MP02-18: Comparing Costs Associated With Management of Antibiotic-Refractory Recurrent Urinary Tract Infections for One Year Pre- and Post-Electrofulguration of Trigonitis

Shivani Gaitonde*, Jacob A. Stevens, Joseph J. Crivelli, Philippe E. Zimmern, Dallas, TX

Introduction: Management of antibiotic-refractory recurrent urinary tract infections (rUTI) in women can be costly and challenging1. Past studies examined the role of electrofulguration (EF) of trigonitis2. We quantified and compared rUTI-associated costs for 1 year before and after EF.

Methods: Following IRB approval, a well-characterized cohort of non-neurogenic women with >3 symptomatic UTIs/year and inflammatory trigonal lesions on cystoscopy who underwent EF was analyzed. Women with alternate source of infection (prior urologic surgeries using mesh, voiding dysfunction, > stage 2 prolapse, upper tract abnormalities) were excluded. Cost of visits, imaging, labs, and medications were summed for 1-year pre- and post-EF. As reported previously3, these individual costs were calculated using the Medicare Physician Fee Schedule, local pharmacy pricing, and institutional expenses.

Results: 93 patients met study criteria (mean age 64yr), with 100% 1-year follow-up. Prior to EF, all patients underwent clinic visit, noninvasive flow studies and cystoscopy with urinalysis. 73% of patients were using daily antibiotic suppression, 6% self-start antibiotics, and 5% post-coital prophylaxis. Some women also used vaginal estrogens (14%), urinary analgesics (13%), and cranberry or D-mannose supplements (7%). In the 1-yr pre-EF, patients averaged 1.7 breakthrough UTIs. Post-EF, all patients underwent 6-wk follow-up and 6-mo cystoscopy with urinalysis. 88% of patients were on post-operative antibiotic prophylaxis for 6wk. At 1yr post-EF, 82% had <1 UTI and no cystoscopic evidence of trigonitis, while 14% required another EF for rUTI and residual cystitis. Patients had on average 0.7 UTIs in 1-year post-EF, which was significantly lower than pre-EF (p < 0.05). Mean 1-year pre-EF cost was $1328 (median $1071, range $291-$5564). Mean 1-year post-EF cost was $617 (median $467, range $275-$4580). On average, post-EF costs were $710 lower than pre-EF (p < 0.05).

Conclusions: For women with antibiotic-refractory rUTI and cystoscopic evidence of trigonitis, EF was associated with a significant reduction in UTI-related costs in the 1-year post EF.

Ref  1 Malik et al. FPMRS 2017   2 Crivelli et al.  IJU 2019    3. Gaitonde et al. Urology, 2019

Source of Funding: N/A