Topic: Urinary Tract Infection

Genitourinary Syndrome of Menopause

Genitourinary Syndrome of Menopause

by | Nov 2024

Kelly J. Casperson, MD, emphasizes the essential role of vaginal estrogen in treating genitourinary syndrome of menopause (GSM). In this 9-minute talk, she explains that many women are misdiagnosed or undertreated because physicians often lack education about menopause. Vaginal estrogen, an inexpensive and effective treatment, can address multiple symptoms, including urinary tract infections (UTIs), overactive bladder, and pain during intercourse, often misinterpreted as separate issues.

Casperson highlights how GSM affects not only sexual health but also urological function, with estrogen deficiency leading to significant anatomical changes such as urethral dysfunction and vaginal atrophy. She critiques outdated misconceptions and stresses the importance of proper hormone replacement therapy over antibiotics or invasive interventions for recurrent UTIs in postmenopausal women.

Furthermore, Casperson advocates for revisiting FDA guidelines on vaginal estrogen, noting the misleading and harmful warning labels that deter its use. She encourages physicians to integrate vaginal estrogen as a first-line treatment for many menopausal symptoms.

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Functional Urology: A New Sub-Specialty or Rebranding?

Functional Urology: A New Sub-Specialty or Rebranding?

by | Nov 2024

Brian J. Flynn, MD, focuses on defining and exploring the evolving specialties of functional and reconstructive urology, emphasizing the need for rebranding within the field. In this 11-minute talk, he stresses that functional urology, similar to specialties like female pelvic medicine and pediatric urology, deserves rebranding efforts.

Dr. Flynn advocates for collaboration between urologists and non-physicians to expand the field’s influence, particularly in addressing lower urinary tract dysfunctions. He also discusses how urologists can better integrate into the broader medical community, learning from global models, especially in Europe and Canada, where functional and integrative approaches are more advanced.

Functional urology is a comprehensive, patient-centered specialty with a broad scope of practice encompassing all lower urinary tract disorders.

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Updates with Addressing the Microbiome

Updates with Addressing the Microbiome

by | Sep 2024

Priya N. Werahera, PhD, explores the characterization of urinary microbiomes in healthy individuals and their implications for understanding disease processes such as urinary tract infections (UTIs) and other urologic conditions. In this 10-minute talk, he shares that urogenital microbiota, residing in the urinary and genital tracts, is now better understood due to advancements in next-generation sequencing.

The study identified urinary microbiomes in healthy men and women. Dr. Werahera discusses key findings, including identifying 609 species dominated by four major phyla and notable differences in microbial profiles between genders. This data encourages further discussion, questioning whether medication, gender, or age affect microbiome profiles.

The findings suggest that a one-size-fits-all approach is inadequate; instead, personalized assessment of urinary microbiomes, considering individual patient factors, is crucial for accurately diagnosing and managing bladder-related symptoms and infections.

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Urodynamics Review

Urodynamics Review

by | Sep 2024

Stephen R. Kraus, MD, MBA, FACS, provides a comprehensive review of urodynamics, discussing key concepts and practical applications in evaluating lower urinary tract function. This 14-minute presentation emphasizes the importance of understanding both the storage and emptying phases of bladder function.

Dr. Kraus details how dysfunction can arise from a bladder issue, an outlet problem, or both. Specific examples are given and complex cases are also included. Kraus notes results from various tests, such as those for stress incontinence, overactive bladder, and neurogenic bladder, help guide the use of urodynamics in clinical practice. He highlights the need for careful interpretation of test results to ensure accurate diagnosis and treatment planning.

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Infections Following Prostate Needle Biopsy – An Evidence-Based Approach to Tackling A Common Problem

Infections Following Prostate Needle Biopsy – An Evidence-Based Approach to Tackling A Common Problem

by | Aug 2024

Jay D. Raman, MD addresses infections following prostate needle biopsy, presenting an evidence-based approach to managing this common problem. He notes the prevalence of infections following prostate needle biopsy in recent years, attributing this increase to antibiotic resistance and the inherent risks associated with transrectal biopsy procedures.

At the core of his presentation, Dr. Raman reviews current evidence and guidelines for preventing infections post-biopsy. He examines the role of prophylactic antibiotics and emphasizes the importance of tailoring antibiotic prophylaxis to individual patient risk profiles, including prior infection history, local resistance patterns, and patient comorbidities.

Dr. Raman also explores alternative biopsy techniques aimed at reducing infection rates. A shift towards transperineal biopsy approaches has demonstrated lower infection risks compared to traditional transrectal methods. The presentation includes an analysis of the benefits and limitations of these techniques, supported by recent clinical data.

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Bladder Microbiome and Recurrent UTIs: Preventing Those Nasty Buggers

Bladder Microbiome and Recurrent UTIs: Preventing Those Nasty Buggers

by | Apr 2024

Suzette E. Sutherland, MD, MS, URPS, addresses the role of the microbiome in recurrent urinary tract infections (UTIs). She begins this 26-minute presentation by reviewing the bladder microbiome, noting that microbes support immune function and maintain the integrity of the bladder lining. She then transitions to prevention and treatment of the condition.

Non-antibiotic prevention strategies are discussed, focusing on hydration, cranberry supplements, estrogen, and probiotics. Probiotics are emphasized for their role in reducing UTI recurrence, but Sutherland stresses the importance of proper diagnosis and judicious antibiotic use to avoid contributing to antibiotic resistance. Catheter-associated UTIs are also addressed, with a preference for clean intermittent catheterization and bladder irrigation with gentamicin in severe cases. Overall, Dr. Sutherland advocates for a conservative, evidence-based approach, using antibiotics only when necessary to preserve the efficacy of these crucial medications.

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Urological Emergencies in the Pregnant Patient

Urological Emergencies in the Pregnant Patient

by | Dec 2023

Michael Coburn, MD, FACS, explores the complexities and management strategies of urological emergencies in pregnant patients. He highlights the anatomical and physiological alterations during pregnancy, such as increased renal blood flow and ureteral dilation, which predispose pregnant patients to specific urological emergencies.

One primary focus of the lecture is urinary tract infections (UTIs), renal colic, and obstructive uropathy and their impact on both maternal and fetal health. Dr. Coburn also delves into rare but serious conditions like urological trauma and acute urinary retention. He underscores the necessity of a multidisciplinary approach, involving obstetricians, urologists, and neonatologists, to optimize outcomes.

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Recurrent UTIs in Women: Ask the Guideline

Recurrent UTIs in Women: Ask the Guideline

by | Jun 2023

Jennifer Anger, MD, MPH, discusses American Urological Association (AUA) guidelines regarding recurrent urinary tract infections (rUTIS) in women. She begins by discussing antimicrobial stewardship and the consideration of collateral damage, explaining antimicrobial resistance among uropathogens has increased dramatically in the past 20 years.

Dr. Anger characterizes the index patient for the 2019 rUTI guideline as an otherwise healthy adult female with an uncomplicated, culture-proven rUTI associated with acute-onset symptoms. She summarizes guideline highlights, including the recommendation that clinicians obtain a complete patient history and perform a pelvic examination in women presenting with rUTIs. Additionally, clinicians should obtain urinalysis, urine culture, and sensitivity with each symptomatic acute cystitis episode prior to initiating treatment for rUTIs.

Dr. Anger outlines first-line therapy (nitrofurantoin, TMP-SMX, and fosfomycin) and explains clinicians should use as short a duration of antibiotics as reasonable for rUTI patients with an acute cystitis episode. For patients with urine cultures resistant to oral antibiotics, clinicians may treat with culture-directed parenteral antibiotics for as short a course as reasonable.

Dr. Anger discusses use, dosing, and duration of prophylactic antibiotics and points out that clinicians may offer cranberry prophylaxis for rUTIs, but explains that studies are lacking in this area. Clinicians should repeat urine culture to guide further management when UTI symptoms persist following antimicrobial therapy.

In peri- and post-menopausal women with rUTIs, clinicians should consider vaginal estrogen therapy to reduce the risk of recurrence. Dr. Anger then highlights the 2022 UTI Guideline Update and explains randomized, controlled trials that contributed evidence to this amendment report.

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Fear and Frustration Among Women with Recurrent UTIs

Fear and Frustration Among Women with Recurrent UTIs

by | Jan 2022

In conversation with A. Lenore Ackerman, MD, PhD, Assistant Professor of Urology and Director of Research in the Division of Female Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, Ja-Hong H. Kim, MD, Associate Professor in the Division of Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, and Victoria C. Scott, MD, Associate Program Director of the FPMRS Fellowship at Cedars-Sinai Medical Center, discuss a recent study of the experience of women with recurrent urinary tract infections (rUTIs). Dr. Scott explains that 29 women were recruited to participate in 1 of 6 focus group discussions to investigate the perspective of women suffering from rUTIs. She then lists some preliminary themes from the discussions with the women, including fear of development of antibiotic resistance, widespread knowledge of the collateral damage from antibiotics, concern about taking unnecessary antibiotics, anger at physicians for “throwing” antibiotics at them, a feeling that the medical profession underestimates the impact of rUTIs, a need for research on nonantibiotic options for prevention and treatment, and resentment towards the medical system for not dedicating more research efforts to providing more timely diagnosis. Dr. Scott synthesizes these themes into two emergent concepts: fear about the overuse of antibiotics and frustration at the medical system for not providing alternative treatments or taking rUTI symptoms seriously. Dr. Kim then notes that this initial study has produced two additional studies on the current management of rUTIs that take expert and personal care provider experiences into account. Dr. Ackerman highlights the importance of data capturing that patients are not seeking antibiotics necessarily in the way doctors assume they are, though Dr. Kim does add the caveat that the women in the study were a relatively homogeneous group of college-educated white women. Dr. Ackerman also muses that the attitudes expressed in this study suggest that this population may be interested in a vaccine for rUTIs. Drs. Ackerman, Scott, and Kim conclude by noting that the study made evident the importance to patients with rUTIs of focusing on their experience rather than merely the clearance of bacteria.

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Fear and Frustration Among Women with Recurrent UTIs

by | Dec 2021

In conversation with A. Lenore Ackerman, MD, PhD, Assistant Professor of Urology and Director of Research in the Division of Female Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, Ja-Hong H. Kim, MD, Associate Professor in the Division of Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, and Victoria C. Scott, MD, Associate Program Director of the FPMRS Fellowship at Cedars-Sinai Medical Center, discuss a recent study of the experience of women with recurrent urinary tract infections (rUTIs). Dr. Scott explains that 29 women were recruited to participate in 1 of 6 focus group discussions to investigate the perspective of women suffering from rUTIs. She then lists some preliminary themes from the discussions with the women, including fear of development of antibiotic resistance, widespread knowledge of the collateral damage from antibiotics, concern about taking unnecessary antibiotics, anger at physicians for “throwing” antibiotics at them, a feeling that the medical profession underestimates the impact of rUTIs, a need for research on nonantibiotic options for prevention and treatment, and resentment towards the medical system for not dedicating more research efforts to providing more timely diagnosis. Dr. Scott synthesizes these themes into two emergent concepts: fear about the overuse of antibiotics and frustration at the medical system for not providing alternative treatments or taking rUTI symptoms seriously. Dr. Kim then notes that this initial study has produced two additional studies on the current management of rUTIs that take expert and personal care provider experiences into account. Dr. Ackerman highlights the importance of data capturing that patients are not seeking antibiotics necessarily in the way doctors assume they are, though Dr. Kim does add the caveat that the women in the study were a relatively homogeneous group of college-educated white women. Dr. Ackerman also muses that the attitudes expressed in this study suggest that this population may be interested in a vaccine for rUTIs. Drs. Ackerman, Scott, and Kim conclude by noting that the study made evident the importance to patients with rUTIs of focusing on their experience rather than merely the clearance of bacteria.

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Fear and Frustration Among Women with Recurrent UTIs

by | Nov 2021

In conversation with A. Lenore Ackerman, MD, PhD, Assistant Professor of Urology and Director of Research in the Division of Female Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, Ja-Hong H. Kim, MD, Associate Professor in the Division of Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, and Victoria C. Scott, MD, Associate Program Director of the FPMRS Fellowship at Cedars-Sinai Medical Center, discuss a recent study of the experience of women with recurrent urinary tract infections (rUTIs). Dr. Scott explains that 29 women were recruited to participate in 1 of 6 focus group discussions to investigate the perspective of women suffering from rUTIs. She then lists some preliminary themes from the discussions with the women, including fear of development of antibiotic resistance, widespread knowledge of the collateral damage from antibiotics, concern about taking unnecessary antibiotics, anger at physicians for “throwing” antibiotics at them, a feeling that the medical profession underestimates the impact of rUTIs, a need for research on nonantibiotic options for prevention and treatment, and resentment towards the medical system for not dedicating more research efforts to providing more timely diagnosis. Dr. Scott synthesizes these themes into two emergent concepts: fear about the overuse of antibiotics and frustration at the medical system for not providing alternative treatments or taking rUTI symptoms seriously. Dr. Kim then notes that this initial study has produced two additional studies on the current management of rUTIs that take expert and personal care provider experiences into account. Dr. Ackerman highlights the importance of data capturing that patients are not seeking antibiotics necessarily in the way doctors assume they are, though Dr. Kim does add the caveat that the women in the study were a relatively homogeneous group of college-educated white women. Dr. Ackerman also muses that the attitudes expressed in this study suggest that this population may be interested in a vaccine for rUTIs. Drs. Ackerman, Scott, and Kim conclude by noting that the study made evident the importance to patients with rUTIs of focusing on their experience rather than merely the clearance of bacteria.

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