For the 2022 Urological Infections Guidelines, new and relevant evidence was identified, collated and appraised through a structured assessment of the literature. Broad and comprehensive literature searches, covering specific sections were performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. The number of unique records identified, retrieved and screened for relevance for each section were:
- 3.5 Recurrent UTI: 3,582 unique abstracts; 361 full texts; 44 included.
- 3.12 Acute Infective Epididymitis: 263 unique abstracts; 41 full texts; 9 included.
- 3.15 Peri-procedural Antibiotic Prophylaxis: 927 unique abstracts; 53 full texts; 14 included
Specific changes include:
- Section 3.5 Recurrent UTI – This section has been comprehensively updated and new treatment recommendations have been made.
Diagnose recurrent UTI by urine culture.
Do not perform an extensive routine workup (e.g cystoscopy, full abdominal ultrasound) in women younger than 40 years of age with recurrent UTI and no risk factors.
Advise pre-menopausal women regarding increased fluid intake as it might reduce the risk of recurrent UTI.
Use vaginal oestrogen replacement in post-menopausal women to prevent recurrent UTI.
Use immunoactive prophylaxis to reduce recurrent UTI in all age groups.
Advise patients on the use of local or oral probiotic containing strains of proven efficacy for vaginal flora regeneration to prevent UTIs.
Advise patients on the use of cranberry products to reduce recurrent UTI episodes; however, patients should be informed that the quality of evidence underpinning this is low with contradictory findings.
Use D-mannose to reduce recurrent UTI episodes, but patients should be informed that further studies are needed to confirm the results of initial trials.
Use endovesical instillations of hyaluronic acid or a combination of hyaluronic acid and chondroitin sulphate to prevent recurrent UTIs in patients where less invasive preventive approaches have been unsuccessful. Patients should be informed that further studies are needed to confirm the results of initial trials.
Use continuous or post-coital antimicrobial prophylaxis to prevent recurrent UTI when non-antimicrobial interventions have failed. Counsel patients regarding possible side effects.
For patients with good compliance self-administered short-term antimicrobial therapy should be considered.