Favorable Outcomes of Repeat Electrofulguration Procedures in Women with Antibiotic-Refractory Recurrent Urinary Tract Infections

Bladder Cancer
02/09/2020

Urology. 2020 Aug 29:S0090-4295(20)31027-X. doi: 10.1016/j.urology.2020.08.030. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the efficacy of repeat endoscopic electrofulguration in women with antibiotic-refractory, recurrent urinary tract infections (RUTIs) with persistent symptoms after one electrofulguration.

METHODS: An institutional review board-approved, prospectively maintained database of non-neurogenic women with RUTIs, persistent symptoms and endoscopic findings of bladder wall inflammation after one electrofulguration, and minimum 6 months follow-up was reviewed. Endoscopic success was defined as complete resolution of previous lesions without new lesions seen during office cystoscopy 6 months after second electrofulguration. Clinical success was defined as no urinary tract infections at last follow-up; improvement as 1-2 treated infections/year; and failure as ≥ 3 treated infections/year, daily antibiotic suppression, or another electrofulguration (third or fourth).

RESULTS: From 2006-2018, 58/70 (83%) women with median age 70 years and median follow-up 26 months were included, and 53/58 had endoscopic data 6 months post-second electrofulguration. Endoscopic success was noted in 26 (49%), and 21/26 had < 3 UTIs within the last year of follow-up, versus 2/27 (7%) with endoscopic failure (p = 0.001). Among those with clinical failure, 6/30 (20%) remained on suppressive antibiotics, 9/30 (30%) required intravenous antibiotic courses, and two proceeded to cystectomy. Of 24 women who underwent a third electrofulguration, 11/24 (46%) were clinically successful or improved at median 22 months follow-up. Urine cultures from the year of last follow-up revealed extended-spectrum beta lactamase producing strains (50%) and strains resistant to > 3 antibiotics (43%).

CONCLUSIONS: Women with persistent RUTIs following one electrofulguration may benefit from a second or even third procedure.