(1)
Department Obstetrics & Gynaecology, St George Hospital, Kogarah, New South Wales, Australia
Abstract
Recurrent bacterial cystitis is defined as recurrent significant bacteriuria (more than 105organisms per ml of a single organism), with significant pyuria (more than ten white blood cells per ml), in the absence of upper tract pathology. “Recurrent” is usually taken to mean more than three proven UTIs in the last 5 years. (Because the abbreviation RBC usually applies to red blood cells, “UTI” is used here.) If upper urinary tract disorders are causing the UTI, then referral to a urologist is required. Also, if there is no upper tract disorder, but the patient has recurrent bouts of hematuria associated with the UTI, then urology referral is also indicated. Recurrent UTI is common in urogynecological patients. About 4 % of women aged 15–65 have significant bacteriuria at any given time (Kass et al. [2]), and the prevalence rises with age. About 25 % of women experience at least one proven recurrence within 6 months of the first attack [1].
Recurrent bacterial cystitis is defined as recurrent significant bacteriuria (more than 105 organisms per ml of a single organism), with significant pyuria (more than ten white blood cells per ml), in the absence of upper tract pathology. “Recurrent” is usually taken to mean more than three proven UTIs in the last 5 years. (Because the abbreviation RBC usually applies to red blood cells, “UTI” is used here.) If upper urinary tract disorders are causing the UTI, then referral to a urologist is required. Also, if there is no upper tract disorder, but the patient has recurrent bouts of hematuria associated with the UTI, then urology referral is also indicated. Recurrent UTI is common in urogynecological patients. About 4 % of women aged 15–65 have significant bacteriuria at any given time (Kass et al. [2]), and the prevalence rises with age. About 25 % of women experience at least one proven recurrence within 6 months of the first attack [1].
Guide to Management of Recurrent UTI
At the first visit, take history of “recurrent” carefully.
Check any previous or family history of renal calculi
Obtain old MSU results from GP if possible.
Check whether the patient has episodes of multiresistant organisms, which may explain why there are “recurrences” (the treatment may have been incorrect).
Check for unusual bacteria such as Proteus mirabilis, Pseudomonas, Streptococcus faecalis, etc., that may suggest upper tract disease.
Ascertain whether UTI is mainly triggered by intercourse.
Check whether previous colposuspension or TVT may have caused voiding dysfunction/high residual urine volumes.
During Examination
Examine the renal angles for silent calculi.
Percuss the abdomen for an enlarged bladder/subacute retention.
Check for a large cystocele that may harbor a stagnant pool of urine.
Check for atrophic vaginitis, which increases susceptibility to UTI.
Investigations for Recurrent UTI
We find it useful to give the patient three sterile urine culture jars and ask her to give a specimen of urine at the very first symptom of any infection, to check organism type. Although dipstick testing is cost effective in general practice, in the patient with recurrent UTI and incontinence/prolapse, the organisms should be identified on culture. Ask for all organisms to be reported, even if count only 102 per ml, with pyuria. Particularly in detrusor overactivity, low-grade UTI may exacerbate the OAB symptoms [7].
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