Preventing Recurrent UTIs in Women

The first trial to demonstrate the long-term efficacy of electrofulguration, a minimally invasive outpatient procedure used to treat chronic urinary tract infections (UTIs) in postmenopausal women, was conducted by researchers at UT Southwestern Medical Center.

Between 2006 and 2012, researchers examined the medical records of 96 women treated at UT Southwestern for recurrent UTIs (three or more per year) with electrofulguration. A third-party researcher conducted telephone conversations with patients who had not previously been seen by a physician. Their median age was 64, and they had been followed for an average of 11 years.

According to the study published in The Journal of Urology, 72% of the patients had successful therapy, with no more than one UTI per year; 22% had improved, with less than three UTIs per year; and 6% were unchanged. Furthermore, antibiotic use has decreased dramatically, with only 5% still on continuous antibiotics at their latest check-up, compared to 74% before to electrofulguration.

“Recurrent UTIs are a serious issue for many postmenopausal women, affecting their quality of life and putting them at risk of serious complications,” said study leader Philippe Zimmern, M.D., Professor of Urology and Director of the John and Felecia Cain Center for Bladder Health at UT Southwestern. “The standard treatment for a UTI is antibiotics, which often provide relief. But some women will develop another infection within a few days or weeks, which requires another round of antibiotics, and the process continually repeats itself. Over time, these patients can build up resistant strains of bacteria or develop allergies to antibiotics, making their UTIs extremely challenging to treat. The result can be a life-threatening bout of sepsis and in some cases require the surgical removal of the bladder.”

Electrofulguration treats superficial regions of chronic infection (cystitis or bladder inflammation) within the bladder wall.

“Cystitis is most often the result of a UTI, so it’s a vicious cycle,” Dr. Zimmern said. “The UTI creates cystitis, and the cystitis can lead to chronic lesions deep in the bladder wall where bacteria thrive, protected from the effects of antibiotics.”

Previous UTSW investigations found bacterial reservoirs in these inflammatory bladder lesions, as well as the short-term efficiency of electrofulguration in preventing recurrent urinary tract infections.

“These findings demonstrate that electrofulguration provides a durable clinical cure that enables many postmenopausal women to remain UTI-free with minimal to no continued need for antibiotic therapy,” Dr. Zimmern said. “Just as important, electrofulguration is a well-tolerated procedure. Given the rise in recurrent UTIs among an aging population and the growth in antibiotic-resistant bacteria, electrofulguration could help treat this condition much earlier in many patients and prevent the cascade of events leading to extensive lesions of cystitis.”

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