How Women Evaluate Syndromic Recurrent Urinary Tract Infections

Woong Bin Kim; Sang Wook Lee; Kwang Woo Lee; Jun Mo Kim; Young Ho Kim; Min Eui Kim

doi:10.14777/uti.2019.14.2.46

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Kim, Lee, Lee, Kim, Kim, and Kim: How Women Evaluate Syndromic Recurrent Urinary Tract Infections

Original Article

Urogenit Tract Infect 2019;14(2):46-54.

Published online: 20 August 2019

DOI: https://doi.org/10.14777/uti.2019.14.2.46

How Women Evaluate Syndromic Recurrent Urinary Tract Infections

Woong Bin Kim, Sang Wook Lee, Kwang Woo Lee, Jun Mo Kim, Young Ho Kim, Min Eui Kim

Department of Urology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea

Correspondence to: Young Ho Kim https://orcid.org/0000-0003-3959-0928 Department of Urology, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bu-cheon 14584, Korea Tel: +82-32-621-5058, Fax: +82-32-621-5018 E-mail: yhkuro@schmc.ac.kr

Received 1 April 2019 Revised 23 May 2019 Accepted 28 June 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the clinical manifestations of patients with the principal complaint of syndromic recurrent urinary tract infection (UTI), correlate these symptoms with the results of urine cultures, and identify the characteristics that can be used to differentiate UTI from similar diseases.

Materials and Methods

A total of 212 consecutive patients with syndromic recurrent UTIs over a 24 month period were evaluated. The major symptoms were recorded using the UTISA questionnaire and VAS. The patients were divided into group A (n=98; positive urine and urethral swab cultures) and group B (n=114; negative cultures), and the symptoms were compared. For group B, cystoscopy was used to diagnose 61 patients who complained of pain levels ≥6 on the VAS.

Results

The proportion of patients with the classic symptoms of UTI (dysuria, urinary frequency, lower abdominal discomfort during bladder filling, and urgency) was similar in groups A and B. Significantly more patients complained of urethral pain in group B, and significantly fewer patients had gross hematuria, low back pain, a post-voiding sensation of residual urine, and general symptoms compared to group A. Of the 61 patients with a VAS ≥6, 29, 28, and four were diagnosed with bladder pain syndrome, interstitial cystitis, and urethral pain syndrome, respectively.

Conclusions

In patients with syndromic recurrent UTI, the classic symptoms were not sufficiently characteristic to allow bacterial cystitis to be differentiated from other bladder diseases. Diagnostic cystoscopy and VAS can assist in making a differential diagnosis in patients with non-bacterial syndromic recurrent UTIs.

Keywords: Urinary tract infections, Cystitis, Interstitial cystitis

References

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Fig. 1.

Flowchart used for inclusion in the study. UTI: urinary tract infection, OAB: overactive bladder, IC: interstitial cystitis.

Fig. 2.

Urine culture-based classification of patients with syndromic recurrent urinary tract infections. VAS: visual analogue scale.

Table 1.

Clinical characteristics and symptoms of patients with syndromic recurrent urinary tract infections according to the urine culture results

Variable	Total (n=212)	Results of urine culture		p-value
Variable	Total (n=212)	Bacterial (n=98)	Non-bacterial (n=114)	p-value
Age (y)	49.6±14.8	50.2±15.7	49.2±14.0	0.617
Number of visit	6.4±3.5	4.9±2.7	7.8±3.5	<0.05
Pyuria	138 (65.1)	90 (91.8)	24 (21.1)	<0.05
Symptoms
Dysuria	177 (83.5)	84 (85.7)	93 (81.6)	0.419
Urinary frequency	159 (75.0)	72 (73.5)	87 (76.3)	0.633
Lower abdominal discomfort during bladder filling	134 (63.2)	60 (61.2)	74 (64.9)	0.579
Urgency	83 (39.2)	38 (38.8)	45 (39.5)	0.917
Urethral pain	73 (34.4)	19 (19.4)	54 (47.4)	<0.05
Gross hematuria	49 (23.1)	30 (30.6)	19 (16.7)	<0.05
Low back pain	35 (16.5)	29 (29.6)	6 (5.3)	<0.05
Post-voiding sensation of residual urine	24 (11.3)	18 (18.4)	6 (5.3)	<0.05
General symptoms	67 (31.6)	40 (40.8)	27 (23.7)	<0.05

Values are presented as mean±standard deviation or number (%).

Table 2.

Result of microorganisms the patients with recurrent cystitis in female

Cultured organism	Data	Routine and special culture (+)	Special culture (+) only	ESBL positive (%)
Routine urine culture (n=81)
Escherichia coli	64 (79.0)			6 (7.4)
Klebsiella pneumoniae	6 (7.4)			1 (1.2)
Coagulation negative Staphylococcus	4 (4.9)
Enterococcus faecalis	3 (3.7)			1 (1.2)
Proteus spp.	3 (3.7)
Group B Streptococcus	1 (1.2)
Special culture with swab (n=212)
Ureaplasma urealyticum	22 (10.4)	9	13
Mycoplasma hominis	16 (7.5)	7	9
U. urealyticum+M. hominis	9 (4.2)	4	5

Values are presented as number (%) or number only.

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