Recurrent Urinary Tract Infections Research Articles

Role of videourodynamics, imaging, and cystoscopy in patients with recurrent urinary tract infections: Should we throw in the kitchen sink?

Purpose:Recurrent urinary tract infection (rUTI) remains a common outpatient problem with discordance and paucity of evidence for management. This study aims to evaluate the role of videourodynamics (VUD), additional imaging, and cystoscopy in the complete workup of these patients. Materials and Methods:A retrospective review was performed on 1421 consecutive patients referred for physician performed VUD. After exclusion criteria, 170 patients were included. Ethics approval was obtained, followed by data collection, and analysis of demographics, symptoms, cystoscopy results, imaging, and VUD parameters. Statistical analyses were performed with IBM SPSS Statistics Version 28. Statistical significance was defined by an alpha level of P ≤0.05. Results:Overall, 117/170 (69%) had identifiable causes of rUTI identified on VUD. There was a statistically significant difference (p<0.001) in identifying a cause in those with voiding symptoms (93/114 = 82%) compared to those without (24/56 = 43%). Gender was not predictive of an identifiable cause on VUD (p=0.47). Neither was a neurogenic history (p=0.11), diabetes (p=0.97), or age (p=0.89). Additional imaging was not diagnostic for rUTI cause. No malignancy was identified on imaging or cystoscopy. Conclusion:In patients with rUTI, VUD may be an important investigative step to find a possible underlying cause, but it is a scarce resource. As VUD has a higher detection rate in patients with voiding symptoms, by first screening for these patients on history, VUD can be used judiciously. Cystoscopy and additional imaging were not as helpful in identifying a target treatment plan for rUTI, when a VUD had already been done.

Innate immunity of the urothelium: A new step in decoding pathogenesis and improving therapeutic strategy for recurrent urinary tract infections in children

Innate immunity of the urothelium: A new step in decoding pathogenesis and improving therapeutic strategy for recurrent urinary tract infections in children

A comparative study on the efficacy of laparoscopic ureteroureterostomy versus single ureteral bladder reimplantation in treating pediatric complete renal duplication.

To explore the therapeutic value of laparoscopic ureteroureterostomy compared to single ureteral bladder reimplantation in the treatment of pediatric complete renal duplication. This retrospective study included 80 pediatric patients with complete renal duplication who underwent surgical treatment at the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2022. Patients were divided into two groups based on the surgical approach: the laparoscopic ureteroureterostomy group (LUU group, n = 45) and the single ureteral bladder reimplantation group (UR group, n = 35). The two groups were compared in terms of operative time, intraoperative blood loss, number of stent placements, postoperative length of hospital stay, changes in ante-posterior diameter (APD) of the affected upper kidney pelvis before and after surgery, changes in upper ureteral diameter (UD), changes in upper renal cortex thickness (RCT) and variations in renal function. The LUU group demonstrated significantly shorter operative time (t = 3.480, P = 0.004), less intraoperative blood loss (t = -2.465, P = 0.0196), and reduced postoperative length of stay (t = 2.308, P = 0.027) compared to the UR group. There was no significant difference between the two groups regarding the number of stent placements (x2 = 0.762, P = 0.383). The UR group had four cases of long-term complications (two cases of anastomotic stricture, one case of vesicoureteral reflux, and one case of recurrent urinary tract infection), while the LUU group experienced one case of long-term complication (one case of anastomotic stricture), with no significant difference between groups (x2 = 1.493, P = 0.222). Both groups showed significant improvement in preoperative and postoperative APD, UD, RCT and affected side differential renal function (DRF). However, the differences in improvement values for upper kidney pelvis APD (ΔAPD; t = -0.032, P = 0.962), upper RCT (ΔRCT; t = -0.042, P = 0.957), ureteral diameter (ΔUD; t = 1.832, P = 0.079), and differential renal function (ΔDRF; Z = 1.895, P = 0.073) were not statistically significant. Both LUU and UR procedures are safe and effective in treating pediatric complete renal duplication. Compared to UR, LUU results in shorter operative time, less intraoperative blood loss, and reduced postoperative length of stay, while also causing less damage to the bladder.

Persistent Elevation in Urinary Neutrophil Gelatinase-Associated Lipocalin Levels Can Be a Predictor of Urinary Tract Infection Recurrence or Persistence in Women

Women commonly experience urinary tract infection (UTI) recurrence. However, there is no effective tool for predicting recurrent UTI after the first UTI episode. Hence, this study aimed to investigate potential urinary inflammatory biomarkers and specific biomarkers for predicting UTI recurrence or persistence after antibiotic treatment in women. Forty women who had a history of recurrent UTI within 1 year after the initial episode and acute bacterial cystitis were treated with broad-spectrum antibiotics for 1 week. To measure inflammatory biomarker levels, urine samples were collected at the baseline and after 1 week, 1 month, and 3 months. The levels of urinary pro-inflammatory proteins such as neutrophil gelatinase-associated lipocalin (NGAL), nerve growth factor, CXC-motif chemokine ligand (CXCL)-1, interleukin-8, CXCL-10, monocyte chemoattractant protein-1, and tumor necrosis factor-alpha were measured using commercial kits. Seven healthy age-matched women were included as controls. The changes in urinary biomarker levels at the baseline and various time points were compared between women with and without UTI recurrence within 1 month or within 3 months after the initial antibiotic therapy. At the baseline, patients with a higher urinary white blood cell count had a significantly higher NGAL level than the controls and those with a low white blood cell count. Of the 40 patients with a history of recurrent UTI, 12 presented with UTI persistence or recurrence within 1 month and 19 within 3 months after the initial antibiotic treatment. Among the 28 patients without UTI recurrence at 1 month after treatment, 7 had UTI recurrence within 3 months. Compared with patients without UTI recurrence, those with UTI recurrence had significantly higher urinary NGAL levels at 1 week, 1 month, and 3 months after the initial treatment. This study concludes that persistent elevation in urinary NGAL levels after the initial antibiotic treatment indicated persistent bladder inflammation. Further, it could be a predictor of UTI persistence or recurrence within 1 or 3 months after the initial antibiotic treatment. Patients with a history of recurrent UTI and high urinary NGAL levels after antibiotic treatment might require a longer treatment duration to completely eradicate or prevent UTI recurrence.

Recent advances in the diagnosis of bladder outlet obstruction in men

Background: Bladder outlet obstruction (BOO) represents a common cause of lower urinary tract symptoms in men, frequently resulting from benign prostatic hyperplasia. Key symptoms include both obstructive and irritative urinary tract symptoms, such as dysuria, increased frequency and urgency of urination, and recurrent urinary tract infections. BOO can also cause upper urinary tract dilation (hydronephrosis), damage structure, and impair function of the bladder. Objective: Early diagnosis of BOO is essential to the protection of kidney and bladder functions. The gold standard for diagnosing BOO is urodynamic studies (UDS), which measure detrusor pressure and urinary flow. However, UDS is an invasive test and is associated with risks for urinary tract infections, bothersome urinary symptoms, and hematuria. Given the invasiveness and discomfort associated with UDS, non-invasive diagnostic methods have been developed. Nevertheless, the main limitation of these techniques is the variability in threshold values, highlighting the need for further standardization of measurement protocols. This article reviews the current diagnostic approaches for BOO in men and explores their clinical utility. Conclusion: Various non-invasive diagnostic methods are promising; yet, UDS remains the primary diagnostic approach.

Effect of an Add-On Multi-Strain Probiotic Formulation in the Prevention of Recurrent Urinary Tract Infections: A Double-Blind Randomized Placebo-Controlled Trial

Urinary tract infections (UTIs) present a significant health challenge for women globally, particularly due to high recurrence rates. This randomized, double-blinded, placebo-controlled study conducted at AIIMS Bhubaneswar, India, evaluated the effectiveness of a multi-strain lactobacilli probiotic formulation as an adjunct to standard antibiotic therapy in preventing recurrent UTIs. Fifty-one adult women (18–50 years) with recurrent UTIs received either the probiotic or a placebo for 24 weeks. The primary outcome was UTI recurrence, while secondary outcomes included the number of UTI episodes and changes in urinary nerve growth factor (NGF) and serum macrophage colony-stimulating factor (M-CSF) levels. The results showed a significant reduction in UTI recurrence in the probiotic group, with 75% remaining recurrence-free, compared to 33% in the placebo group (p = 0.007). The relative risk for recurrence absence was 2.67 (95% CI: 1.19–5.99). Although the mean number of UTI episodes decreased in the probiotic group, the difference was not statistically significant (p = 0.379). The urinary NGF and serum M-CSF levels significantly decreased from baseline in both groups, but there were no significant differences between them. This study suggests probiotics may be a valuable adjunct therapy for preventing recurrent UTIs.

Characteristics of Urinary Tract Infections in Patients with Diabetes from Timișoara, Romania: Prevalence, Etiology, and Antimicrobial Resistance of Uropathogens.

Background and Objectives: Diabetic patients are more likely to develop infections compared to the general population, especially urinary tract infections (UTIs). The aim of this study was to assess the prevalence of UTIs in a population of patients with diabetes (DM) from Romania, to identify the most common uropathogens and their antimicrobial resistance (AMR) patterns, as well as to determine the correlations between resistance behavior and particularities of patients with UTIs according to DM type. Materials and Methods: The hospital records of 1282 type 1 (T1D) and type 2 DM (T2D) adult inpatients who were ordered urine cultures during hospitalization were reviewed, and all 241 patients who presented a positive urine culture were included in the present study analysis. Results: The prevalence of UTIs in diabetic patients was 18.8% and higher in patients with T2D vs. T1D. Patients with UTIs and T2D had a significantly older age, longer duration of DM, higher waist circumference and body mass index, lower levels of estimated glomerular filtration rate, and more frequent chronic complications of DM than patients with T1D. E. coli was the most frequently isolated uropathogen (56.4%), with a significantly higher incidence for T2D, followed by K. pneumoniae (12.9%) and Enterococcus spp. (9.5%). Although the acquired resistance phenotypes were more frequently isolated in T2D patients (over 90% of the multidrug-resistant and extended-spectrum beta-lactamase-producing isolates, respectively, and 75% of the total carbapenem-resistant organisms), no statistically significant correlation was found regarding the distribution of AMR patterns in the two types of DM. Conclusions: The present study brings new data regarding the prevalence of UTIs in diabetic patients from Western Romania. By identifying the spectrum of uropathogens and their AMR pattern, this paper may contribute to improving UTI management in diabetic patients, thus reducing antibiotic overuse and preventing recurrent UTIs.

Gender specific differences in urethral swabs: a retrospective single-center analysis.

Sexually transmitted infections (STIs) are globally on the rise yet accurate data regarding infection rates remains scarce. There is the assumption that STIs among women with chronic urinary tract infections (UTIs) have been underestimated. This may arise from the reliance on specialised cultivation or Nucleic Acid Amplification Techniques (NAT) for detection, which are more costly than standard urine culture and are typically only conducted by specialists like urologists. A retrospective, observational, single-centre study using medicals records of patients who received a urethral swab in a German urological practice in the past five years has been conducted. 55% had a STI requiring treatment. People with recurrent UTI had a STI in 35% of the casees. Younger age is associated with the detection of STI. The female gender is significantly associated with a positive swab result. Distinguishing between cystitis and urethritis, particularly in women with recurrent UTIs experiencing dysuria, presents a clinical challenge. The prevalence of asymptomatic infections suggests that the true burden of urethritis, particularly STIs, may be substantially higher in the general population. This underscores the urgency of establishing guidelines for referral and diagnostic evaluation, as delayed or inadequate treatment may contribute to escalating infection rates and antibiotic resistance.

Implementing a Digital Platform for Recurrent Urinary Tract Infections.

A patient-centered care model is needed for recurrent urinary tract infection (UTI) management. The aim of this study was to develop a conceptual model for a digital platform to implement evidence-based guidelines for recurrent UTI management. This was a qualitative, 3-stage mixed methods study that included (1) developing an evidence-based prototype texting platform; (2) qualitative feedback from recurrent UTI patients using the platform; and (3) quantitative data on acceptability (proportion of patients engaging with the platform), accuracy (proportion of patient messages interpreted accurately by the platform), and usability (score 0-100). Thirty-one women with recurrent UTI (median age, 71 years; range, 60-74 years) participated in testing over 4 months. The prototype platform was modified through iterative rounds of qualitative and quantitative analysis until engagement ≥85%, accuracy ≥90%, and usability score of ≥80 were achieved in 10 patients. Qualitative feedback indicated that patients valued rapid access to treatment through fewest possible health encounters during an acute episode, evidence-based education about prevention, and ability to participate in self-management with support from health care providers. Based on this feedback, a conceptual model consisting of 3 main components was developed: (1) an algorithm to triage acute symptoms, (2) educational videos emphasizing prevention strategies, and (3) supportive messages. Patient feedback identified 4 key implementation outcomes-usability, acceptability (engagement), fidelity (accuracy), and cost-and 3 clinical outcomes-self-efficacy, health care utilization, and rate of unnecessary antibiotics for testing the model. The proposed model can be used to implement and test a patient-centered evidence-based digital platform for the management of recurrent UTI.

Green Cystoscopy: Does Minimizing the Use of Drapes Increase Infection Rates?

The U.S. health care system has an enormous carbon footprint made worse by the escalating use of single-use supplies. Emerging evidence suggests that smaller surgical fields ("green" draping) may represent a safe alternative to traditional draping. The aim of the study was to determine if the proportion of cases treated for culture-proven urinary tract infection (UTI) within 2 weeks of operating room cystoscopy after the green draping protocol implementation is noninferior to preprotocol cases. Secondary objectives included risk factors for UTI and waste and cost savings. A pre-post implementation noninferiority study was performed from 2021 to 2023 in a urogynecology division at an academic medical center. The green draping protocol eliminated the use of top drapes, leg drapes, and gowns; blue towels were permitted per the surgeon's discretion. All minor cystoscopy cases were included. The cohort included 240 patients. Treatment of culture-proven UTI in the green cohort was noninferior to the preprotocol group (9 [7.5%] vs 7 [5.8%], P < 0.05). The odds of a culture-proven UTI were higher with history of recurrent UTI (odds ratio = 7.02), interstitial cystitis/bladder pain syndrome (odds ratio = 4.33), and older age (odds ratio per 5-year increase = 1.21). Approximately $1,403.92 (2023 USD) was saved, and 165 pounds of waste was diverted from the landfill. A green draping protocol is noninferior to standard draping with respect to rates of postoperative culture-positive UTIs. Clinicians may use a smaller operating room field to decrease the carbon footprint without compromising quality of care.

Does Tobacco Smoking Affect Vaccine-Induced Immune Response? A Systematic Review and Meta-Analysis.

Background. Causing approximately 8 million deaths each year, tobacco smoking represents a significant public health concern. Evidence shows that smoking significantly impairs antibody production and immune cell activity following vaccination. Objectives. This review aims to provide a comprehensive overview of the literature regarding how smoking reduces the effectiveness of active immunization by affecting vaccine-induced immune response. Methods. This study was performed according to the PRISMA guidelines, and the protocol was registered on the PROSPERO platform (ID: CRD42024582638). PubMed, Scopus and Web of Science were consulted as bibliographic and citation databases. Studies published in Italian and English and that aimed to investigate the effects of exposure to active and passive tobacco smoking on vaccine-induced immune response were included. Results. Thirty-four studies were selected. Overall, a decrease in antibody levels and avidity and in immune cell production were observed in individuals exposed to smoke. The meta-analysis showed a weighted mean difference between smokers and non-smokers equal to 0.65 (95% CI: 0.10-1.19, p = 0.02) for vaccinations against COVID-19, influenza, pneumococcus, HBV, HPV, tetanus, pertussis, polio, haemophilus influenzae type b, measles-mumps-rubella, and recurrent urinary tract infections. Conclusions. Smoking cessation campaigns should be considered in order to increase the effectiveness of vaccination programs. Furthermore, the opportunity to adopt different vaccine dosing schemes for smokers and non-smokers, especially in acute epidemics, should be considered.

Short and long-term clinical results of a minimally invasive syringe adapter for catheter free instillation of intravesical treatments

Introduction:Intravesical treatment is currently dependent on catheterization which can cause urethral discomfort and risk of urinary tract infections in selected patient groups such as interstitial cystitis/bladder pain syndrome (IC/BPS), overactive bladder syndrome (OAB) and recurrent urinary tract infections (rUTI). This study describes real-life clinical experience of a minimally invasive syringe adapter (Ialudapter®) for catheter-free instillation of intravesical treatment. Methods:A retrospective study from a single center was performed. Quantitative and qualitative data was obtained on the use of the syringe adapter (IALUADAPTER®) in 61 patients with IC/BPS (n=48), rUTI (n=6) and mixed /other diagnoses (including OAB; n= 7) who were receiving intravesical therapy. The evaluation period was 6 months during 2018–2019. Reasons for trying the syringe adapter, reasons for continuing with it and occurrence of UTIs before and during the evaluation period were recorded. In addition, 3 year follow-up data were obtained to assess long-term usage of the syringe adapter. Results:Mean follow-up was 4 months. The use of the syringe adapter was successful in 75% and a positive experience in 74% with the latter continuing to use the syringe adapter. Long-term (>3 yrs) adherence of 40% was observed. The patients reported less pain (41%) while 23% reported that it was easier to use compared to conventional catheters. Only 6 UTIs were observed in the follow-up period. Discussion and conclusions:This retrospective study shows that the Ialudapter® is a good, safe alternative to conventional catheterization for intravesical treatment.

Clinical characteristics of primary vesicoureteral reflux in children with an allergic constitution.

This study was designed to compare the clinical data of vesicoureteral reflux (VUR) in children with and without an allergic constitution. The clinical data of patients hospitalized with VUR due to a urinary tract infection (UTI) between September 1, 2019, and December 31, 2020, were retrospectively analyzed. The patients were divided into two groups: an anallergic constitution group (AC group) and a non-allergic constitution (NAC group), and their UTIs and VUR were compared at baseline and during the follow-up period. (1) Between September 1, 2019, and December 31, 2020, a total of 284 children were hospitalized at Shengjing Hospital Affiliated to China Medical University due to a UTI. These children included 37 cases with primary VUR and 247 cases without VUR (including 59 cases of non-VUR urinary malformation). The proportion of children with an allergic constitution was significantly higher in the patients with VUR than it was in those without VUR or with other urinary malformations (72.97% vs. 48.18% vs. 50.85%, P = 0.005, 0.032). (2) At baseline, the levels of immunoglobulin and immunoglobulin E in the AC group were significantly higher than those in the NAC group (P = 0.042, 0.017). (3) During the follow-up period, the number of recurrent UTI cases in the AC group was significantly higher than that in the NAC group (0.70 ± 0.91 vs. 0.10 ± 0.32, P= 0.005). The difference between the two groups in the VUR remission rate was not statistically significant (40% vs. 50%, P = 0.563). (4) During the follow-up period, the differences in the remission rates of recurrent UTIs and VUR in the two groups were not statistically significant. The incidence of having an allergic constitution is high in patients with VUR, and patients with an allergic constitution present with a higher frequency of recurrent UTIs.

A Case Study of Urinary Tract Infection and its Ayurveda Management

A Urinary Tract Infection (UTI) is the most common bacterial infection encountered in daily medical practice. It is more prevalent in females than males due to the shorter urethra in females, which allows bacteria a quicker access to the bladder. One in five women develop UTI at least once in her lifetime. UTIs in men are uncommon, but when they do occur, they can be very serious. In Ayurveda, the symptoms of UTI closely resemble a condition known as Mutrakriccha. Acharya Charaka has explained eight types of Mutrakriccha in Charaka Chikitsa Sthana 26. In this condition, the aggravated Pitta Dosha, along with Apana Vayu, reaches the Vasti (bladder) and affects the Mutravaha Srotas, leading to painful and burning urination. In this case report, a 50-year-old male patient presented with symptoms of urinary urgency, increased frequency, and intermittent burning urination for the past 1-2 months. He was diagnosed with UTI and was effectively managed with Syp. Neeri, Chandraprabha Vati, Gokshuradi Guggulu, Shweta Parpati, and Hajaralyahud Bhasma. The treatment resulted in significant improvement in signs, symptoms, and urine examination results. During follow-up visits, there were no recurrences of UTI. Ayurvedic management offers a promising alternative for treating Mutrakriccha.

Prophylaxis Options in Children With a History of Recurrent Urinary Tract Infections: A Systematic Review.

The prevention of urinary tract infection recurrence (UTI) in children has been a challenge yet to be solved. Current practice in children with recurrent UTI (RUTI) suggests that antibiotic prophylaxis may prevent further episodes of UTI and future complications. To conduct a systematic review and meta-analysis of randomized controlled trials comparing prophylaxis options for the prevention of UTI and kidney scarring in children with a history of RUTI. We conducted a systematic literature search through major electronic databases (PubMed/Medline, Scopus and Cochrane Library) up to November 26th, 2023. Mean difference and SD were used for continuous outcomes and odds ratio for dichotomous outcomes. Our meta-analysis included 3335 participants from 23 studies. The primary outcome was the effect of the different prophylaxis options on the incidence of symptomatic UTI in children with RUTI during prophylactic treatment. Cranberry products and nitrofurantoin lead to lower odds of symptomatic UTI episodes during prophylaxis compared with the control group and control, trimethoprim-sulfamethoxazole, or trimethoprim groups accordingly. Nitrofurantoin may be the best option for UTI incidence reduction compared with all available documented interventions. No prophylaxis option has been shown to reduce kidney scarring. Nitrofurantoin and cranberry products may decrease the incidence of symptomatic UTI episodes in pediatric patients with a history of RUTI. Future randomized control trials studying nonantibiotic prophylaxis options focusing on children with UTI recurrence and the risk for kidney scarring are needed to draw further conclusions.

When Dysuria Is More Than Just a Urinary Tract Infection

This Teachable Moment describes a 66-year-old woman with mild dysuria, vulvar discomfort, and recurrent urinary tract infections.

Subureteric injection for the treatment of vesicoureteral reflux in transplant kidneys.

Treatment of de novo vesicoureteral reflux (VUR) into the transplanted kidney constitutes a clinical challenge. Herein, we present our data on patients who underwent endoscopic subureteric injection for the treatment of VUR following renal transplantation (RT) in our center. The patients who underwent endoscopic subureteric injection for VUR into the transplanted kidney after RT in our department between 2008 and 2023 were reviewed retrospectively. Indication for subureteric injection, age, gender, laterality, number of injections, amount of material used, renal failure etiology, auxiliary procedures, and treatment success were noted. All interventions were performed by pediatric urologists who also perform RT. During a median followup of 27.5 (4-160) months, 22 patients (17 women, 77.2%) and 23 transplanted ureters (13 right, eight left, one bilateral) were treated with subureteric injections. In all patients, the indications for subureteric injection were recurrent febrile urinary tract infection (UTI), and the grades of VUR varied between I and IV. Patients received a median of 1.65 cc (0.7-2.7) dextranomer-hyaluronic acid copolymer. In total, 10 RTs (eight from living donors, two from cadaveric donors) were performed in another center, whereas 13 RTs were carried out in our center (eight from cadaveric donors and five from living donors). Among the patients who were transplanted in our center, the rate of subureteric injections due to de novo symptomatic VUR after RT was 2.2% (13/593 patients). After subureteric injections, five patients required a second injection due to the recurrence of VUR. Ureteroureterostomy (to the native ureter) was performed in two patients who had further UTIs after the second endoscopic treatment. Eventually, 19/21 patients (90.4%) benefited clinically from the endoscopic treatment and none of the patients underwent re-do ureteroneocystostomy. It is noteworthy that the etiology of renal failure was VUR nephropathy in seven (31.8%) patients. Subureteric injection provides a high clinical success for the treatment of de novo VUR after RT.

Recurrent Urinary Tract Infection Prevention: Progress and Challenges.

Recurrent Urinary Tract Infection Prevention: Progress and Challenges.

The mediating role of coping in the relationship between perceived health and psychological wellbeing in recurrent urinary tract infection: the rUTI Illness Process Model

ABSTRACT Background: Recurrent urinary tract infection (rUTI) is associated with significant symptom and quality of life burden. Given the unique challenges in diagnostics and management, healthcare disillusionment and stigmatisation which distinguish rUTI from other urological conditions, specific identification of the key illness processes experienced by this patient population is required. This study aimed to identify the unique illness processes and perceptions that contribute to quality of life in rUTI, through perceived health status, psychological wellbeing, and coping. Methods: An international sample of adults living with rUTI (N = 389, 96.9% female) completed a cross-sectional survey comprising the following standardised questionnaires: the EuroQoL EQ-5D-5L, Patient Health Questionnaire 9 (PHQ-9), Generalised Anxiety Disorder 7 (GAD-7), Connor-Davidson Resilience Scale–10 (CD-RISC-10), Pain Catastrophising Scale (PCS). Sociodemographic characteristics were also assessed. Structural equation modelling was conducted to identify the underlying constructs which contributed to psychological wellbeing in rUTI, establishing the ‘rUTI Illness Process Model’. Results: The positive relationship between ‘perceived health status’ and ‘psychological wellbeing’ was partially mediated by ‘rUTI coping’, after controlling for the impact of household income and age (p < .001). The model demonstrated a large effect size (R 2 = .81) and good local and global fit. Overall, rUTI coping skills, boosted by resilience and weakened by pain catastrophising, contribute to a significant proportion of the positive relationship between perceived health status and psychological wellbeing in rUTI. A uniquely vulnerable patient phenotype emerges from this new research, with patients who are younger and/or of lower socioeconomic status at greater risk of poorer rUTI health outcomes and psychological wellbeing, potentially requiring further support. Conclusions: The rUTI Illness Process Model establishes the crucial need to clinically characterise the individualised illness perceptions and metacognitive strategies held by people living with rUTI, revealing that patient-centred interventions targeting illness perceptions and coping strategies require prioritisation to enhance patient outcomes and the patient experience of living with rUTI.

Effectiveness of a Combination of Nasturtium Herb and Horseradish Root (Angocin®Anti-Infekt N) Compared to Antibiotics in Managing Acute and Recurrent Urinary Tract Infections: A Retrospective Real-world Cohort Study.

The goal of this study was to evaluate whether the medical recommendation of Angocin®Anti-Infekt N, compared to standard antibiotic treatment shortly after the diagnosis of a urinary tract infection (UTI) or cystitis, is negatively associated with an early, sporadic, or recurrent UTI, subsequent antibiotic prescriptions, pyelonephritis as a renal complication, or UTI-associated sick leave. This retrospective cohort study was based on data from the IQVIATM Disease Analyzer database and included patients diagnosed with acute UTI or cystitis by physicians in Germany between 2005 and 2021, who were prescribed either Angocin® or standard antibiotics within 4 days after diagnosis. Patients prescribed antibiotics were matched to those prescribed Angocin® (5:1) using propensity scores. Univariable logistic and Cox regression models were used to investigate the association between Angocin® prescription and the defined study outcomes. The effects of Angocin® were adjusted for age, sex, insurance status, index diagnosis, and physician specialty. A total of 2277 Angocin® patients and 11,385 antibiotic patients were available for analysis. Compared to antibiotic prescriptions, Angocin® prescription was associated with significantly lower odds of an early relapse within 1-30 days after the index date (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.62-0.87; p < 0.001), further sporadic UTI within 31-365 days after the index date (OR: 0.68; 95% CI: 0.58-0.78; p < 0.001), and recurrent UTI (OR: 0.63; 95% CI: 0.48-0.82; p < 0.001). This was also accompanied by reduced antibiotic prescriptions (1-30 days: OR: 0.63; 95% CI: 0.53-0.74, p < 0.001; 31-365 days: OR: 0.56; 95% CI: 0.49-0.64, p < 0.001). A strong, but due to the low incidence, not significant, negative association was observed between Angocin® prescription and the occurrence of pyelonephritis (hazard ratio (HR): 0.67; 95% CI: 0.43-1.06; p = 0.073). The results of this real-world data study demonstrate that Angocin® can be an effective therapeutic option for managing acute and recurrent UTIs and serves as an alternative therapy to antibiotics.