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

• Published in: International journal of urology 2019-06, Vol.26 (6), p.662-668
• Main Authors: Crivelli, Joseph J, Alhalabi, Feras, Zimmern, Philippe E
• Format: Article
• Language: English
• Subjects: cystitis; electrofulguration; female urology; recurrent urinary tract infections; trigonitis
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/iju.13963

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