Treatment and Prevention of rUTI in Women

White woman with short brown hair sitting with doctor in an office, discussing rUTI.

By Dr. A. Keith Levinson, M.D.

Symptomatic, recurrent lower urinary tract infections (rUTI) in women are a common condition for which best practice guidelines related to treatment and prevention have not been well established. rUTi affects women of all ages and is defined as 2 or more symptomatic episodes in 6 months or 3 episodes in 1 year. Between 20% to 30% of women who have one UTI will have a rUTI, and approximately 25% of these women will have more recurrent episodes.

Symptoms of rUTI may typically include burning with urination, foul smelling urine, urinary urgency, and frequency. Treatment strategies should focus on relieving symptoms while at the same time preventing the overuse of antibiotics, which can cause increased side effects as well as the development of antibiotic resistance.

Who is at risk or rUTI? 

  • For premenopausal women, sexual activity can be associated with rUTI.
  • Birth control products such as nonoxynol-9 spermicide can be a risk factor as well.
  • Lack of estrogen in postmenopausal women can lead to vaginal atrophy, acidic PH changes, and overgrowth of bacteria leading to UTI

What type of work up is needed to treat rUTI?

A urine culture prior to treatment with antibiotics is important to document infection and help determine optimal antibiotic treatment. More complex cases may require renal imaging or cystoscopy.

How is rUTI best treated? 

Short course treatment of 3-5 days is recommended. Preferred first line antibiotics are Nitrofurantoin, Trimethoprim-Sulfa, and Fosfomycin. Fluoroquinilones such as Cipro are discouraged.

rUTI prevention strategies:

Some prevention strategies include lifestyle and behavioral modifications:

  • controlling blood glucose in diabetics is important
  • Sexually active women should avoid spermicide gel use. It is unclear whether voiding after intercourse is useful
  • Avoid unnecessary or prolonged antibiotic use (more than 5 days)
  • maintain adequate hydration

There are also therapeutic interventions, such as antibiotic treatments:

  • The use of antibiotic prophylaxis may sometimes be indicated and can be done in several ways.
    • The use of a single low dose antibiotic immediately after intercourse can be very effective in preventing.
    • Once daily low dose antibiotics for 6-12 months may be required at times and is effective.
    • A patient self start 3 day course of antibiotics can be a convenient way to treat intermittent It is best to get a urine culture prior to starting treatment.

Nonantibiotic therapy: 

While commonly used to prevent rUTI, there is little data to support the use of Cranberry products or D-mannose. The value of oral and vaginal probiotics is questionable.

Vaginal estrogen therapy reduces vaginal PH, reduces bacterial colonization, restores lactobacillus, and reduces rUTI in postmenopausal women. There is no documentation of increased breast cancer risk or rise in serum Estrogen levels. Oral estrogens do not reduce UTI risk.

Methenamine Hippurate :

This is a bacteriostatic agent that increases urinary levels of formaldehyde. It does not promote antibiotic resistance. There is some evidence that using methenamine as prophylaxis may help prevent rUTI and reduce need for prophylactic antibiotics.

Vaccines: 

OM-89 (Uro-Vaxom) is an oral vaccine only available in Europe. It appears to be safe and effective in reducing rUTI. Hopefully, this will available in the U.S. soon

rUTI’s are frustrating for women and can significantly impact quality of life, and daily activities. Identifying underlying risk factors is important. There are potentially preventive measures worth discussing with your doctor.

If you have any more questions about the treatment and prevention of rUTIs in women, click here to schedule an appointment with a Georgia Urology expert today.

How to Prevent and Manage STDs

Urologist tells patient that they have STDs.

By Dr. Darrell J. Carmen, M.D., F.A.C.S.

Unfortunately, sexually transmitted diseases (STDs) are common.

Chlamydia is the most commonly reported STD in the U.S. It’s spread mostly by vaginal or anal sex, but you can get it through oral sex, too. Sometimes you’ll notice an odd discharge from your vagina or penis, or pain or burning when you urinate. But only about 25% of women and 50% of men get symptoms. Some other common STDs are gonorrhea, genital herpes, human papillomavirus (HPV), syphilis, trichomoniasis, and HIV/AIDS human immunodeficiency virus or acquired immunodeficiency syndrome.

Not all conditions that affect the sex organs are considered STDs, and some are not related to sex at all. Some are sexually-associated, meaning that they aren’t transmitted during sex, but occur as a result of it. A urinary tract infection can occur because of irritation from intercourse but is not an STD.

How to Prevent STDs

To prevent getting a sexually transmitted disease, always avoid sex with anyone who has genital sores, a rash, discharge, or other symptoms. The only time unprotected sex is safe is if you and your partner have sex only with each other, and if it’s been at least six months since you each tested negative for STDs. Otherwise, you should:

  • Use latex condoms every time you have sex. Condoms are not 100% effective at preventing disease or pregnancy. However, they are extremely effective if used properly.
  • If you use a lubricant, make sure it’s water-based.
  • Avoid sharing towels or underclothing.
  • Shower before and after intercourse.
  • Get a vaccination for hepatitis B. This is a series of three shots.
  • Get tested for HIV.
  • If you have a problem with drug or alcohol abuse, get help. People who are drunk or on drugs often fail to have safe sex.
  • Consider that not having sex is the only sure way to prevent STDs.

It was once thought that using condoms with nonoxynol-9 helped to prevent STDs by killing the organisms that can cause disease. Current research shows that doing so also irritates a woman’s vagina and cervix and may increase the risk of an STD infection. New recommendations are to avoid using condoms with nonoxynol-9.

How to Manage STDs

  • Stop having sex until you see a doctor and are treated. Most tests to diagnose STDs can be obtained from a voided urine or blood specimen. urethral swab not needed.
  • Follow your doctor’s instructions for treatment.
  • Use condoms whenever you have sex, especially with new partners.
  • Don’t resume having sex unless your doctor says it’s OK.
  • Return to your doctor to get rechecked.
  • Be sure your sex partner or partners also are treated.
  • Use latex condoms every time you have sex. If you use a lubricant, make sure it’s water-based.

If you have any more questions about STDs from our experts, click here to contact us today.

Urinary Tract Fistula After Hysterectomy: What are the Options?

Urologist is speaking with patient about Urinary Tract Fistula.

By Dr. Lambda Msezane

Severe continuous leakage of urine is a rare complication after routine hysterectomy. This can be a sign of a fistula between the bladder, vaginal wall, or the ureter and the vaginal wall. A fistula is an abnormal tract that forms between two areas of the body.

Keep reading below to learn more about urinary tract fistula from a Georgia Urology expert.

What are the Symptoms of Urinary Tract Fistula?

The main symptom of a urinary tract fistula to the vagina is nonstop leakage of urine. Associated symptoms include abdominal pain or fever if urine collects in the abdomen. The type of leakage associated with a fistula is more severe than the typical stress and urge incontinence that can also occur. In most cases, it requires surgical intervention to repair this complication.

How is Urinary Tract Fistula Treated?

In the past, women would have to wait 6 weeks to 3 months before repairs could be attempted after a traditional open hysterectomy. This is due to the number of adhesions or scar tissue that forms after surgery. This was especially true because the signs of fistula can be delayed for a week to 10 days as the tract forms and this is when the adhesions start to become difficult. A woman would have to wait either with a catheter, a nephrostomy tube (a tube into the kidney through the back), or deal with the leakage until the repair could be attempted.  

Robotic-assisted surgery has changed the urologist’s approach to this life-changing complication. Due to the robotic arms and 10x magnification camera, we are allowed the ability to access the pelvis with great visualization and dexterity. This is done through small incisions as opposed to a large midline incision. Urologists no longer need to wait months to repair the fistula. We can either re-implant the ureter to move it away from the fistula tract in the case of a ureterovaginal fistula or dissect the bladder away from the vaginal wall in the case of a vesicovaginal fistula.

What is Recovery Like for Treating Urinary Tract Fistula?

Since the surgery is minimally invasive, the patient can go home the next day and can be completely healed in about 4 weeks. This significantly shortens the recovery time compared to open repair. An indwelling catheter to drain the bladder and a ureteral stent may be needed postoperatively for a short period of time.  

Although initially devasting, the repair of vesicovaginal or ureterovaginal fistula post hysterectomy can be performed in a timely fashion thanks to the robotic approach. Women with this complication can return to their normal life with a smaller incision, less pain and recovery time, and most importantly no further severe leakage of urine.

If you have any more questions about this urological condition or treatment options, get in contact with Georgia Urology physicians by clicking here.