Transposition of Distal Urethra in Female Patients with Recurrent Lower Urinary Tract Infections Associated with Sexual Intercourse

Abstract

Background: Recurrent lower urinary tract infection (UTI) is often associated with sexual intercourse. Usually these patients are young females. Repeated courses of antibiotic therapy help some, but not helpful to all patients. Distal urethra vaginal ectopy seems to play an important role in accumulating microorganisms, resulting in recurrent UTI. The repositioning of the distal part of the urethra may potentially minimize microbial contamination in this area. Objective: The purpose of this study is to share the results of minimal invasive procedures, such as distal urethral transposition, in the treatment of female patients with symptomatic UTI associated with sexual intercourse. Patients: A total of 328 woman (mean age 25.9 years) with recurrent symptomatic lower UTI associated with sexual intercourse and repeated unsuccessful conventional treatment were found to have intravaginal urethral displacements during vaginal examinations. Two hundred and seventy-one patients underwent distal urethral transposition (group I) – a procedure depicted on a DVD provided with this article. Fifty-seven patients (mean age 25.9 years) with the same histories, anatomical findings, and symptoms and signs of lower UTI, receiving conventional treatment, served as controls (group II). The mean follow-up time of the 271 patients from group I was 52.5 months (48 – 57 months). Surgical Procedure: The operation makes it possible to withdraw the meatus from the area concerned. Measurements: All patients were initially diagnosed and treated for chronic cystitis and urethritis for at least 6 months without success. During vaginal examinations, special emphasis was given to the position of the distal urethra. A plastic penile imitator was introduced vaginally to evaluate urethral movements simulating intercourse. All patients were required to avoid sexual intercourse postoperatively for 1 month and were treated with standard antibiotic therapy for a mean time of 3 weeks. Results and Limitations: Patients from group I were evaluated after 3 months, showing no postoperative complications. Examinations of 204 (75.3%) patients from group I 1 year later showed no symptoms or signs of UTI. Sixty-seven (24.7%) patients required further antimicrobial prophylaxis after the procedure because of the longer preoperative duration of their symptoms. Nineteen patients (7.0%) showed poor results. One hundred and eighty-three patients were available for additional examinations after 3 and 5 years, (mean 4.4 years) revealing stable results with no lower UTI for these patients. Group II patients were followed-up for 1 year. Fortysix (80.7%) of them were found to have recurrent symptoms with poor response to the therapy, and had to undergo repeated treatment. Conclusions: Young female patient suffering from recurrent lower UTI should be evaluated with a specific emphasis on possible intravaginal urethral displacement during sexual intercourse. Conventional treatment can be long and often unsuccessful for the majority of patients. Distal urethral transposition is feasible, replicable, and can be used for these patients, leading to good and stable results in 93% of cases.