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RECURRENT URINARY TRACT INFECTIONS IN WOMEN AND THE ROLE OF THE URINE PRODUCTION
THE JOURNAL OF UROLOGY®
142
Vol. 181, No. 4, Supplement, Sunday, April 26, 2009
RESULTS: A total of 95,962 subjects were identified for evaluation. Gender distribution was 57.1% male and 42.9% female. The Table demonstrates the effects of increasing BMI. BMI
n
% Diagnosed with UTI
Odds Ratio (95% CI)
p Value
<30
62,530
12.0
--
--
30-34.9 21,711
13.8
1.25 (1.20-1.32)
<0.0001
35-39.9
4,353
14.6
1.21 (1.13-1.30)
<0.0001
40-44.9
2,670
15.8
1.26 (1.13-1.41)
<0.0001
45-49.9
883
17.1
1.32 (1.11-1.59)
0.0024
>50
545
17.9
1.41 (1.13-1.77)
0.0028
CONCLUSIONS: Elevated BMI, particularly among those with severe obesity, is associated with an increased risk for UTI. These results may serve to guide urologists who treat obese patients, and may also assist clinicians who counsel on the benefits of weight loss. Source of Funding: None
396 SYMPTOMS AND RISK FACTORS ASSOCIATED WITH FIRST UTI IN COLLEGE-AGED WOMEN: A PROSPECTIVE COHORT STUDY Charles R Vincent*, Mary Brown, Leticia Reyes, Benjamin K Canales, Keith Muller, Veronique Vincent, Qin Li, Tami Thomas, Gainesville, FL INTRODUCTION AND OBJECTIVE: Urinary tract infection (UTI) is a significant health care problem in the female population, and the majority of published studies focus on recurrent UTIs in older women. In order to better identify origin, evaluate risk, and recommend intervention, we identify the urinary symptoms and risk factors associated with first time UTI in a cohort of college-aged women compared to controls. METHODS: From July 2001 through April 2005, we prospectively enrolled 181 women with their first UTI episode who presented to the student health care facility at the University of Florida. A control group of 80 females attending the student health care facility for routine health care with no prior history of UTI was also enrolled. A study nurse dedicated to the project obtained informed consent from all participants and administered a validated questionnaire that addressed lifestyle habits and dietary intake to identify contributing factors to UTI. Urinalysis, urine cultures, and vaginal cultures were obtained on all enrollees. All women with UTI were seen two weeks post treatment, and women in both groups were seen for a minimum of one and maximum of three post-infection, healthy visits. Comparisons between the symptomatic and control groups were made using ANOVA and Student t-test. RESULTS: The most common presenting symptoms of first time UTI patients were frequency and urgency, and the majority of patients sought treatment between days 3 and 4 of first symptoms (p<0.01). UTIs were most common in women who had increased sexual activity (p<0.01), who recently used alcohol-containing beverages (p<0.01), and who used sanitary napkins during menstruation (p<0.05). Direction of wiping, hesitating to urinate, and use of tampons did not appear to correlate with increased UTI risk. Co-existing chlamydia, gonorrhea, and yeast infections did not contribute significantly to urinary symptoms. CONCLUSIONS: According to this cohort, urinary frequency and urgency are the predominant presenting urinary symptoms in females affected by their first UTI. Increased sexual activity and the recent use of alcohol-containing beverages were associated with increased incidence of first time urinary tract infection in college-aged women.
397 RECURRENT URINARY TRACT INFECTIONS IN WOMEN AND THE ROLE OF THE URINE PRODUCTION. Ernst P van Haarst*, Amsterdam, Netherlands; Erik B. Cornel, Hengelo, Netherlands; Eddi A Heldeweg, Brechje L Ronkes, Amsterdam, Netherlands INTRODUCTION AND OBJECTIVE: It is generally assumed that the risk to develop a urinary tract infection (UTI) is decreased by an adequate fluid intake and frequent voiding. However, this theory is not substantiated by evidence. In less than 10 human studies, in most of which the urine production was estimated by interviews, the conclusions were not equivocal. In this patient-control study we examined the relation between the urine production and UTIs. METHODS: In 3 hospitals all patients referred for recurrent UTIs were study candidates. 182 women had bacteriological proof of a UTI and completed a 24-hours frequency-volume chart (FVC). In 35 patients the date of the FVC was less than 3 days before or 7 days after the date of a positive culture. These patients were excluded, assuming that an active UTI was likely to influence the drinking and voiding pattern. The remaining 147 FVC’s were compared to those of 538 women without urological complaints. All were asked before filling in the FVC to estimate their fluid intake as low, normal or high. For each woman the parameters of the FVC were calculated, as well as the maximum interval between voiding moments and the urine production per interval. RESULTS: De mean age in both groups was 48 years. There was a weak correlation between the self-estimated fluid intake and the diuresis (r=0.26). There was no relation between the number of UTIs per year and the diuresis. In the UTI-group the diuresis (1780 vs 2037 ml) and voiding frequency are higher. Analysis of the categorised urine output showed in the group with a diuresis < 1.5 liter an output per interval of < 20 ml/hr in 50% of the patients and 20% of the healthy women (graph). In the patient group the lowest interval diuresis was lower (29 vs 22 ml/hour) and the nocturnal urine production per hour was lower than in the healthy group. CONCLUSIONS: Women with recurrent UTIs do not have a lower overall urine output than women without UTI’s. In the group with a diuresis < 1.5 liter the women with UTIs have a lower nocturnal urine output and lowest interval diuresis than healthy women. These might be risk factors to develop UTI. Only a FVC will be able to give a proper indication of the true urine production. A FVC should be advocated as a basic diagnostic tool in the investigation of women with recurrent UTIs.
Source of Funding: NIH NIAID grant 5R01AI045875 (MBB) Source of Funding: None
142
Vol. 181, No. 4, Supplement, Sunday, April 26, 2009
RESULTS: A total of 95,962 subjects were identified for evaluation. Gender distribution was 57.1% male and 42.9% female. The Table demonstrates the effects of increasing BMI. BMI
n
% Diagnosed with UTI
Odds Ratio (95% CI)
p Value
<30
62,530
12.0
--
--
30-34.9 21,711
13.8
1.25 (1.20-1.32)
<0.0001
35-39.9
4,353
14.6
1.21 (1.13-1.30)
<0.0001
40-44.9
2,670
15.8
1.26 (1.13-1.41)
<0.0001
45-49.9
883
17.1
1.32 (1.11-1.59)
0.0024
>50
545
17.9
1.41 (1.13-1.77)
0.0028
CONCLUSIONS: Elevated BMI, particularly among those with severe obesity, is associated with an increased risk for UTI. These results may serve to guide urologists who treat obese patients, and may also assist clinicians who counsel on the benefits of weight loss. Source of Funding: None
396 SYMPTOMS AND RISK FACTORS ASSOCIATED WITH FIRST UTI IN COLLEGE-AGED WOMEN: A PROSPECTIVE COHORT STUDY Charles R Vincent*, Mary Brown, Leticia Reyes, Benjamin K Canales, Keith Muller, Veronique Vincent, Qin Li, Tami Thomas, Gainesville, FL INTRODUCTION AND OBJECTIVE: Urinary tract infection (UTI) is a significant health care problem in the female population, and the majority of published studies focus on recurrent UTIs in older women. In order to better identify origin, evaluate risk, and recommend intervention, we identify the urinary symptoms and risk factors associated with first time UTI in a cohort of college-aged women compared to controls. METHODS: From July 2001 through April 2005, we prospectively enrolled 181 women with their first UTI episode who presented to the student health care facility at the University of Florida. A control group of 80 females attending the student health care facility for routine health care with no prior history of UTI was also enrolled. A study nurse dedicated to the project obtained informed consent from all participants and administered a validated questionnaire that addressed lifestyle habits and dietary intake to identify contributing factors to UTI. Urinalysis, urine cultures, and vaginal cultures were obtained on all enrollees. All women with UTI were seen two weeks post treatment, and women in both groups were seen for a minimum of one and maximum of three post-infection, healthy visits. Comparisons between the symptomatic and control groups were made using ANOVA and Student t-test. RESULTS: The most common presenting symptoms of first time UTI patients were frequency and urgency, and the majority of patients sought treatment between days 3 and 4 of first symptoms (p<0.01). UTIs were most common in women who had increased sexual activity (p<0.01), who recently used alcohol-containing beverages (p<0.01), and who used sanitary napkins during menstruation (p<0.05). Direction of wiping, hesitating to urinate, and use of tampons did not appear to correlate with increased UTI risk. Co-existing chlamydia, gonorrhea, and yeast infections did not contribute significantly to urinary symptoms. CONCLUSIONS: According to this cohort, urinary frequency and urgency are the predominant presenting urinary symptoms in females affected by their first UTI. Increased sexual activity and the recent use of alcohol-containing beverages were associated with increased incidence of first time urinary tract infection in college-aged women.
397 RECURRENT URINARY TRACT INFECTIONS IN WOMEN AND THE ROLE OF THE URINE PRODUCTION. Ernst P van Haarst*, Amsterdam, Netherlands; Erik B. Cornel, Hengelo, Netherlands; Eddi A Heldeweg, Brechje L Ronkes, Amsterdam, Netherlands INTRODUCTION AND OBJECTIVE: It is generally assumed that the risk to develop a urinary tract infection (UTI) is decreased by an adequate fluid intake and frequent voiding. However, this theory is not substantiated by evidence. In less than 10 human studies, in most of which the urine production was estimated by interviews, the conclusions were not equivocal. In this patient-control study we examined the relation between the urine production and UTIs. METHODS: In 3 hospitals all patients referred for recurrent UTIs were study candidates. 182 women had bacteriological proof of a UTI and completed a 24-hours frequency-volume chart (FVC). In 35 patients the date of the FVC was less than 3 days before or 7 days after the date of a positive culture. These patients were excluded, assuming that an active UTI was likely to influence the drinking and voiding pattern. The remaining 147 FVC’s were compared to those of 538 women without urological complaints. All were asked before filling in the FVC to estimate their fluid intake as low, normal or high. For each woman the parameters of the FVC were calculated, as well as the maximum interval between voiding moments and the urine production per interval. RESULTS: De mean age in both groups was 48 years. There was a weak correlation between the self-estimated fluid intake and the diuresis (r=0.26). There was no relation between the number of UTIs per year and the diuresis. In the UTI-group the diuresis (1780 vs 2037 ml) and voiding frequency are higher. Analysis of the categorised urine output showed in the group with a diuresis < 1.5 liter an output per interval of < 20 ml/hr in 50% of the patients and 20% of the healthy women (graph). In the patient group the lowest interval diuresis was lower (29 vs 22 ml/hour) and the nocturnal urine production per hour was lower than in the healthy group. CONCLUSIONS: Women with recurrent UTIs do not have a lower overall urine output than women without UTI’s. In the group with a diuresis < 1.5 liter the women with UTIs have a lower nocturnal urine output and lowest interval diuresis than healthy women. These might be risk factors to develop UTI. Only a FVC will be able to give a proper indication of the true urine production. A FVC should be advocated as a basic diagnostic tool in the investigation of women with recurrent UTIs.
Source of Funding: NIH NIAID grant 5R01AI045875 (MBB) Source of Funding: None