Role of videourodynamics, imaging, and cystoscopy in patients with recurrent urinary tract infections: Should we throw in the kitchen sink?

Purpose:

Recurrent urinary tract infection (rUTI) remains a common outpatient problem with discordance and paucity of evidence for management. This study aims to evaluate the role of videourodynamics (VUD), additional imaging, and cystoscopy in the complete workup of these patients.

Materials and Methods:

A retrospective review was performed on 1421 consecutive patients referred for physician performed VUD. After exclusion criteria, 170 patients were included. Ethics approval was obtained, followed by data collection, and analysis of demographics, symptoms, cystoscopy results, imaging, and VUD parameters. Statistical analyses were performed with IBM SPSS Statistics Version 28. Statistical significance was defined by an alpha level of P $\le 0.05$.

Results:

Overall, 117/170 (69%) had identifiable causes of rUTI identified on VUD. There was a statistically significant difference (p<0.001) in identifying a cause in those with voiding symptoms (93/114 $=$ 82%) compared to those without (24/56 $=$ 43%). Gender was not predictive of an identifiable cause on VUD ($p=0.47$). Neither was a neurogenic history ($p=0.11$), diabetes ($p=0.97$), or age ($p=0.89$). Additional imaging was not diagnostic for rUTI cause. No malignancy was identified on imaging or cystoscopy.

Conclusion:

In patients with rUTI, VUD may be an important investigative step to find a possible underlying cause, but it is a scarce resource. As VUD has a higher detection rate in patients with voiding symptoms, by first screening for these patients on history, VUD can be used judiciously. Cystoscopy and additional imaging were not as helpful in identifying a target treatment plan for rUTI, when a VUD had already been done.