Relationship between obstetric history and recurrent urinary tract infections

Cynthia Vanaclocha-Ferrer-1 C1, Barbara-Yolanda Padilla-Fernandez-2 B2, Maria-Helena Garcia-Sanchez-3 M3, Maria-de-la-O Rodriguez-Martin-3 M3, Naira Hernandez-Navarro-1 N1, Cristina Domenech-Perez-4 C4, Lauro-Sebastian Valverde-Martinez-5 L5, Magaly-Teresa Marquez-Sanchez-5 M5, Maria-Carmen Flores-Fraile-1 M1, Marquez-Sanchez, Gerardo-5 M5, Garcia Gomez, Francisco-6 G6, Flores-Fraile, Javier-1 F1, Esteban-Fuerte Manuel-7 E7, Maria-Begoña Garcia-Cenador-1 M1, Maria-Fernanda Lorenzo-Gomez-1,5,6 M8

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 183
On Demand Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction
Scientific Open Discussion Session 17
On-Demand
Female Infection, other Infection, Urinary Tract
1. 1.-Department of Surgery, University of Salamanca, Spain., 2. 2.-Urology Section of the Department of Surgery, University of La Laguna, Tenerife, Spain, 3. 3.-Department of Obstetrics and Gynecology. University Hospital of Salamanca, Spain., 4. 4.-Department of Surgery, University of Valencia, Spain., 5. 5.-Renal Urological Multidisciplinary Research Group (GRUMUR for its acronym in Spanish) of the Biosanitary Research Institute of Salamanca (IBSAL for its acronym in Spanish). Spain., 6. 6.-Department of Urology of the University Hospital of Salamanca, Spain., 7. 7.-Department of Urology of the National Hospital for Paraplegics of Toledo, Spain., 8. 1.-Department of Surgery, University of Salamanca, Spain.5.-Renal Urological Multidisciplinary Research Group (GRUMUR for its acronym in Spanish) of the Biosanitary Research Institute of Salamanca (IBSAL for its acronym in Spanish). Spain. 6.-Department of Urology of the University Hospital of Salamanca, Spain.
Presenter
M

Maria-Fernanda Lorenzo-Gomez Maria-Fernanda Lorenzo-Gomez-1,5,6
1.-Department of Surgery, University of Salamanca, Spain.5.-Renal Urological Multidisciplinary Research Group (GRUMUR for its acronym in Spanish) of the Biosanitary Research Institute of Salamanca (IBSAL for its acronym in Spanish). Spain. 6.-Department of Urology of the University Hospital of Salamanca, Spain.
Links

Abstract

Hypothesis / aims of study 
Urinary tract infections (UTIs) affect more than 50% of women. 25% derive in recurrent UTI (RUTI). The relationship between RUTI, estrogenic status, and pelvic floor function is known, but not the relationship between obstetric history and RUTI occurrence. The aims of this study are: 
1)	To know the prevalence of obstetric history in women with RUTI. 
2)	To investigate if there is any relationship between the obstetric events and the occurrence of RUTIs.
Study design, materials and methods 
Multicenter, observational, case-control, retrospective study of 714 patients followed in the Urology department. 
Two groups were differentiated:
•	Group A (n=588; GA): women with RUTI (Cases). 
•	Group B (n=126; GB): women without RUTI (Controls, women treated for renal cancer and with no evident recurrence). 
Variables: Age, obstetric history, gynaecological surgical background, oestrogen status, urine cultures.
Descriptive statistics, ANOVA analysis, t-Student, Fisher's exact test's Pearson’s correlation test, multiple regression. p <0.05 is considered significant.
Results 
Mean age was 61.04 years (range 19-92) for the whole sample; in GA mean 56.77 years, SD 4.46 (range 19-85), and in GB 71 years, SD 6.73 (range 25-92) (p=0.0001). 
Obstetric history: 
-	Nulliparous: GA 20 (3.4%); GB 90 (71.42%); p = 0.0001; 
-	Eutocic childbirths:  GA 416 (70.74%); GB 30 (23.8%); p = 0.0001;
-	Dystocic childbirths: GA 58 (9.86%); GB 56 (44.44%); p = 0.0001;
-	Miscarriage: GA 102 (17.34%); GB 30 (23.8%); p = 0.1381.
Gynaecological surgical background:
-	Hysterectomy without adnexectomy: GA 100 (17%); GB 18 (14.28%); p = 0.5640;
-	Hysterectomy with adnexectomy: GA 100 (17%); GB 66 (52.28%); p = 0.0001. 
In the multiple regression analysis, we found that age (coefficient 0.030, p= 0.002) has a direct correlation with the appearance of UTI, in contrast with BMI that had a inverse correlation (coefficient -0.060, p= 0.060).
Women with RUTI have a more frequent history of eutocic delivery (coefficient 0.034, p= 0.422) compared to those without infections (coefficient 0.060, p= 0.004). However, nulliparity (coefficient 0.760, p= 0.040), dystocic delivery (coefficient -0.048, p= 0.407) and hysterectomy with adnexectomy (coefficient 0.098, p= 0.017) are more frequent in women without UTI. Having had miscarriage in the past showed a positive correlation with the development of UTI (coefficient 0.220, p= 0.0010). No relationship was found between a past hysterectomy without adnexectomy and the occurrence or absence of UTI (coefficient 0.045, p= 0.278).
The most prevalent obstetric antecedent in women with RUTI is eutocic delivery associated with good health (coefficient 0.034, p= 0.422), but the relationship was not statistically significant.
In women with a more deteriorated health status, the medical background associated with RUTI is dystocic delivery (coefficient -0.048, p= 0.407), with the condition of concomitant urinary incontinence being much more prevalent.
Interpretation of results 
Patients with a past history of hysterectomy with adnexectomy could be more asked about symptoms associated with hypoestrogenism by their healthcare providers, and therefore be treated with topical oestrogens, but this fact has not been studied in this sample and could bias the results of the multivariate analysis (hysterectomy with adnexectomy was more frequent in women without UTI). Another factor that could influence this result could be that patients in group B were older than in group A, and for this reason hysterectomy with adnexectomy could have been more indicated by their gynaecologists following the trend of the recommendations of the last century.
Most patients in the control group were nulliparous; it could condition that the patients in this group have a fitter pelvic floor without muscle avulsions, being more prone to protect the genitourinary tract against UTIs.
Concluding message 
Nulliparity is more frequent in women without RUTI, while eutocic births are more associated with RUTI. The most prevalent gynecological-obstetric history in women with RUTI is eutocic delivery associated with a good health status.

Keywords: Urinary Tract Infection (UTI), Recurrent Urinary Tract Infection (RUTI), Nulliparity, Eutocic, Dystocic, Abortion.
Disclosures
Funding Multidisciplinary Renal Research Group of the Institute for Biomedical Research ofSalamanca (IBSAL). Spain. Clinical Trial No Subjects Human Ethics Committee Ethics Committee for Drug Research (CEIm) of the Ávila Health Area. Ávila, Spain Helsinki Yes Informed Consent Yes
06/05/2025 03:41:19