University of Texas Southwestern Medical Center, Dallas, Texas.
Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.
J Urol. 2016 Aug;196(2):422-8. doi: 10.1016/j.juro.2016.01.111. Epub 2016 Feb 13.
We compared the rates of upper tract imaging abnormalities of recurrent urinary tract infections due to bacterial persistence or reinfection.
Following institutional review board approval we reviewed a prospectively maintained database of women with documented recurrent urinary tract infections (3 or more per year) and trigonitis. We searched for demographic data, urine culture findings and findings on radiology interpreted upper tract imaging, including renal ultrasound, computerized tomography or excretory urogram. Patients with irretrievable images, absent or incomplete urine culture results for review, no imaging performed, an obvious source of recurrent urinary tract infections or a history of pyelonephritis were excluded from analysis.
Of 289 women from 2006 to 2014 with symptomatic recurrent urinary tract infections 116 met study inclusion criteria. Mean ± SD age was 65.0 ± 14.4 years. Of the women 95% were white and 81% were postmenopausal. Almost a third were sexually active and none had prolapse stage 2 or greater. Of the 116 women 48 (41%) had persistent and 68 (59%) had reinfection recurrent urinary tract infection. Imaging included ultrasound in 52 patients, computerized tomography in 26, ultrasound and computerized tomography in 31, and excretory urogram with ultrasound/computerized tomography in 7. Of the total of 58 imaging findings in 55 women 57 (98%) were noncontributory. One case (0.9%) of mild hydronephrosis was noted in the persistent recurrent urinary tract infection group but it was not related to any clinical parameters. Escherichia coli was the dominant bacteria in 71% of persistent and 47% of reinfection recurrent urinary tract infections in the most recently reported urine culture.
This study reaffirms that upper tract imaging is not indicated for bacterial reinfection, recurrent urinary tract infections. However, the same conclusion can be extended to recurrent urinary tract infections secondary to bacterial persistence, thus, questioning the routine practice of upper tract studies in white postmenopausal women with recurrent urinary tract infections and trigonitis.
我们比较了细菌持续存在或再感染引起的复发性尿路感染上行尿路影像学异常的发生率。
经机构审查委员会批准，我们回顾了一组有记录的复发性尿路感染（每年 3 次或以上）和膀胱炎女性患者的前瞻性维护数据库。我们寻找了人口统计学数据、尿液培养结果以及影像学解读的上尿路影像学结果，包括肾脏超声、计算机断层扫描或排泄性尿路造影。我们排除了无法获取图像、尿液培养结果缺失或不完整、未进行影像学检查、复发性尿路感染明显来源或肾盂肾炎病史的患者。
2006 年至 2014 年间，有 289 名有症状的复发性尿路感染女性患者，其中 116 名符合研究纳入标准。平均年龄±标准差为 65.0±14.4 岁。这些女性中 95%为白人，81%处于绝经后状态。近三分之一的患者有性生活，无一例有 2 级或更高级别的脱垂。在 116 名女性中，48 名（41%）患有持续性复发性尿路感染，68 名（59%）患有再发性复发性尿路感染。116 名女性中的 52 名进行了超声检查，26 名进行了计算机断层扫描，31 名进行了超声和计算机断层扫描，7 名进行了排泄性尿路造影和超声/计算机断层扫描。在 55 名女性的总共 58 个影像学发现中，57 个（98%）没有帮助。在持续性复发性尿路感染组中，仅发现 1 例（0.9%）轻度肾积水，但与任何临床参数无关。在最近报告的尿液培养中，大肠杆菌在 71%的持续性复发性尿路感染和 47%的再发性复发性尿路感染中占主导地位。
本研究再次证实，对于细菌再感染引起的复发性尿路感染，上行尿路影像学检查并非必需。然而，同样的结论也可以扩展到继发于细菌持续存在的复发性尿路感染，因此，质疑对复发性尿路感染和膀胱炎的白人绝经后女性常规进行上尿路研究的做法。
