Recurrent Urinary Tract Infections
Recurrent urinary tract infections (rUTIs) are defined as the occurrence of at least three urinary tract infections (UTIs) in one year or two infections in the past six months.
These infections may be presented as cystitis (bladder infection) or pyelonephritis (kidney infection). Recurrent pyelonephritis should be carefully evaluated to rule out complicated causes.
Source: European Association of Urology
Symptoms
Typical symptoms of UTIs include:
- Dysuria: burning sensation or pain during urination.
- Pollakiuria: frequent need to urinate, often with a small amount of urine.
- Urinary urgency: sensation of an urgent need to urinate.
- Cloudy or foul-smelling urine.
- Suprapubic or lower abdominal pain.
In cases of pyelonephritis, additional symptoms may appear such as fever, chills, and flank pain.
Diagnosis
The evaluation of recurrent UTIs includes:
Detailed medical history:
- Record of frequency and characteristics of previous infections.
- Identification of risk factors, such as sexual activity, use of spermicides, or family history.
Urinalysis and urine culture:
- Detection of bacteria and determination of antibiotic susceptibility.
Imaging studies:
- In selected cases, ultrasound or computed tomography may be performed to identify structural or functional abnormalities of the urinary tract.
Treatment
Therapeutic strategies for UTIs may include:
General measures:
- Proper hygiene: cleaning the genital area from front to back to prevent the introduction of bacteria.
- Postcoital voiding: urinating after sexual intercourse to eliminate bacteria introduced during intercourse.
- Adequate hydration: sufficient fluid intake to promote urine flow and the elimination of bacteria.
Antibiotic therapy:
- Treatment of acute episodes: use of antibiotics according to the bacterial sensitivity profile.
- Antibiotic prophylaxis: in selected cases, the administration of low-dose antibiotics on a continuous or postcoital basis may be considered to prevent recurrences.
Complementary therapies:
- Use of probiotics: some studies suggest that certain probiotics may help restore the vaginal flora and reduce the risk of UTIs.
- Cranberry-based products: although the evidence is mixed, some patients may benefit from them to prevent UTIs.
Prevention
To reduce the risk of recurrent UTIs, the following measures are recommended:
- Proper genital hygiene: maintaining correct cleanliness and avoiding the use of irritating products in the genital area
- Ensure proper hydration by drinking enough water to facilitate bacterial clearance from the urinary tract.
- Avoid holding urine: urinate regularly and do not delay voiding.
- Wear appropriate underwear, preferably cotton, and avoid tight clothing that may retain moisture.
- Control of predisposing factors: management of conditions such as diabetes or constipation that can increase the risk of UTIs.
It is essential that patients with recurrent UTIs consult a Urology specialist for a detailed evaluation and the implementation of a personalized management plan.
