Electrofulguration in the advanced management of antibiotic‐refractory recurrent urinary tract infections in women

Abstract

Objective To evaluate the long‐term efficacy of electrofulguration in women with recurrent urinary tract infections. Methods After institutional review board approval, a retrospective study of women who underwent electrofulguration alone was carried out. All patients had recurrent urinary tract infections defined as three or more urinary tract infections/year, and a preoperative office cystoscopy showing inflammatory lesions, categorized by location: urethra, bladder neck, trigone and beyond the trigone. All lesions were cauterized during outpatient electrofulguration under anesthesia. On 6‐month postoperative office cystoscopy, endoscopic success was defined as resolution of all lesions previously seen and no new lesions. The primary outcome was urinary tract infections/year, with urinary tract infection defined as antibiotic treatment for urinary tract infection‐like symptoms and/or for positive urine culture. Clinical cure was defined as no further urinary tract infections, clinical improvement as less than three urinary tract infections/year, and clinical failure as three or more urinary tract infections/year. Results Of 95 women who met the study criteria between 2004 and 2016, 62 (65%) were endoscopically successful, and 33 (35%) were endoscopic failures based on postoperative cystoscopy. Among all patients, over a median follow‐up period of 4.9 years, the median number of urinary tract infections/year was 0.8. Endoscopically successful patients had fewer urinary tract infections/year compared with endoscopic failures (0.6 vs 0.9, P = 0.03). Clinically, 14 (15%) patients were cured, 69 (73%) were improved and 12 (13%) failed. Compared with clinically improved patients, clinical failures were more likely to have infections with multiple organisms (92% vs 35%, P < 0.001) and highly resistant organisms (92% vs 23%, P < 0.001). Conclusions In our experience, nearly two‐thirds of women with recurrent urinary tract infection can be successfully treated with electrofulguration, and >80% experience long‐term clinical cure or improvement in urinary tract infections.

Editorial Comment from Dr Yang to Electrofulguration in the advanced management of antibiotic‐refractory recurrent urinary tract infections in women

“…With a mean follow‐up period of 4.9 years, 62 of 95 women (65%) with recurrent UTIs had resolution of all lesions seen preoperatively and did not develop new lesions. This group of patients had significantly fewer UTI events per year compared with patients with endoscopic failure (0.6 vs 0.9, P = 0.03) . If similar results of EF can be reproduced in other centers, the EF approach could be considered as a treatment option for preventing recurrent UTIs.…”

“…Currently, there is no good evidence regarding the treatment of recurrent UTIs. In this study by Crivelli et al ., inflammation of the trigone has been viewed as a potential bacterial reservoir site . The authors reported a novel approach, electrofulguration (EF) to eradicate the bacteria in trigone, to reduce recurrent UTIs in women.…”

FIMBRIAE AND FLAGELLA MEDIATED SURFACE MOTILITY AND THE EFFECT OF GLUCOSE ON NONPATHOGENIC AND UROPATHOGENICESCHERICHIA COLI

“…For localized infections, an outpatient endoscopic procedure aimed at cauterizing these chronic sites of infection (electrofulguration) eliminates these resistant bacterial sites. Long-term data with this fulguration procedure in women with antibiotic recalcitrant rUTI has yielded adequate control of rUTI in a large proportion of affected patients (8). Treating diffuse pancystitis is more problematic.…”

Editorial Comment from Dr Takahashi to Electrofulguration in the advanced management of antibiotic‐refractory recurrent urinary tract infections in women

“…Crivelli et al . clearly showed that electrofulguration (EF) for female patients with recurrent urinary tract infections (rUTIs) mostly led to improvement in urinary tract infection (UTI) and long‐term clinical cure . Therefore, EF might show promise in the management of refractory rUTI.…”

“…From this point of view, research on EF might be relevant to the discussion of antimicrobial stewardship and, in particular, development of antimicrobial resistance, because Crivelli et al . found that the patients with success by EF rarely received suppressive antibiotics …”