Lower Urinary Tract Infections in Urogynaecology

Overview

Urinary tract infections belong among the most common infectious diseases in adult women. Sporadic infection is usually not a diagnostic and therapeutic problem. Recurrent lower urinary tract infections significantly decrease the quality of life of the affected women. Colonisation of the vagina, vulva and the perineum by the uropathogens is the main risk factor of any urinary infection, but only concomitant action of some other factor (e.g. immunosuppression, urethral stenosis, urolithiasis, urethral diverticulum, diabetes and urinary incontinence) can induce the recurrent infection. Correct primary treatment and proper used preventive method is highly advantageous not only from the individual but also from the global point of view (high diagnostic and therapeutic expenses, increase of resistance and imminent success decrease of the modern treatment). Continuous low dose antimicrobial treatment is the most common prophylactic modality. Postcoital antimicrobial prophylaxis and immunomodulative therapy are the other used modalities. Local vaginal estrogen therapy is recommended in postmenopausal women. Estrogens improve the symptoms of the urogenital atrophy and decrease the vaginal pH, which is very important in prevention of the pathological bacterial colonisation of the vagina. Decision about the individual therapy and prophylaxis must be preceded by the evaluation of the risk factors with positives and negatives of the used drug. 

Key words:
recurrent urinary tract infections, complications, prophylaxis, antimicrobial therapy, immunomodulative therapy, estrogens.