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Bethanechol continues to be prescribed in elderly women primarily for detrusor atony, urinary retention, or incomplete bladder emptying.

In patients with ischemic LV systolic dysfunction, the extent of severe disease and a lower numbers of collaterals predict the occurrence of low-dose SWMA. Low-dose SWMA is a highly specific marker for severe disease.

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Study Need and Importance: Antibiotic-refractory recurrent urinary tract infections (UTIs) are challenging to manage. Prior studies have shown that, in selected patients, electrofulguration (EF) of cystitis may disrupt potential nidus of recurrent UTI. We report on long-term outcomes of EF in women with at least 5 years of follow-up. What We Found: From 2006 to 2012, 96 women met study criteria with median age 64. Median follow-up was 11 years (IQR: 10-13.5); 71 women had >10year follow-up. The clinical outcome distribution by years of follow-up is displayed in the Figure . Prior to EF, 74% used daily antibiotic suppression, 5% used postcoital prophylaxis, 14% used self-start therapy, and 7% were not on prophylaxis. At last post-EF visit, 72% of women were cured, 22% improved, and 6% failed. Antibiotic usage decreased post-EF (P < .05). Five percent were on continuous antibiotics at last follow-up as compared to 74% on continuous antibiotics pre-EF (McNemar P < .05). Nineteen percent of women underwent a repeat EF. Limitations: This study was conducted at a single, tertiary-care, academic center with mainly postmenopausal and Caucasian women and a potential referral bias to a Female Pelvic Medicine and Reconstructive Surgeryespecialized practice, so generalizability may be limited. Given the length of the study period, there are also potentially confounding variables that may affect patient's UTI rates, including new onset of medical comorbidities (eg, diabetes, neurodegenerative conditions) that developed independently, as well as socio-environmental factors that may be difficult to capture. Interpretation for Patient Care: In women with over 5 years of follow-up after EF for antibiotic-refractory recurrent UTIs, some were cured durably, whereas others sustained prolonged benefit with overall reduction in antibiotic usage. These long-term data can help guide management for women with challenging recalcitrant UTIs in whom chronic bladder inflammatory lesions observed on cystoscopy can be considered for fulguration. Figure. Distribution of clinical outcomes by years of follow-up.