Recurrent urinary tract infections in patients with incomplete bladder emptying: is there a role for intravesical therapy?

Dray, Elizabeth; Clemens, J. Quentin

doi:10.21037/tau.2017.04.08

Cited by 23 publications

(19 citation statements)

References 59 publications

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“…The mean age participants in the included studies were 52 years with a male to female ratio of 1:1 (Table 1 ). Although majority of studies (7/11) used gentamicin as the IVA, this included 3 where it was used as treatment and 4 where it was used a prophylaxis against rUTI [ 2 , 4 , 5 , 8 ••, 9 , 10 •, 11 ]. The other IVA used were a combination of neomycin/polymyxin ( n = 2) and isolated neomycin and colistin in one study each [ 1 , 3 •, 6 , 7 ].…”

Section: Resultsmentioning

confidence: 99%

“…A high success rate of 88% ( n = 103%) was seen in the treatment group in the short term (3–6 months) [ 1 , 2 , 3 •, 4 , 5 ], with a low discontinuation rate of 5% ( n = 6). A success rate of 71% ( n = 120) was seen in the prophylaxis group in the short term [ 6 , 7 , 8 ••, 9 , 10 •, 11 ], with a discontinuation rate of 8% ( n = 14).…”

Section: Resultsmentioning

confidence: 99%

“…The majority of patients with rUTIs, either from idiopathic UTI or due to an underlining pathology, often have a poor quality of life. In the presence of underlying risk factors such as spinal cord injury (SCI), urinary diversion or intermittent self-catheterisation (ISC) [ 2 , 3 •, 4 – 7 , 8 ••, 9 , 10 •, 11 ], it is marked by frequent hospital admissions with repeated use of wide-spectrum intravenous antibiotics [ 13 ]. However, over time, there is development of both bacterial resistance and the systemic side effects that are well recognised after protracted courses of intravenous and oral antibiotics [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Instillation of therapeutic agents into the bladder to combat recurrent urinary tract infections (rUTIs) has been part of clinical practice since the 1960s [ 1 , 2 , 3 •, 4 – 7 , 8 •, 9 – 11 ]. These are usually reserved as end of line strategy.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Use and Effectiveness of Antimicrobial Intravesical Treatment for Prophylaxis and Treatment of Recurrent Urinary Tract Infections (UTIs): a Systematic Review

et al. 2018

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Purpose of ReviewIntravesical antibiotics (IVA) has been used for prophylaxis and treatment of recurrent urinary tract infections (rUTIs). However, there is a lack of comprehensive evidence and consensus on its use. We conducted a systematic review to collect all available data about the effectiveness of IVA in prevention and treatment of rUTIs and to give an overview on the outcomes to date.MethodsA systematic review was carried out for all English language articles from inception to August 2017, according to the Cochrane and PRISMA standards using MEDLINE, Scopus, Biomed Central, EMBASE, CINAHL, and Web of Science with references cross-checked and individual urology journals hand-searched.ResultsAfter an initial identification of 658 studies, we screened 37 abstracts and 18 full-text papers of which 11 were included in our final review. This included 285 patients with a mean age of 52 years and a female:male ratio of 129:117. The IVA used was gentamicin, neomycin/polymyxin, neomycin or colistin and IVA was used for rUTIs as prophylaxis in 5 studies (n = 168) and treatment in 6 studies (n = 117). Overall, a good reduction in symptomatic UTI was seen in 78%, with a short-term success rate and discontinuation rates of 71% (120/168) and 8% (14/168) in the prophylaxis group and 88% (103/117) and 5% (6/117) in the treatment groups respectively. There was a change in the sensitivity of organisms in 30% (50/168) and 23% (27/117) in the treatment and prophylaxis groups respectively. Twenty patients discontinued their IVA instillations which were higher for the non-gentamicin group (11%) compared to the gentamicin group (5%). The side effects were minor and included allergy, suprapubic discomfort, autonomic dysreflexia, urinary tract infections and diarrhoea.SummaryIntravesical antimicrobial instillation seems to be a relatively safe and effective method for the prophylaxis and treatment of recurrent UTIs, especially in the short term. It gives clinicians an alternative treatment modality in high-risk patients predisposed to UTIs where all other forms of systemic treatments have failed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Use and Effectiveness of Antimicrobial Intravesical Treatment for Prophylaxis and Treatment of Recurrent Urinary Tract Infections (UTIs): a Systematic Review

et al. 2018

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“…After five years of unsuccessful antibiotic prophylaxis, bladder irrigation with antibiotics 3 , 4 was considered, however not elected. Instead, 1 g of oral methenamine hippurate bid accompanied by 1 g of vitamin C for urine acidification was prescribed resulting in the best outcome to date, with bacterial cystitis every 4–5 months sensitive to oral antibiotics.…”

Section: Patient Informationmentioning

confidence: 99%

Intravesical acetic acid in combination with prophylactic methenamine and ascorbic acid to decrease the incidence of recurrent urinary tract infections associated with intermittent urinary self-catherization: A case report

Bachow¹

2021

Urology Case Reports

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A case is presented demonstrating improved efficacy of the use of oral methenamine hippurate and vitamin C urinary tract infection prophylaxis achieved by adding self-administered acetic acid irrigation twice daily during routine intermittent bladder self-catheterization in a post-menopausal female patient with multiple sclerosis. The patient in this case report is me, a retired radiologist.

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Bladder irrigation with povidone‐iodine prevent recurrent urinary tract infections in neurogenic bladder patients on clean intermittent catheterization

Moussa

Chakra

Papatsoris

et al. 2021

Neurourology and Urodynamics

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Aims: To determine if daily povidone-iodine (PI) bladder irrigation in neurogenic lower urinary tract dysfunction (NLUTD) patients doing clean intermittent catheterization (CIC) can reduce the rate of symptomatic urinary tract infections (UTIs), emergency department (ED) visit for UTIs, and hospitalization for UTIs. Methods: We prospectively reviewed the records of patients with NLUTD on CIC who had recurrent symptomatic UTIs and who were placed on daily intravesical instillations of PI. This trial was conducted from January 2014 to January 2020 on 119 patients. Results: After using daily PI bladder irrigation, the rate of symptomatic UTIs was reduced by 99.2% (incidence rate ratio [IRR]: 0.008, 95% confidence interval [CI]: 0.001-0.059; p < .001), the rate of ED visits was reduced by 99.2%% (IRR: 0.008, 95% CI: 0.001-0.059; p < .001), and the rate of inpatient hospitalizations for UTI was reduced by 99.9% (IRR: 0.0008, 95% CI: 0.0002-0.0035; p < .001). There was also a significant decrease in multidrug resistance in UTI organisms with the use of PI bladder instillation. Conclusions: Daily intravesical PI instillation is a well-tolerated approach to prevent UTIs and related ED visits and hospitalizations in NLUTD patients doing CIC.

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Recurrent urinary tract infections in patients with incomplete bladder emptying: is there a role for intravesical therapy?

Cited by 23 publications

References 59 publications

Use and Effectiveness of Antimicrobial Intravesical Treatment for Prophylaxis and Treatment of Recurrent Urinary Tract Infections (UTIs): a Systematic Review

Use and Effectiveness of Antimicrobial Intravesical Treatment for Prophylaxis and Treatment of Recurrent Urinary Tract Infections (UTIs): a Systematic Review

Intravesical acetic acid in combination with prophylactic methenamine and ascorbic acid to decrease the incidence of recurrent urinary tract infections associated with intermittent urinary self-catherization: A case report

Bladder irrigation with povidone‐iodine prevent recurrent urinary tract infections in neurogenic bladder patients on clean intermittent catheterization

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