From the Guidelines
Patients with recurrent urinary tract infections (UTIs) should be referred to a urologist after experiencing at least three UTIs/year or two UTIs in the last 6 months, as these recurrences negatively impact a patient's quality of life 1. When considering referral, it's essential to distinguish between uncomplicated and complicated UTIs, with the latter involving structural abnormalities, urinary obstruction, immunocompromised status, or persistent symptoms despite appropriate antibiotic therapy. Key factors that warrant referral to a urologist include:
- Recurrence of UTIs, defined as at least three episodes per year or two episodes in the last six months 1
- Complicated UTIs, which may involve structural abnormalities, urinary obstruction, or immunocompromised status
- Persistent symptoms despite appropriate antibiotic therapy
- Presence of risk factors such as urolithiasis, history of urological surgery, congenital urinary tract abnormalities, or hematuria during or after infection Before referral, clinicians should obtain a urine culture to identify the causative organism and its antibiotic sensitivities and consider basic imaging like ultrasound to detect obvious structural abnormalities 1, 1. Prophylactic measures such as increased fluid intake, post-coital voiding, cranberry products, and in some cases, low-dose prophylactic antibiotics may be initiated while awaiting specialist evaluation. Urological assessment typically includes a comprehensive history, physical examination, specialized imaging, and possibly cystoscopy to identify anatomical abnormalities or other underlying causes that may require specific interventions beyond antibiotic management.
From the Research
Referral to Urology for Recurrent UTIs
- Referral to a urologist may be considered for patients with recurrent urinary tract infections (UTIs) who have underlying structural or pathological abnormalities, or those who do not respond to standard treatment [(2,3)].
- Investigations such as urine culture and susceptibility testing, as well as imaging studies, may be necessary to rule out underlying conditions that may be contributing to recurrent UTIs [(3,4)].
- Patients with recurrent UTIs who have risk factors such as frequent sexual intercourse, spermicide use, or a history of UTIs before age 15 may benefit from referral to a urologist for further evaluation and management [(2,5)].
- Referral to a urologist may also be considered for patients with complicated UTIs, such as those with upper tract infections or urosepsis, or those with underlying medical conditions that may increase the risk of complications [(5,6)].
Indications for Referral
- Recurrent UTIs despite standard treatment
- Underlying structural or pathological abnormalities
- Complicated UTIs, such as upper tract infections or urosepsis
- Underlying medical conditions that may increase the risk of complications
- Risk factors for recurrent UTIs, such as frequent sexual intercourse or spermicide use
Management of Recurrent UTIs
- Antibiotic prophylaxis may be effective in preventing recurrent UTIs, but may also increase the risk of antibiotic resistance and adverse effects [(2,4)].
- Non-antibiotic approaches, such as increased fluids and cranberry products, may also be effective in preventing recurrent UTIs [(2,4)].
- Patient-initiated treatment and self-diagnosis may be accurate and effective in managing recurrent UTIs, but should be guided by a healthcare provider [(2,4)].