Urine trouble without cranberries?

Abstract

une, 18 years ago, I was standing on the front lawn of the in women undergoing pelvic reconstructive surgery that J First Baptist Church in Augusta, GA, having just recited the Hippocratic Oath as part of graduation ceremonies. My brother, having also just graduated from a different medical school asks me, “So what do you think you can actually treat?” My reply belies reality. “I guess I could treat a UTI.” For many medical professionals, a urinary tract infection (UTI) is simple. Throw some antibiotic at the problem and it will go away. Simple things, however, do not often remain so simple with improved understanding. UTIs are a problem. About 20% of the US population (with >80% of that number being women) will have at least 1 UTI during their lifetime. Millions of office visits and dollars are spent on the problem with the therapies in many cases spawning new problems and more spending. The issue is particularly vexing in the context of gynecologic surgery. The most common complication of pelvic floor surgery is UTI. In the randomized Stress Incontinence Surgical Treatment Efficacy trial that compared Burch colposuspension to autologous fascial sling in women with stress urinary incontinence, 48% of women in the sling group and 32% women in the Burch group reported UTI within the first 24 months of follow-up. Among women pursuing obliterative surgery for pelvic organ prolapse, 45% had UTI within 3 months of surgery. Given the morbidity, and in some cases mortalityeapproximately 13,000 deaths attributable to UTI occur annually in the United Statesefinding an effective prophylaxis is a worthy goal. Unfortunately, trials of UTI prophylaxis in the context of female pelvic floor surgery arrive at opposite conclusions. In a multicentered, randomized trial comparing nitrofurantoin to placebo among women with a suprapubic tube following pelvic floor surgery, antibiotics decreased UTI incidence. Similarly, a randomized placebo-controlled trial with nitrofurantoin among women undergoing a midurethral sling also concluded that antibiotics decreased UTI incidence in this high-risk context. In contrast, a recent randomized trial