Very Long–term Outcomes After Electrofulguration for Antibiotic-refractory Recurrent Urinary Tract Infections in a Predominantly Menopausal Cohort of Women

Abstract

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.

Secondary Analysis of Interstitial Cystitis/Bladder Pain Syndrome Patients Enrolled in a Recurrent Urinary Tract Infection Prevention Study Provides a Novel Paradigm for Etio-Pathogenesis and Practical Management of This Infection Phenotype

“…Another option to reduce long-term IC/BPS cystitis symptoms that has recently been popularized is cauterization of observable bladder inflammation (even repeating this procedure as many times as necessary until the patient reports improvement) [24]. Some studies have indicated that this approach has been successful in some patients [25], but it is costly, destructive to the bladder mucosa, and may perhaps have long-term consequences for the bladder wall itself. The administration of a safe sublingual immunomodulator would be a more attractive option.…”

Electrofulguration for Women With Uncomplicated Recurrent Urinary Tract Infections and Chronic Cystitis: Time for Trials!

“…8 A recent long-term study also reported favorable and durable outcomes on curing or reducing rUTI episodes in women with stages 1 and 2 cystitis lesions and observed a marked decrease in antibiotic usage post-EF. 9 Additional studies have examined the efficacy of EF based on the extent of cystitis, with the early stages faring better than the more advanced stages, which exhibit large and extensive areas of cystitis. 5 Repeating EF, if necessary, has also demonstrated beneficial outcomes.…”

“…5 Repeating EF, if necessary, has also demonstrated beneficial outcomes. 5,9 The reported side effects from EF for rUTI are minimal and most often transient, resolving within days. While EF has proven valuable for many, several complicating factors unique to each individual may impact the efficacy of the procedure.…”