Cystoscopy in women with recurrent urinary tract infection

Abstract

Objective: To investigate if women with recurrent urinary tract infection (UTI) warrant cystoscopy to exclude an abnormality of the lower urinary tract. This is particularly relevant given that non-invasive imaging has often been performed to exclude abnormality. Our further aims were to correlate imaging and risk factors with cystoscopic findings to determine their predictive value in finding pathology. Patients and methods: A database of women undergoing cystoscopy with recurrent UTI has been maintained at our institution for 10 years. We retrospectively examined this and patient records for patient demographics, and investigative and operative data. Results: A total of 118 patients (mean 55 years) having recurrent UTI (mean 4.7 infections/year) were available. There were nine patients (8%) with significant abnormalities at cystoscopy: urethral stricture (six), bladder calculus (one), bladder diverticulum (one) and colovesical fistula (one). The negative predictive value (NPV) of imaging was 99% and significant (P < 0.01). Women with no risk factors for UTI had a NPV of 93% for normal cystoscopy (P > 0.05). The positive predictive value was low for imaging and risk factors in predicting cystoscopy findings. Conclusions: In our study, 8% of women had significant abnormalities detected during cystoscopy with most over 50 years. Women without risk factors for recurrent UTI and with normal imaging could have a cystoscopy omitted. Younger women are less likely to have pathology and this must be factored into decisions to perform cystoscopy.Key words cystoscopy, female, recurrence, urinary tract infections, urological diagnostic techniques. ObjectiveThe current incidence of cystitis amongst premenopausal sexually active women is 0.5-0.7 infections/person year. Further, 20% of women will have a urinary tract infection (UTI) in their lifetime with 3% having recurrent infection. The majority of infections are asymptomatic and clear spontaneously. [1][2][3][4] For definitional purposes, recurrent UTI refers to more than three infections in 1 year.5 Recurrent infections are due to either reinfection or bacterial persistence. Reinfection is recurrent infection with different bacteria from outside the urinary tract. Each infection is a new agent; the urine must show no growth after the preceding infection. Relapse is frequently used interchangeably. 6 Of those having recurrent UTI, up to 99% will have reinfections as opposed to bacterial persistence. 2A small number of women with recurrent UTI will have abnormalities of the urinary tract from kidney to urethra including calculi, urethral stricture and other lesions that may become a nidus for infection or interfere with adequate voiding (Table 1). In such individuals it is important to identify structural abnormalities of the urinary tract responsible for recurrent UTI.2 Thus the basis for radiologic or urologic investigation of women with recurrent UTI is to exclude abnormalities of the genitourinary tract that if uncorrected could result in future morbidity.However, most...

Recurrent Urinary Tract Infections Management in Women : A Review = الإلتهابات المتكررة للمسالك البولية عند النساء و طرق علاجها : مراجعة

“…31 More advanced investigations, such as cystoscopy, are advised in women over the age of 50. 32 Ultrasound of the kidneys, an intravenous pyelogram (IVP) and a computed tomography (CT) scan can help in detecting congenital structural urogenital anomalies. 9 …”

Guidelines for the diagnosis and management of recurrent urinary tract infection in women

“…[19][20][21][22][23][24] It, therefore, seems unnecessary to perform cystoscopy on all women presenting with recurrent uncomplicated UTI given this low pre-test probability. The small size of these studies prevented univariate or multivariate analysis to evaluate pre-test risk factors for an abnormal cystoscopy.…”

The Importance of Urethrocystoscopy and Bladder Biopsy in Gynecologic Patients

“…Reinfection is recurrent infection with different bacteria. The majority of infections are asymptomatic and clear spontaneously (Lawrentschuk et al 2006). In symptomatic patients the most common symptoms are dysuria, frequency, urgency, nocturia and suprapubic discomfort.…”

“…However, the published literature is in favor of cystoscopy in women with RUTI, principally in patients of more than 50 years old (Lawrentschuk et al 2006;Van Haarst et al 2001). …”

“…There are certain risk factors for developing urinary infections: hematuria, pyelonefritis, calculi, diabetes, in the elderly patients, urethral obstruction, pelvic surgery and urethral diverticulum (Lawrentschuk et al 2006). The majority of urinary tract infections are ascending infections from the fecal flora which colonize the vaginal introitus, then the periurethral tissues, and eventually gain entry to the bladder.…”