Pathogenesis of recurrent urinary tract infection: use of understanding as therapy.

Understanding bacterial adherence and explaining it to patients is essential in the management of recurrent urinary tract infection. Bowel flora, usually Escherichia coli, colonize first the vaginal introitus, then the urethral mucosa, and they subsequently ascend to the bladder. The essential step is bacterial adhesion to receptor sites on uroepithelial cells. Women who suffer recurrent infections have more receptive cells than the cells of other women. Long-term antimicrobial therapy reduces susceptibility to reinfection. Bringing patients into an understanding of their infectious process and into a partnership in the alleviation of their suffering is a powerful therapeutic tool.