Objective The risk of urinary tract infection (UTI) among women undergoing elective gynecologic surgery where a catheter is placed is high: 10 to 64% following catheter removal. We conducted the first randomized, double-blind, placebo-controlled trial of the therapeutic efficacy of cranberry juice capsules in preventing UTI post surgery. Study Design We recruited patients from a single hospital between August 2011 and January 2013. Eligible participants were undergoing elective gynecologic surgery that did not involve a fistula repair or vaginal mesh removal. 160 patients were randomized and received two cranberry juice capsules two times a day, equivalent to two 8-ounce servings of cranberry juice, for 6 weeks after surgery, or matching placebo. The primary endpoint was the proportion of participants who experienced clinically-diagnosed and treated UTI with or without positive urine culture. Kaplan-Meier plots and logrank tests compared the two treatment groups. Results The occurrence of UTI was significantly lower in the cranberry treatment group compared to the placebo group (15/80 (19%) versus 30/80 (38%); OR=0.38; 95% CI: 0.19, 0.79; p=0.008). After adjustment for known confounders, including frequency of intermittent self-catheterization in the post- operative period, the protective effects of cranberry remained (OR=0.42; 95% CI: 0.18, 0.94). There were no treatment differences in the incidence of adverse events; including gastrointestinal upset (56% vs. 61% for cranberry vs. placebo). Conclusions Among women undergoing elective benign gynecologic surgery involving urinary catheterization, use of cranberry extract tablets during the postoperative period reduced the rate of UTI by half.

Objective: Urinary catheterization, even of short duration, increases risk of subsequent urinary tract infection (UTI). Whether the bacteria found on the surface of catheters placed for <3 days are associated with UTI risk is unknown. Methods:We screened the biofilms found on the extraluminal surface of 127 catheters placed for <3 days from women undergoing elective gynecologic surgery, using targeted qPCR and an untargeted 16SrRNA taxonomic screen.Results: Using qPCR, Enterococcus spp. were found on virtually all catheters and lactic acid bacteria in most catheters regardless of duration, but neither genus was associated with UTI development during follow-up. Enterococcus, Streptococcus and Staphylococcus were the most commonly identified genera in the taxonomic screen but were not associated with subsequent UTI. Although the most common cause of UTI following catheter removal was E. coli, detectable E. coli on the catheter surface was not associated with subsequent UTI.Conclusions: Our analysis does not suggest that the composition of the bacteria growing on the catheter surface of catheters placed for <3 days are the reservoir for subsequent UTI. Other aspects of catheter care are likely more important than preventing bacterial colonization of the catheter surface for preventing UTI following short term catheter placement.

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between groups (Table 1). In the standard group, 5/15 patients correctly answered the comprehension question before and after counseling. In the iPad group, 0/10 patients answered the question correctly before, but 6/10 answered correctly after. A positive trend between iPad counseling and improved comprehension was seen (RR ¼ 1.8, 95% CI ¼ 0.7-4.3). Using logistic regression models, there was no correlation between responses to other questions, age or education and whether comprehension improved. Overall, 22/25 (88%) patients were satisfied or strongly satisfied with their counseling experience, irrespective of counseling type they received (RR ¼ 1.0, 95% CI ¼ 0.7-1.3). CONCLUSION: A trend towards improved comprehension was seen when Boston Scientific's, Pelvic Floor Institute POP-Q, 3D iPad app was used compared to our standard model. Current literature implores improvement in POP counseling, given that rates of surgical dissatisfaction are associated with feeling "unprepared." This "unpreparedness" is tied to ineffective counseling and a lack of patient comprehension. While statistical significance was not met due to a small sample size, our pilot study provides preliminary evidence that dynamic models may improve patient comprehension and perhaps, surgical preparedness. At minimum, using visual models provide high patient satisfaction with counseling. Future studies should evaluate interactive models in pre-operative counseling and how it affects patient preparedness and satisfaction with surgery.