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O&G CasesUrogynaecology — infection

O&G Cases · Urogynaecology — infection

Recurrent UTI in a post-menopausal woman — management station

Outpatient management station on recurrent UTI in a post-menopausal woman: tests the candidate's ability to identify oestrogen deficiency as a modifiable risk factor, choose vaginal oestrogen as the first-line non-antibiotic prevention, defend the antibiotic strategy, and counsel on the antibiotic stewardship principle of not treating asymptomatic bacteriuria.

management3 min readVerification in progress

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FRANZCOGMRCOGABOG
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Target exams

FRANZCOGMRCOGABOG
Prompt
A 62-year-old woman presents with six culture-confirmed Escherichia coli urinary tract infections in the last 12 months. She is post-menopausal (last menstrual period 9 years ago), not on hormone therapy, and has not used topical oestrogen. Examination shows atrophic vaginitis with thin, pale vaginal mucosa. She is sexually active and has not had post-coital voiding as a habit. Her urine cultures show E. coli with sensitivity to nitrofurantoin, trimethoprim and fosfomycin. You are the urogynaecology fellow in clinic with the consultant.

Station brief

Format. Outpatient management station, approximately 12 minutes. You are the urogynaecology fellow in clinic; the consultant is in the next room. The patient has heard from a friend that she will need long-term antibiotics and is reluctant. The assessor will run the clock and feed you clinical information. [1]

Candidate instruction. Take the history in summary form, propose your management plan for recurrent UTI in a post-menopausal woman, defend the choice of vaginal oestrogen as first-line non-antibiotic prevention, and outline an antibiotic stewardship plan. [1][3]

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References6ShowHide
  1. [1]Anger J, Lee U, Ackerman AL, et al. Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline J Urol, 2019.PMID 31042112
  2. [2]Fox KA, Lokken EM, Reed SD, et al. Evaluation of systemic estrogen for preventing urinary tract infections in postmenopausal women Menopause, 2021.PMID 33973539
  3. [3]Caretto M, Giannini A, Russo E, et al. Preventing urinary tract infections after menopause without antibiotics Maturitas, 2017.PMID 28364867
  4. [4]Harding C, Chadwick T, Homer T, et al. Methenamine hippurate compared with antibiotic prophylaxis to prevent recurrent urinary tract infections in women: the ALTAR non-inferiority RCT Health Technol Assess, 2022.PMID 35535708
  5. [5]Fu Z, Liska D, Talan D, et al. Cranberry Reduces the Risk of Urinary Tract Infection Recurrence in Otherwise Healthy Women: A Systematic Review and Meta-Analysis J Nutr, 2017.PMID 29046404
  6. [6]Brodie A, El-Taji O, Jour I, et al. A retrospective study of immunotherapy treatment with Uro-Vaxom (OM-89) for prophylaxis of recurrent urinary tract infections Curr Urol, 2020.PMID 33224005
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