Recurrent Urinary Tract Infection in Women from a Urologist’s Perspective

Urinary tract infection (UTI) referred to microbial invasion of the urinary tract system, typically due to bacteria. UTI is more common in women than men, which is thought to be due to differences in lower urinary tract anatomy. Making a diagnosis of UTI begins with the presence of clinical symptoms consistent with either pyelonephritis and cystitis. When pyelonephritis symptoms are present, it is usually associated with bacterial infection, while the symptoms of clinical cystitis may or may not be caused by infection. As both urologic and non-urologic conditions can produce the clinical symptoms of cystitis, diagnosis of UTI requires both pyuria and bacteriuria on urine examination. Complicated UTI is when the infection is associated with either host or bacterial factors that increase the chance of reinfection and decrease treatment efficacy, such as altered organism virulence, immunocompromise, or urinary tract abnormalities. The urologist’s primary role in UTI management is to evaluate for such urinary tract abnormalities and, if needed, resolve those conditions to prevent recurrent infection. This review will describe the urologists’ evaluation and management of complicated and recurrent UTI and inform physician about the urinary tract abnormalities that can predispose to recurrent UTI.