Study design, materials and methods
102 patients were referred to the service between March 2016 and 2018. Following triage by urology consultants the patients were appointed to see a Nurse Continence Specialist. They were assessed and data was collected from this assessment which included the following data;
number of culture proven infections
post void residual,
lifestyle factors and weight
All patients underwent US urinary tract. Only patients with visible haematuria were referred for flexible cystoscopy. All women were given written and conservative advice leaflets (BAUS cystitis, NICE IBS, bladder training, toilet positions, pelvic floor exercise, intercourse positions and lubrication advice).
72 women aged 15 to 29 years attended for consultation. Despite being referred as rUTI, 31 women had no culture proven samples and 16 had only 1 infection. 25 patients had at least 2 proven cultures with the maximum being 6.
Triggers were identified in 33 women; 28 (85%) reported sexual intercourse, 2 alcohol consumption, 2 infrequent voiding and 1 had a high post void residual.
All women has US KUB requested; 60 were performed, of which 49 (82%) were normal. 11 identified an abnormality but none were considered causative for rUTI.
16 women reported visible haematuria of which 13 had flexible cystoscopy – 10 (77%) were normal and 3 identified abnormalities - tight meatus, schistosomiasis and cystitis cystica.
In the 25 patients with 2 or more proven infections, we analysed results separately after 12 months of conservative interventions. In those with 2 infections (14 patients) 86% had 0 or 1. Patients with 3 infections (6 patients), 66% had 0 or 1. Those with 4 infections (3 patients), 66% had no further and finally the 2 patients with 5 or 6 infections both patients had 0. Only 3 of these 25 women required prophylactic, 0 required post coital and 1 obtained self-start antibiotics
13 out of these 25 (52%) women only required 1 appointment with the service and at 12 months 21/25 no longer require any contact (discharge or DNA).
Interpretation of results