Is a pelvic examination contributory in the initial evaluation of women with recurrent urinary tract infections?

Abstract

Recurrent urinary tract infections (rUTIs) affect up to 44% of women; evidenced-based guidelines regarding the contributory role of a pelvic examination in these women are lacking. We hypothesize that routine pelvic examination has a limited role in evaluation and management of women with rUTI when appropriate symptoms-based screening is performed and normal post-void residual volume (PVR) is confirmed. We performed a retrospective chart review of women ages 18-85 years presenting to Wake Forest Pelvic Health Center with two culture-proven UTIs in 6months or three UTIs in 12months with a documented pelvic examination. Pregnant women were excluded. Data extraction included demographics, medical history, screening assessment of vaginal bulge symptoms, urine culture results, imaging, physical/pelvic examination findings, PVR, treatment recommendations and outcomes within 1year of initial assessment. Descriptive statistics and Fisher's exact test were performed. Of 160 charts screened, 91 met the inclusion criteria. Nineteen (21%) had symptoms of vaginal bulge, and 14 (17%) had PVR > 100ml. Pelvic examination provided new/contributory information in eight (8.8%) of women. The negative predictive value of absence of bulge symptoms and normal PVR was 89%. Within 1year, 41 (46%) reported symptom resolution with rUTI treatment with no difference between those with or without a contributory pelvic examination (p value = 0.64). In women with rUTI who report absence of vaginal bulge symptoms and have a PVR < 100ml, a pelvic examination provides contributory information in < 10% of women and did not change treatment outcomes.