Avoiding "overkill" in diagnosis and treatment of lower urinary tract infections.

Lower urinary tract infections are not procedure-related conditions. Genitourinary tract abnormalities are uncommon, and there are few indications for an extensive workup of women with urinary tract infections. To avoid overtreating and yet remain confident of providing the best possible care, it is important to recognize that urinary tract infections are a spectrum of diseases with different etiologies and different diagnostic and therapeutic requirements. In the vast majority of cases, the urologist's responsibility is to avoid unnecessary treatment, to educate the patient on her condition, and to provide treatment with a first-line, established antimicrobial. The excretory urogram is indicated when the patient presents with symptoms of upper tract infection or asymptomatic hematuria. Urodynamic studies are useful for the patient with an abnormal voiding pattern or suspicion of neurogenic bladder. Cystoscopy has a place only when there is suspicion of bladder tumor. The voiding cystourethrogram is the most useful study for patients with urinary tract infection when there is suspicion of urethral diverticula. Studies are not recommended during a period of acute infection. Procedures that manipulate the urethra are contraindicated.