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Erschienen in: International Urogynecology Journal 6/2020

12.12.2019 | Original Article

Is a pelvic examination contributory in the initial evaluation of women with recurrent urinary tract infections?

verfasst von: Olivia Hostetter, Kshipra Hemal, Katherine N. Hines, Catherine A. Matthews

Erschienen in: International Urogynecology Journal | Ausgabe 6/2020

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Abstract

Introduction and hypothesis

Recurrent urinary tract infections (rUTIs) affect up to 44% of women; evidenced-based guidelines regarding the contributory role of a pelvic examination in these women are lacking. We hypothesize that routine pelvic examination has a limited role in evaluation and management of women with rUTI when appropriate symptoms-based screening is performed and normal post-void residual volume (PVR) is confirmed.

Methods

We performed a retrospective chart review of women ages 18–85 years presenting to Wake Forest Pelvic Health Center with two culture-proven UTIs in 6 months or three UTIs in 12 months with a documented pelvic examination. Pregnant women were excluded. Data extraction included demographics, medical history, screening assessment of vaginal bulge symptoms, urine culture results, imaging, physical/pelvic examination findings, PVR, treatment recommendations and outcomes within 1 year of initial assessment. Descriptive statistics and Fisher’s exact test were performed.

Results

Of 160 charts screened, 91 met the inclusion criteria. Nineteen (21%) had symptoms of vaginal bulge, and 14 (17%) had PVR > 100 ml. Pelvic examination provided new/contributory information in eight (8.8%) of women. The negative predictive value of absence of bulge symptoms and normal PVR was 89%. Within 1 year, 41 (46%) reported symptom resolution with rUTI treatment with no difference between those with or without a contributory pelvic examination (p value = 0.64).

Conclusions

In women with rUTI who report absence of vaginal bulge symptoms and have a PVR < 100 ml, a pelvic examination provides contributory information in < 10% of women and did not change treatment outcomes.
Literatur
1.
Zurück zum Zitat Bergamin PA, Kiosoglous AJ. Non-surgical management of recurrent urinary tract infections in women. Transl Androl Urol. 2017;6(S2):S142–52.CrossRef Bergamin PA, Kiosoglous AJ. Non-surgical management of recurrent urinary tract infections in women. Transl Androl Urol. 2017;6(S2):S142–52.CrossRef
2.
Zurück zum Zitat Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon. 2003;49(2):53–70.CrossRef Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon. 2003;49(2):53–70.CrossRef
3.
Zurück zum Zitat Yamamoto S, Tsukamoto T, Terai A, Kurazono H, Takeda Y, Yoshia O. Genetic evidence supporting the fecal-perineal-urethral hypothesis in cystitis caused by Escherichia Coli. J Urol. 1997;157:1127–9.CrossRef Yamamoto S, Tsukamoto T, Terai A, Kurazono H, Takeda Y, Yoshia O. Genetic evidence supporting the fecal-perineal-urethral hypothesis in cystitis caused by Escherichia Coli. J Urol. 1997;157:1127–9.CrossRef
4.
Zurück zum Zitat Dason S, Dason JT, Kapoor A. Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Can Urol Assoc J. 2011;5(5):316–22.CrossRef Dason S, Dason JT, Kapoor A. Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Can Urol Assoc J. 2011;5(5):316–22.CrossRef
5.
Zurück zum Zitat Aydin A, Ahmed Z, Zaman I, Khan MS, Dasgupta P. Recurrent urinary tract infections in women. Obstet Gynecol Surv. 2015;70(10):621–2.CrossRef Aydin A, Ahmed Z, Zaman I, Khan MS, Dasgupta P. Recurrent urinary tract infections in women. Obstet Gynecol Surv. 2015;70(10):621–2.CrossRef
6.
Zurück zum Zitat Hooton TM. Recurrent urinary tract infection in women. Int J Antimicrob Agents. 2001;17(4):259–68.CrossRef Hooton TM. Recurrent urinary tract infection in women. Int J Antimicrob Agents. 2001;17(4):259–68.CrossRef
7.
Zurück zum Zitat Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000;182(4):1177–82.CrossRef Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000;182(4):1177–82.CrossRef
8.
Zurück zum Zitat Car J, Sheikh A. Recurrent urinary tract infection in women. BMJ. 2003;327(7425):1204.CrossRef Car J, Sheikh A. Recurrent urinary tract infection in women. BMJ. 2003;327(7425):1204.CrossRef
9.
Zurück zum Zitat Brubaker L, Carberry C, Nardos R, Carter-Brooks C, Lowder JL. American Urogynecologic Society best-practice statement: recurrent urinary tract infection in adult women. Female Pelvic Med Reconstr Surg. 2018;24(5):321–35.CrossRef Brubaker L, Carberry C, Nardos R, Carter-Brooks C, Lowder JL. American Urogynecologic Society best-practice statement: recurrent urinary tract infection in adult women. Female Pelvic Med Reconstr Surg. 2018;24(5):321–35.CrossRef
11.
Zurück zum Zitat Kodner CM, Thomas Gupton EK. Recurrent urinary tract infections in women: diagnosis and management. American family physician. Am Fam Physician. 2010;82(6):638–43.PubMed Kodner CM, Thomas Gupton EK. Recurrent urinary tract infections in women: diagnosis and management. American family physician. Am Fam Physician. 2010;82(6):638–43.PubMed
12.
Zurück zum Zitat Anger JT, Litwin MS, Wang Q, Pashos C, Rodriguez L. Complications of sling surgery among female medicare beneficiaries. Obstet Gynecol. 2007;109(3):707–14.CrossRef Anger JT, Litwin MS, Wang Q, Pashos C, Rodriguez L. Complications of sling surgery among female medicare beneficiaries. Obstet Gynecol. 2007;109(3):707–14.CrossRef
13.
Zurück zum Zitat Hammet J, Lukman R, Oakes M, Whitcomb E. Recurrent urinary tract infection after mid urethral sling. Female Pelvic Med Reconstr Surg. 2016;22(6):438–41.CrossRef Hammet J, Lukman R, Oakes M, Whitcomb E. Recurrent urinary tract infection after mid urethral sling. Female Pelvic Med Reconstr Surg. 2016;22(6):438–41.CrossRef
14.
Zurück zum Zitat Nygaard I, Brubaker L, Chai T, Markland A, Menefee S, Sirls L, et al. Risk factors for urinary tract infection following incontinence surgery. Int Urogynecol J. 2011;22(10):1255–65.CrossRef Nygaard I, Brubaker L, Chai T, Markland A, Menefee S, Sirls L, et al. Risk factors for urinary tract infection following incontinence surgery. Int Urogynecol J. 2011;22(10):1255–65.CrossRef
15.
Zurück zum Zitat Committee Opinion No. 694 Summary. Management of mesh and graft complications in gynecologic surgery. Female Pelvic Med Reconstr Surg. 2017;23(3):171–6. Committee Opinion No. 694 Summary. Management of mesh and graft complications in gynecologic surgery. Female Pelvic Med Reconstr Surg. 2017;23(3):171–6.
17.
Zurück zum Zitat Lawrentschuk N, Ooi J, Pang A, Naidu K, Bolton D. Cystoscopy in women with recurrent urinary tract infection. Int J Urol. 2006;13(4):350–3.CrossRef Lawrentschuk N, Ooi J, Pang A, Naidu K, Bolton D. Cystoscopy in women with recurrent urinary tract infection. Int J Urol. 2006;13(4):350–3.CrossRef
18.
Zurück zum Zitat Toz E, Kurt S, Sahin C, Canda MT. Frequency of recurrent urinary tract infections in patients with pelvic organ prolapse. Res Rep Urol. 2015;7:9–12.PubMedPubMedCentral Toz E, Kurt S, Sahin C, Canda MT. Frequency of recurrent urinary tract infections in patients with pelvic organ prolapse. Res Rep Urol. 2015;7:9–12.PubMedPubMedCentral
19.
Zurück zum Zitat O’Grady F, Cattell WR. Kinetics of urinary tract infection. Br J Urol. 1966;38(2):149–55.CrossRef O’Grady F, Cattell WR. Kinetics of urinary tract infection. Br J Urol. 1966;38(2):149–55.CrossRef
20.
Zurück zum Zitat Gehrich A, Stany MP, Fischer JR, Buller J, Zahn CM. Establishing a mean postvoid residual volume in asymptomatic perimenopausal and postmenopausal women. Obstet Gynecol. 2007;110(4):827–32.CrossRef Gehrich A, Stany MP, Fischer JR, Buller J, Zahn CM. Establishing a mean postvoid residual volume in asymptomatic perimenopausal and postmenopausal women. Obstet Gynecol. 2007;110(4):827–32.CrossRef
21.
Zurück zum Zitat Taylor DL, Sierra T, Duenas-Garcia OF, Kim Y, Leung K, Hall C, et al. Accuracy of bladder scanner for the assessment of postvoid residual volumes in women with pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2018;1. Taylor DL, Sierra T, Duenas-Garcia OF, Kim Y, Leung K, Hall C, et al. Accuracy of bladder scanner for the assessment of postvoid residual volumes in women with pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2018;1.
22.
Zurück zum Zitat Theisen JF, Deveneau NE, Agrawal A, Kinman C, Gaskins J, Meriwether K, et al. The accuracy of portable ultrasound bladder scanner measurements of postvoid residual volume in women with pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2019;25(5):388–91.CrossRef Theisen JF, Deveneau NE, Agrawal A, Kinman C, Gaskins J, Meriwether K, et al. The accuracy of portable ultrasound bladder scanner measurements of postvoid residual volume in women with pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2019;25(5):388–91.CrossRef
23.
Zurück zum Zitat Santoni N, Ng A, Skews R, Aboumarzouk O. Recurrent urinary tract infections in women what is evidence for investigating with flexible cystoscopy, imaging, and urodynamics? Urol Int. 2018;101(4):373–81.CrossRef Santoni N, Ng A, Skews R, Aboumarzouk O. Recurrent urinary tract infections in women what is evidence for investigating with flexible cystoscopy, imaging, and urodynamics? Urol Int. 2018;101(4):373–81.CrossRef
24.
Zurück zum Zitat Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med. 1993;329(11):753–6.CrossRef Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med. 1993;329(11):753–6.CrossRef
25.
Zurück zum Zitat Barber MD, Neubauer NL, Klein-Olarte V. Can we screen for pelvic organ prolapse without a physical examination in epidemiologic studies? Am J Obstet Gynecol. 2006;195(4):942–8.CrossRef Barber MD, Neubauer NL, Klein-Olarte V. Can we screen for pelvic organ prolapse without a physical examination in epidemiologic studies? Am J Obstet Gynecol. 2006;195(4):942–8.CrossRef
Metadaten
Titel
Is a pelvic examination contributory in the initial evaluation of women with recurrent urinary tract infections?
verfasst von
Olivia Hostetter
Kshipra Hemal
Katherine N. Hines
Catherine A. Matthews
Publikationsdatum
12.12.2019
Verlag
Springer International Publishing
Erschienen in
International Urogynecology Journal / Ausgabe 6/2020
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-019-04198-z

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