Introduction: Antibiotic-refractory recurrent urinary tract infections (rUTI) are challenging to manage. Prior studies have shown that in well-selected patients, electrofulguration (EF) of chronic trigonitis may disrupt a potential nidus of rUTI [1,2]. We report on long-term outcomes for women with at least five years of follow-up after EF.
Methods: Following IRB approval, we analyzed a cohort of non-neurogenic women with >3 symptomatic UTI/yr and cystoscopic evidence of trigonitis, who underwent EF from 2006 to 2011. Those with alternate identifiable source of rUTI (upper tract, prior mesh, stage 2 prolapse) or less than 5yr follow-up were excluded. Preoperative characteristics (demographics, antibiotic regimens, UTI/yr) were reported. The primary outcomes at 5yr post-EF were clinical cure (0-1 UTI/yr), improvement (2/yr) or unchanged (>3/yr), and endoscopic cure (no lesions on cystoscopy), improvement (persistent trigonitis), or progression (lesions beyond the trigone). Secondary outcomes were need for antibiotics prophylaxis or repeat EF.
Results: Of 44 women, median age was 65yr (56-74), parity was 2 (1-3), and BMI was 24.2 (20.7-29.3). Mean follow-up was 117 months (60-180); 22 women had >10yr follow-up. Prior to EF, 80% used daily antibiotic suppression, 9% used post-coital prophylaxis, and 14% used additional self-start therapy if symptomatic. 6 patients required IV antibiotics for pyelonephritis or multidrug resistance. By 5yr post-EF, 57% were clinically cured, 32% were improved, and 11% were unchanged. 86% had endoscopic cure, 7% had improvement and 7% had progression. 45% of all women did not need any antibiotic regimen, 35% used self-start therapy as needed, 18% used daily prophylaxis, and 9% used post-coital prophylaxis. All clinically cured patients also had endoscopic cure, and 79% did not use any antibiotic therapy. In contrast, both improved and unchanged patients were more likely to continue post-EF prophylaxis (p < 0.05) and have endoscopic persistence or progression (p < 0.05). 80% of clinically unchanged patients underwent repeat EF; median time to repeat EF was 12 months (6-58).
Conclusions: In women with over 5yr follow-up after EF for antibiotic-refractory rUTI and trigonitis, there appears to be durable clinical cure and improvement, with decreased need for long-term antibiotics.
Reference 1 Crivelli et al. IJU 2019 2 DeNisco et al. JMB 2019
.jpg)
.jpg)