostic criteria and preventive therapy is warranted.
Female pelvic medicine & reconstructive surgery. 2021 May 01 [Epub]
Alexis A Dieter, Margaret G Mueller, Uduak U Andy, Anna C Kirby, Denicia S Dwarica, Cindy L Amundsen, W Thomas Gregory, Shivani Desai, Laura Clayton, Natalie A Squires, Antoinette Allen, Kaitlyn P Casper, Mary J Murphy, Jonathan P Shepherd, Developed by the AUGS Junior Faculty Research Network
Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL., Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pennsylvania, Philadelphia, PA., University of Washington, Seattle, WA., Division of Female Pelvic Medicine and Reconstructive Surgery, University of Missouri, Columbia, MO., Division of Urogynecology and Reconstructive Pelvic Surgery, Duke University Medical Center, Durham, NC., Division of Urogynecology and Reconstructive Pelvic Surgery, Oregon Health & Science University, Portland, OR., From the Division of Urogynecology and Reconstructive Pelvic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC., Trinity Health of New England, Hartford, CT., University of Missouri School of Medicine, Columbia MO.