Rubin Rachel, Sanaee May, Yee Alyssa, Moyneur Erick, Dea Katherine, Dury Alain Y
From the Department of Urology, Georgetown University Hospital, Washington, DC.
Department of Obstetrics and Gynecology, Division of Urogynecology, University of Alberta, Edmonton, Alberta, Canada.
Menopause. 2025 Mar 1;32(3):217-227. doi: 10.1097/GME.0000000000002485. Epub 2025 Jan 7.
The aims of this study were to assess the prevalence of urinary tract infections (UTI) in women newly diagnosed with vulvovaginal atrophy (VVA) versus women without VVA and to evaluate the potential of vaginal prasterone to be used in postmenopausal VVA women with UTI as prophylaxis to reduce the future UTI risk. As a first subgroup analysis, women using aromatase inhibitors, medications that stop the production of estrogen were analyzed. As a second subgroup analysis, we looked at women with diabetes to investigate whether the same prophylaxis approach should be considered.
This observational retrospective inception cohort study was conducted using the Integrated Dataverse open-source claims database with data from February 2015 through January 2020.
A total of 22,245 women treated with prasterone for a minimum of 12 weeks were matched to women without any prescribed VVA-related treatment. Overall, women treated with prasterone have a significantly lower UTI prevalence compared to those untreated (6.58% vs 12.3%; P < 0.0001). The highest difference in UTI prevalence among the prasterone treated and untreated women was observed in those aged 65-74 (7.15% vs 16.2%; P < 0.0001). Among aromatase inhibitor users and women with diabetes, those treated with prasterone have a significantly lower UTI prevalence (4.90% vs 9.79%; P < 0.01 and 14.59% vs 20.48%; P < 0.0001, respectively).
This study suggests that intravaginal prasterone may be a good candidate for prophylaxis in postmenopausal women with UTI to reduce future UTI risk, including for women taking aromatase inhibitors and women with diabetes. This study is based on real-world evidence and warrants further investigation in a clinical setting.
本研究旨在评估新诊断为外阴阴道萎缩（VVA）的女性与无VVA的女性中尿路感染（UTI）的患病率，并评估阴道用普拉睾酮在绝经后VVA合并UTI女性中作为预防措施以降低未来UTI风险的潜力。作为第一个亚组分析，对使用芳香化酶抑制剂（即阻止雌激素产生的药物）的女性进行了分析。作为第二个亚组分析，我们观察了糖尿病女性，以研究是否应考虑相同的预防方法。
本观察性回顾性起始队列研究使用了综合数据集开源索赔数据库，数据来自2015年2月至2020年1月。
共有22245名接受普拉睾酮治疗至少12周的女性与未接受任何规定的VVA相关治疗的女性进行了匹配。总体而言，与未接受治疗的女性相比，接受普拉睾酮治疗的女性UTI患病率显著更低（6.58%对12.3%；P<0.0001）。在接受和未接受普拉睾酮治疗的女性中，UTI患病率差异最大的是65 - 74岁的女性（7.15%对16.2%；P<0.0001）。在芳香化酶抑制剂使用者和糖尿病女性中，接受普拉睾酮治疗的女性UTI患病率显著更低（分别为4.90%对9.79%；P<0.01和14.59%对20.48%；P<0.0001）。
本研究表明，阴道用普拉睾酮可能是绝经后UTI女性预防未来UTI风险的良好选择，包括服用芳香化酶抑制剂的女性和糖尿病女性。本研究基于真实世界证据，值得在临床环境中进一步研究。
