The role of excretory urography and cystoscopy in the evaluation and management of women with recurrent urinary tract infection.

We examined the roles of excretory urography and cystoscopy in the evaluation and management of 153 otherwise healthy women seen consecutively with recurrent urinary tract infections. The excretory urograms were entirely normal in 89 per cent of the patients; the abnormalities were incidental findings with no influence on subsequent management. These results, combined with the known expense and risks inherent in the use of iodinated radiologic contrast material, suggest that excretory urography be limited to those patients possessing other risk factors. These include a history of unexplained hematuria, obstructive symptoms, neurogenic bladder dysfunction, renal calculi, analgesic abuse, severe diabetes mellitus or bacteriologic evidence of rapid recurrence suggesting bacterial persistence within the urinary tract or an enterovesical fistula. On the other hand, cystoscopy under local anesthesia has essentially no risks and occasionally will yield information helpful in future management.