Gyftopoulos Kostis, Matkaris Miltos, Vourda Aikaterini, Sakellaropoulos George
Department of Anatomy, University of Patras Medical School, Patras, Greece.
Olympion Hospital, Patras, Greece.
Int Urogynecol J. 2019 Aug;30(8):1351-1357. doi: 10.1007/s00192-018-3710-7. Epub 2018 Jul 2.
Recurrent post-coital urinary infection (rUTI)-usually cystitis-is a common entity among otherwise healthy young women. However, little is known about the possible influence of genital anatomical variations. Only a shorter urethral meatus-anus distance has been described as a risk factor. The aim of this study was to evaluate our hypothesis that a shorter urethra-vagina distance is involved in the etiology of post-coital urinary infection.
In this prospective case-control study, 61 young women aged between 18 and 40 years with an acute post-coital UTI and a history of intercourse-related rUTI were consecutively recruited between January 2013 and February 2018. Fifty-six age-matched, sexually active women with no history of UTI served as controls. Perineal measurements included the distances between the clitoris-urethra (C-U), urethra-vagina (U-V), urethra-anus (U-A) and perineum. Demographic and sexual behavior characteristics and the morphology of the urethral meatus were also noted. Univariate analysis compared variables between groups. ROC analysis was used to define the efficiency of perineal measurements in predicting outcome. Odds ratios and 95% confidence intervals for UTI-predisposing variables were estimated using logistic regression analysis.
The U-V and U-A distance was shorter in patients compared with controls [median (interquatile range): 16 mm (14-18) vs. 21 mm (19-23) and 51 mm (47-53) vs. 59 mm (55-62), respectively, p < 0.001]. The U-V performed better in ROC analysis than the U-A distance (AUC 0.952 vs. 0.875, p = 0.023). The only statistically significant parameters in multivariate analysis influencing UTI were BMI (OR: 0.702; 0.510-0.967, p = 0.030) and U-V (OR: 0.297; 0.161-0.549, p < 0.001).
Our results indicate an association between shorter urethra-vagina distance and post-coital rUTIs.
复发性性交后尿路感染（rUTI）——通常为膀胱炎——在其他方面健康的年轻女性中很常见。然而，关于生殖器解剖变异可能产生的影响知之甚少。仅有尿道口至肛门距离较短被描述为一个危险因素。本研究的目的是评估我们的假设，即尿道至阴道距离较短与性交后尿路感染的病因有关。
在这项前瞻性病例对照研究中，2013年1月至2018年2月期间连续招募了61名年龄在18至40岁之间、患有急性性交后尿路感染且有性交相关性rUTI病史的年轻女性。56名年龄匹配、有性活动但无尿路感染病史的女性作为对照。会阴测量包括阴蒂至尿道（C-U）、尿道至阴道（U-V）、尿道至肛门（U-A）以及会阴的距离。还记录了人口统计学和性行为特征以及尿道口的形态。单因素分析比较了组间变量。ROC分析用于确定会阴测量在预测结果方面的有效性。使用逻辑回归分析估计UTI易感变量的比值比和95%置信区间。
与对照组相比，患者的U-V和U-A距离较短[中位数（四分位间距）：分别为16毫米（14 - 18）与21毫米（19 - 23）以及51毫米（47 - 53）与59毫米（55 - 62），p < 0.001]。在ROC分析中，U-V比U-A距离表现更好（AUC 0.952对0.875，p = 0.023）。多因素分析中影响UTI的唯一具有统计学意义的参数是BMI（OR：0.702；0.510 - 0.967，p = 0.030）和U-V（OR：0.297；0.161 - 0.549，p < 0.001）。
我们的结果表明尿道至阴道距离较短与性交后rUTI之间存在关联。
