Recurrent Lower Urinary Tract Infections Research Articles

The use of the combined drug «Urolife-Next» for recurrent lower urinary tract infections: clinical and microbiological aspects

The use of the combined drug «Urolife-Next» for recurrent lower urinary tract infections: clinical and microbiological aspects

Возможности магнитно-резонансной томографии в диагностике воспалительных изменений парауретральных желез у женщин.

Introduction. Inflammation of the paraurethral glands (skеneitis) is a complex urological disease, often hidden under the guise of other pathological conditions and causing recurrent lower urinary tract infection (UTI) in women. A significant problem for the diagnosis of skineitis at present is the absence or extremely low sensitivity and specificity of available laboratory, instrumental and radiation methods. Thus, the search for new ways to examine patients with recurrent UTI caused by chronic inflammation of the Skene’s glands is an important clinical and socio-economic task of modern healthcare. Materials and methods. The study involved 30 patients aged from 24 to 51 years who underwent magnetic resonance imaging (MRI) of the pelvis with contrast enhancement and targeted examination of the urethra and periurethral area using a device with a 3T fi ld strength. To study the MR semiotics of chronic inflammation of the gallbladder, in addition to standard MR protocols, high-resolution T2-weighted images with a slice thickness of 2 mm and T2-weighted Space 3D images in a sagittal projection with a slice thickness of 1 mm were used. The first group consisted of 16 urologically healthy women without complaints of dysuria, who underwent an assessment of the MRI anatomy of the normal female urethra. MRI of 14 respondents with chronic infl mmation of the paraurethral glands (second group) was performed to search for recurring (natural) changes characteristic of this disease. Such parameters as the diameter of the urethra, the separate thickness of its anterior and posterior walls, clarity at the boundary of the layers, and the presence of pathological changes and formations were studied. Results. Analysis of the obtained tomograms showed that urologically healthy respondents are characterized by symmetrical thickness of the walls of the urethra without pathological formations in it, as well as evenness and clarity of the contour at the boundary of the layers. When studying the results of examination of patients with chronic skeneitis, all of them (100%) noted the following recurring changes: an increase in the diameter of the urethra due to thickening of its posterior wall, in particular the submucosal layer, impaired differentiation at the border of the submucosal and muscular layers, the presence of small cystic changes in the structure of the posterior wall of the urethra (85.7%) or fragmentarily dilated ducts of the urinary tract (14%). Hypertrophy of the bulbospongiosus muscles, detected in 85.7% of respondents in the second group, is likely an indicator of frequent exacerbations and duration of the disease, and can be considered as an additional nonspecific criterion for this disease. Conclusions. These changes can tentatively, given the small sample, be considered pathognomonic MR signs of chronic skineitis. Thus, MRI of the pelvis with a targeted examination of the urethra and periurethral area can help in the differential diagnosis of patients with suspected inflammation of the paraurethral glands, establishing the correct diagnosis and prescribing adequate treatment.

The Role of Ureaplasma and Mycoplasma Species in Recurrent Lower Urinary Tract Infection in Females: A Scoping Review.

It is unknown if recurrent urinary tract infection in the gynecologic population is associated with Mycoplasma and Ureaplasma genitourinary infections. The purpose of this scoping review is to highlight the literature surrounding Mycoplasma and Ureaplasma infections in the setting of recurrent urinary tract infections in the gynecologic population. MEDLINE ALL and Embase were searched to retrieve articles published in or after 1950 through 2024. Studies included were those with adults over age 18, non-pregnant, diagnosed with recurrent urinary tract infection and concurrent genitourinary infection with Ureaplasma or Mycoplasma published in English. Study designs eligible were quantitative, qualitative, and mixed methods studies. Publication types were also extended to conference abstracts and unpublished data. 2 independent investigators systematically performed title/abstract screening and full-text review using standardized inclusion criteria. For disagreements in either title and abstracts or full-text articles, consensus was reached through discussion by the 2 screeners and/or a 3rd final adjudicator. Screening and data extraction were performed on Covidence, a web-based platform for systematic review management. There were 1170 studies identified before title and abstract screening. 26 full-text articles were reviewed for eligibility. Of these, 23 full-text studies were excluded. 3 studies met full inclusion criteria and data extraction was performed on these 3 studies. There were 2 additional studies included after identification via other methods. There is a need for more recent and robust studies examining the role of Ureaplasma and Mycoplasma genitourinary infections amongst gynecologic patients with recurrent urinary tract infections.

Two Natural Births with Unremoved Iuds Causing Bladder Stone Formation Due to IUD Migration: A Rare Case

Background: Intrauterine Device (IUD) Multiload 375 is a method of contraception widely used worldwide. One of the rare complications is that the IUD punctures the uterus and moves into the bladder. Common manifestations are recurrent urinary tract infections and bladder stones. A long-term and neglected IUD increases the risk of uterine perforation and migration to other organs. Diagnosis: Clinical history, Cystoscopy, Transvaginal Ultrasound (US) or Computed Tomography helps confirm the diagnosis. Case Report: We report successful surgical treatment of a 39-year-old woman who neglected to insert a Multiload 375 IUD for 16 years, but still experienced 2 subsequent vaginal deliveries and eventually developed UTI. Bladder stone formation caused by the passage of the Multiload 375 intrauterine device through the bladder. Conclusions: Urologists should consider bladder foreign bodies as a displaced IUD in women with recurrent lower urinary tract infections or bladder stones, with a history of IUD use. The moving IUD needs to be removed through cystoscopy, laparoscopy, or open surgery. Proper monitoring and education for women’s health before and after IUD insertion helps to detect complications in a timely manner.

Воспаление парауретральных протоков и желез у женщин: проблема с 350-летней историей.

Introduction. Inflammation of the Skene glands is one of the common causes of persistent dysuria and recurrent lower urinary tract infections. Lack of awareness about this pathology can lead to diagnostic errors and inadequate treatment. This pathology is not sufficiently covered in the literature, which was the reason for preparing this lecture. Results. The lecture review covers the history of studying the anatomy of the paraurethral glands in women, the first attempts to diagnose and treat various diseases. The issues of homology of the paraurethral ducts and glands in women with the prostate gland in men are considered, the anatomy, morphology and immunohistochemical properties of the Skene glands are described, as well as modern ideas about their function. The historical background, nomenclature and classification are presented. The role of inflammation in these structures as a cause of persistent dysuria and a source of persistent lower urinary tract infections has been demonstrated. The need to standardize the methodology for examining patients with skineitis and the search for a specialized instrument for an adequate examination of the female urethra is substantiated. An analysis of the effectiveness of electrical resection of Skene's glands was carried out. Conclusions. One of the main factors behind unsatisfactory treatment results for lower urinary tract infections is inflammation of the paraurethral ducts and glands. Their insufficient visualization and assessment are the reasons for frequent relapses of the disease and repeated surgical interventions.

Early treatment of vulvar synechiae in childhood - prevention of late complications.

Synechiae of the vulva occurs especially in girls in the so-called resting hormonal period with a minimal serum concentration of estrogens. If the external genitalia of the girl are not treated properly, the mucous membrane of the vaginal entrance is not regularly checked and mechanically removed, then the smegma of the opposite mucous membranes of the vulva can stick together. The place of the adhesion of epithelium in the vaginal introitus can be covered by a new epithelium and can create a firm adhesion, synechiae of the vulva, which is usually asymptomatic and is discovered incidentally during pediatric examination. Clinically significant vulvar synechiae can cause impaired bladder evacuation and recurrent lower urinary tract infections. Dissection of synechiae in the stage of conglutination or thin adhesion is performed manually on an outpatient basis, but extensive and firm adhesions must be divided surgically under general anesthesia. Local application of cream with estriol or betamethasone is also used for the therapy of synechiae of the vulva, but this treatment is more time-consuming compared to rapid manual separation and requires good compliance of the girls and their parents. The prevention of synechiae is based on the education of parents by pediatricians and gynecologists about the need for regular checks of the external genitalia and sufficient hygiene.

Recurrent lower urinary tract infections: more than an infection for older women.

Older adults tend to have more urinary tract infections (UTIs). The frequency of recurrent lower urinary tract infections (rLUTIs) increases with age. rLUTIs are associated with long-term chronic effects on geriatric syndromes in older adults. We aimed to investigate possible risk factors that influence rLUTIs in older adults based on comprehensive geriatric assessment (CGA). This cross-sectional study included 235 older adults admitted to Gaziantep University's Geriatric Outpatient Clinic between June 1 and November 30, 2022. All patients underwent CGA. The Geriatric Depression Scale (GDS), the European Quality of Life-Five Dimension (EQ-5D) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Katz Index of Activities of Daily Living (ADL), the Lawton and Brody Index of Instrumental Activities of Daily Living (IADL), and the Mini Nutritional Assessment (MNA) tool were,administered. Handgrip strength (HGS) and gait speed were also measured, and the number of falls in the last year was recorded. The mean age of the participants was 72.8 ± 6.8 years and 61.3% were female. Sixty-four patients had rLUTIs. The rLUTI group had higher frequencies of sarcopenia, hypertension, and diabetes; higher numbers of comorbidities and medications; higher GDS and PSQI scores; and more reported falls. They had lower ADL, MNA, EQ-5D, and gait speed scores. HGS was found to be lower in women with rLUTIs. Higher numbers of comorbidities and GDS scores and lower HGS were independent predictors of rLUTIs in women (p = 0.011, OR: 1.75; p = 0.018, OR: 1.14; and p = 0.042, OR: 0.91, respectively). We revealed that decreased HGS, higher GDS, and the number of comorbidities in older women were independent risk factors for rLUTIs. Our findings offer a new perspective on the importance of CGA in diagnosing and preventing rLUTIs.

Лейкоплакия мочевого пузыря – есть ли место этому диагнозу в эру доказательной медицины?

Over the past 15 years, the clinical diagnosis of «leukoplakia of the bladder» has become a frequently used diagnosis among outpatient and inpatient urologists. But how valid is it, what pathology does it describe and what are we treating? Most often it is established in patients with recurrent lower urinary tract infection (rLUTI), long-term dysuric disorders or chronic pelvic pain syndrome (CPPS). In most cases, it serves as a kind of «last resort» for the practitioner to find finally the cause of persistent complaints of the patient. In this «clinical trash» is thrown all that can potentially be associated with the bladder and is not treated by standard methods defined by clinical guidelines and generally accepted algorithms. At the same time, these are complex patients with a long history and multifactorial pathogenesis, requiring careful examination and thoughtful personalized approaches to treatment. Only such an attitude to the problem makes it possible to find the true cause of the patient's complaints. To date, the questions of the origin and treatment of patients with «leukoplakia of the bladder» remain very controversial. Unfortunately, the lack of knowledge in this matter often serves as a reason for unfair speculations and unjustified surgical activity. The data collected in this article should help practicing physicians to take a more sober look at the problem of «leukoplakia of the bladder» and learn how to help complex patients with persistent dysuria and chronic pelvic pain.

Роль фитоэстрогенов в комплексной терапии и профилактике рецидивирующей инфекции нижних мочевых путей у пациенток в климактерии

Роль фитоэстрогенов в комплексной терапии и профилактике рецидивирующей инфекции нижних мочевых путей у пациенток в климактерии

Vaginal dysbiosis as a factor contributing to the development of recurrent lower urinary tract infections

Introduction. It is known that women are significantly more likely to suffer from lower urinary tract infections (LUTIs) than men. Nowadays, there is growing evidence to demonstrate the impact of vaginal microbiota on the development of recurrent LUTIs.Objectives. To demonstrate the impact of vaginal microbiota disorders on the development of recurrent lower urinary tract infections.Materials & methods. Seventy-five women with recurrent LUTIs 19 – 76 years old were enrolled in this study. The examination was performed according to the algorithm developed in the Department of Urology and Surgical Andrology, Russian Medical Academy of Continuous Professional Education. Real-time PCR of vaginal epithelial cell scrapings (Femoflor 16) was performed to comprehensively evaluate the vaginal microbiota.Results. Vaginal dysbiosis was detected in 47/75 (62.7%) women with recurrent UTIs: moderate vaginal dysbiosis was detected in 25/75 (33.3%) women and severe dysbiosis — in 22/75 (29.3%) women. A moderate correlation between the presence/absence of vaginal dysbiosis and the number of LUTI recurrences over 6 months was found (r = 0.310; p = 0.007). Vaginal dysbiosis was significantly more common among peri- and postmenopausal women with recurrent LUTIs than reproductive women (OR = 4.85; 95% CI = 1.45 – 16.17).Conclusion. Vaginal dysbiosis contributes to the development of recurrent LUTIs with more relapses. Vaginal microbiota disorders and, consequently, recurrent LUTIs are more common in peri- and postmenopausal women than reproductive women.

The effect of anal hygiene method in prevention from recurrent lower urinary tract infections in women

Aim: To evaluate the effects stopping the use of water and hands on preventing urinary tract infections (UTI) for a group of female patients having recurrent UTIs (rUTI).
 Material and Method: A retrospective observational study conducted in a tertiary care hospital between February 2017 and March 2018. 273 female patients which had rUTIs without any concomitant risk factors were included. In the study, 2 or more bacteriologically documented UTIs in the last 6 months were accepted as rUTI. The groups of the study defined as using their hands, using water only and using toilet paper (using either one of these two methods and then using toilet paper). Patients were observed for an average time of 10.4 months after stopping the use of water and hands for anal cleansing after defecation. Instead they were all given toilet education and started wiping for anal hygiene.
 Results: There was a statistically significant relationship between previous history of UTI and washing with hands + water (p=0.021). The rate of previous UTIs were significantly higher in the group of patients using their hands for anal washing (69% vs 31%). No relation was found between previous UTI history variable for using toilet paper and flushing with water only (p>0.05). Our results showed a statistically significant decrease of UTIs after stopping the use of water and hands in the patient group who had a previous UTI history (p=0.001).
 Conclusion: We managed to underline that washing with hands for anal cleansing as a risk factor for rUTIs in women. Also showed the positive effect of stopping the use of water and hands for anal cleansing after defecation for prevention from rUTIs. We encourage all clinicians for further studies to investigate this issue in the future.

Patient-Friendly Summary of the ACR Appropriateness Criteria: Recurrent Lower Urinary Tract Infections in Females.

A urinary tract infection (UTI) is a bacterial infection of the urinary system. Uncomplicated UTIs, without physical or functional abnormalities of the urinary tract, usually respond to antibiotics and do not require further imaging tests. In contrast, complicated UTIs, in which individuals may suffer from an underlying condition, usually require imaging tests for diagnosis.

The management of urogynaecological problems in pregnancy and the postpartum period

Key content Stress urinary incontinence is common in pregnancy and its severity can be reduced with pelvic floor muscle training. Overactive bladder syndrome prevalence increases with gestation and treatment can be conservative or medical. Pelvic organ prolapse is multifactorial. Pelvic floor exercises and pessaries are important treatments and previous surgical management can affect the mode of delivery. Recurrent urinary tract infections can be treated with antibiotic prophylaxis or with non‐antibiotic prophylaxis such as methanamine hippurate, D‐Mannose and hygiene behaviour. Urinary retention can occur at any point during pregnancy, causing bladder distension, voiding dysfunction and subsequent lifelong catheterisation. Learning objectives To be aware of the pathophysiology and management of different types of urinary tract dysfunction in pregnancy and the postpartum period. To understand the potential causes and management of pelvic organ prolapse in pregnancy and the postpartum period. To understand the different potential management options in recurrent lower urinary tract infections.

Эффективность комбинированной биологически активной добавки Уронекст у женщин с рецидивирующими циститами: клинико-микробиологическое исследование.

Introduction. Introduction Antibacterial therapy is the main line of treatment for lower urinary tract infections (LUTIs). At the same time, not always satisfactory efficacy and the growing problem of antibiotic resistance of the main uropathogens determine the importance of finding alternative approaches. Many studies have confirmed the clinical efficacy of non-antibacterial therapy for LUTIs, however, a number of aspects of its pharmacological action remain unclear. Aim. Assessment of the clinical and microbiological effects of the dietary supplement «Uronext», containing D-mannose, vitamin D and cranberry extract, in women with recurrent LUTIs. Materials and methods. Under supervision were 67 women aged 18 to 65 years (mean 42.8±12.9 years) with recurrent LUTIs. By the time the study began, all patients were diagnosed with an exacerbation of cystitis. The study consisted of two parts: clinical and laboratory. During the first of these, patients were prescribed Uronext 1 sachet (2000 mg of D-mannose, Cran-Max (highly purified 100% natural cranberry extract with standardized activity (36 mg of proanthocyanidins) and 1 μg of vitamin D3) daily for 7 days and studied the dynamics of the symptoms of cystitis. The laboratory part included an assessment of the minimum inhibitory concentration (MIC), adhesion index, degree and time characteristics of the antimicrobial activity of Uronext against the main uropathogens. Results. Reception Uronekst was accompanied by a positive dynamic of the severity of symptoms of cystitis. The average total score of the «typical» section of the ACSS questionnaire decreased from the initial 8.27±2.05 on the 1st day of the study to 4.73±1.98 by the 3rd day and to 4.16±2.03 by the 7th day of the study. mu day of admission. By this time, 37 (55.2%) women indicated a significant improvement in their condition, and 7 (10.4%) women indicated the complete disappearance of symptoms. Initially, bacteriuria in a titer of ≥1000 CFU/ml was detected in 50 (74.6%) patients, while the antimicrobial activity of Uronext against isolated uropathogens was 48%. In vitro, the product had an antibacterial effect on both Gram-negative and Gram-positive uropathogens. At the same time, for gram-negative microorganisms, the MIC was 10 times lower than for gram-positive ones. In vitro antibacterial activity against uropathogens peaked 2 hours after the addition of Uronext to cell culture and persisted for at least 8 hours. A pronounced anti-adhesive effect of Uronext was revealed, leading to a decrease in the adhesion index to epithelial cells by 3.1–4.8 times, depending on the type of microorganisms. Conclusion. The appointment of a combined dietary supplement "Uronext" for patients with LUTI with exacerbation of cystitis seems to be a pathogenetically justified alternative to the use of antibiotics in this category of patients. The substances included in Uronext have a synergistic effect and contribute to its high microbiological efficiency

Cystoscopy Findings in Females with Recurrent Lower Urinary Tract Infections who were referred to Tishreen University Hospital between 2021 - 2022

The importance of our study comes from that recurrent lower urinary tract infection in females is one of the most common cases that referred to the urology clinic, and it is considered a challenge to treatment in the case of reliance on clinical, radiological and laboratory diagnosis only, while cystoscopy may provide information that may be useful in managing the reviewed cases.

Opportunities of drugs based on D-mannose and herbal components in the treatment and prevention of recurrent lower urinary tract infections in women

BACKGROUND: Recurrent cystitis is a common form of urinary tract infections. In the treatment of this disease antibacterial drugs are usually used. At the same time, there are plant components that can be a worthy substitute for antibiotic therapy.
 AIM: To evaluate the efficacy and safety of the biologically active complex Cystalis, containing D-mannose, grape seed extract and bearberry extract, in the treatment and prevention of recurrent cystitis in women.
 MATERIALS AND METHODS: The study included 60 women with recurrent cystitis. All patients answered the Acute Cystitis Symptom Scale (ACSS). The patients were divided into 2 groups of 30 people each. Patients of the 1st group received standard antibiotic therapy for recurrence of cystitis in accordance with the results of bacteriological examination of urine, followed by observation for 6 months. Patients of the second group instead of antibiotic therapy received the biologically active complex Cistalis one capsule (350 mg) 2 times a day for 3 months, followed by observation for 3 months.
 RESULTS: Before the start of treatment Escherichia coli was detected in 26 patients (86.7%) in the 1st group and in 28 (93.3%) patients in the 2nd group. At a follow-up visit 30 days after the initial examination the total score on the ACSS scale in patients of the 1st group decreased from 6.6 1.4 to 0.03 0.18 points (p 0.001), in patients of the 2nd group from 6.4 1.3 to 0 (p 0.001). The sum of scores in the Quality of Life (QoL) domain in the representatives of the 1st group decreased from 6.3 1.3 to 0 (p 0.001), and in the 2nd group decresead from 5.6 1.0 also to 0 (p 0.001). In patients of both groups, the level of leukocytes and erythrocytes in the urine significantly decreased. During the 6-month follow-up period 8 recurrences of UTIs were registered in patients of the 1st group, and only 2 recurrences in patients of the 2nd group. The probability of developing a recurrence of cystitis in patients of the 2nd group was significantly lower than in patients of the 1st group (2 = 4.603, p = 0.032).
 CONCLUSIONS: An analysis of the results of the study showed the high efficiency of using the Cystalis complex for the treatment of cystitis and the prevention of its recurrence.

RETRACTED: Биологические свойства грамнегативных бактерий, верифицированных в моче пациенток с рецидивирующей неосложненной инфекцией нижних мочевых путей

Article retracted. Uncomplicated infections of the lower urinary tract are more often recorded in women and are characterized by recurrent severe course. The lack of effective approaches to the management of this cohort of patients and the insufficient knowledge of the qualitative characteristics of uropathogens hinder the successful treatment of these infections. The purpose of this project is to study the biological properties of representatives of Gram-negative bacteria isolated from the urine of patients with recurrent uncomplicated lower urinary tract infection at various levels of bacteriuria. We present here the results of the one-stage cohort study of 62 patients 20-50 years old with recurrent uncomplicated lower urinary tract infection. The level of bacteriuria, genes of virulence factors, hemolytic, adhesive and anti-lysozyme activities were determined for the Gram-negative bacteria isolated from the urine of patients. Representatives of Gram-negative microorganisms (62 strains) were isolated from the urine of all patients. Their bacteriuria levels ranged from 10 2 to 10 8 CFU/ml. A wide range of the virulence factor genes with the prevalence of papGII , feoB, fyuA , were found in all strains regardless of the degree of bacteriuria. Twenty significant (p<0.05) coefficients of mutual contingency between different pairs of genes were found. We found that the hemolytic activity of Enterobacteriaceae is statistically significantly associated with papA , feoB , fyuA , kpsMII , and usp , while the anti-lysozyme activity is associated with papA , afa , and usp . The detection of genotypic and some phenotypic traits expressed in various variations in all Gram-negative bacteria regardless of their bacteriuria levels creates a potential risk for recurrent of the lower urinary tract infection. Consequently, even the minimal levels of bacteriuria become clinically significant. Therefore, in bacteriological diagnostics it is necessary to determine all levels of bacteriuria, including the minimum level (10 2 CFU/ml), since isolated microorganisms at this level have not only adhesive and anti-lysozyme activities, but also contain genes encoding the virulence factors.

Lower urinary tract dysfunction in diabetes mellitus: the forgotten disease

Diabetic cystopathy is a common complication in patients with diabetes mellitus. It may cause a variety of manifestations ranging from bladder hyperactivity to decreased bladder contractibility. However, the presence of bladder dysfunction in diabetic patients is often underdiagnosed by clinicians. We present a case report of a 54-year-old woman with a medical history of diabetes with recurrent lower urinary tract infections and pyelonephritis. Her bladder dysfunction was never assessed until she was admitted to our department. We identified an impaired sensation of bladder filling and an inability to voluntarily contract the detrusor. We provided pharmacological treatment to enhance bladder emptying and proposed a new bladder-emptying regimen. The patient remains with this therapeutic strategy with no evidence of further complications. This case aims to raise awareness among clinicians about diabetic bladder dysfunction.

Evaluation of the effectiveness of prevention of recurrent lower urinary tract infection caused by Escherichia Mli in women

Evaluation of the effectiveness of prevention of recurrent lower urinary tract infection caused by Escherichia Mli in women

Results of open prospective study of clinical assessment of efficacy and safety of Nifuratel during exacerbations of recurrent cystitis

The article presents the results of an open prospective study of the clinical assessment of the efficacy and safety of the use of nifuratel during exacerbations of recurrent cystitis. The aim of the program was to assess the change in the duration of the relapse-free course of recurrent cystitis and the effectiveness of the course treatment with Nifuratel-SZ in the treatment of recurrent cystitis. During a non-interventional program, Nifuratel-SZ has been shown to be an effective and well-tolerated drug for the treatment of recurrent uncomplicated lower urinary tract infection.