Jacqueline A Chavez1, Alana L Christie2, Philippe E Zimmern3. 1. Department of Urology, UT Southwestern Medical Center, Dallas, TX. 2. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX. 3. Department of Urology, UT Southwestern Medical Center, Dallas, TX. Electronic address: Philippe.Zimmern@utsouthwestern.edu.
Abstract
OBJECTIVE: To evaluate the efficacy of repeat endoscopic electrofulguration in women with antibiotic-refractory, recurrent urinary tract infections (RUTIs) with persistent symptoms after 1 electrofulguration. METHODS: An institutional review board-approved, prospectively maintained database of non-neurogenic women with RUTIs, persistent symptoms and endoscopic findings of bladder wall inflammation after 1 electrofulguration, and minimum 6 months follow-up was reviewed. Endoscopic success was defined as complete resolution of previous lesions without new lesions seen during office cystoscopy 6 months after second electrofulguration. Clinical success was defined as no urinary tract infections at last follow-up; improvement as 1-2 treated infections/year; and failure as ≥3 treated infections/year, daily antibiotic suppression, or another electrofulguration (third or fourth). RESULTS: From 2006 to 2018, 58/70 (83%) women with median age 70 years and median follow-up 26 months were included, and 53/58 had endoscopic data 6 months postsecond electrofulguration. Endoscopic success was noted in 26 (49%), and 21/26 had <3 UTIs within the last year of follow-up, vs 2/27 (7%) with endoscopic failure (P = .001). Among those with clinical failure, 6/30 (20%) remained on suppressive antibiotics, 9/30 (30%) required intravenous antibiotic courses, and 2 proceeded to cystectomy. Of 24 women who underwent a third electrofulguration, 11/24 (46%) were clinically successful or improved at median 22 months follow-up. Urine cultures from the year of last follow-up revealed extended-spectrum beta lactamase producing strains (50%) and strains resistant to >3 antibiotics (43%). CONCLUSION: Women with persistent RUTIs following 1 electrofulguration may benefit from a second or even third procedure.
OBJECTIVE: To evaluate the efficacy of repeat endoscopic electrofulguration in women with antibiotic-refractory, recurrent urinary tract infections (RUTIs) with persistent symptoms after 1 electrofulguration. METHODS: An institutional review board-approved, prospectively maintained database of non-neurogenic women with RUTIs, persistent symptoms and endoscopic findings of bladder wall inflammation after 1 electrofulguration, and minimum 6 months follow-up was reviewed. Endoscopic success was defined as complete resolution of previous lesions without new lesions seen during office cystoscopy 6 months after second electrofulguration. Clinical success was defined as no urinary tract infections at last follow-up; improvement as 1-2 treated infections/year; and failure as ≥3 treated infections/year, daily antibiotic suppression, or another electrofulguration (third or fourth). RESULTS: From 2006 to 2018, 58/70 (83%) women with median age 70 years and median follow-up 26 months were included, and 53/58 had endoscopic data 6 months postsecond electrofulguration. Endoscopic success was noted in 26 (49%), and 21/26 had <3 UTIs within the last year of follow-up, vs 2/27 (7%) with endoscopic failure (P = .001). Among those with clinical failure, 6/30 (20%) remained on suppressive antibiotics, 9/30 (30%) required intravenous antibiotic courses, and 2 proceeded to cystectomy. Of 24 women who underwent a third electrofulguration, 11/24 (46%) were clinically successful or improved at median 22 months follow-up. Urine cultures from the year of last follow-up revealed extended-spectrum beta lactamase producing strains (50%) and strains resistant to >3 antibiotics (43%). CONCLUSION: Women with persistent RUTIs following 1 electrofulguration may benefit from a second or even third procedure.
Authors: Tahmineh Ebrahimzadeh; Amy Kuprasertkul; Michael L Neugent; Kevin C Lutz; Jorge L Fuentes; Jashkaran Gadhvi; Fatima Khan; Cong Zhang; Belle M Sharon; Kim Orth; Qiwei Li; Philippe E Zimmern; Nicole J De Nisco Journal: Life Sci Alliance Date: 2021-05-06