Updates in Clinical Management of Recurrent Urinary Tract Infections.

Urinary tract infections (UTIs) are common and burdensome in women. Here, we discuss challenges with our current models of care and how evolving insights into the female urogenital microbiome have advanced the understanding of how we diagnose, treat, and prevent recurrent UTIs in nonpregnant adult women. Traditional care models attribute recurrent UTIs mainly to gastrointestinal sources, resulting in significant emphasis on eradicating pathogens with potential overreliance on antibiotics.

Updates to Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025).

Purpose: Our perceptions of recurrent UTI (rUTI) have evolved due to additional insights into rUTI pathophysiology, an appreciation for the adverse effects of repetitive antimicrobials ("collateral damage"), rising rates of bacterial antimicrobial resistance, and better reporting of the natural history of localized cystitis and rUTI. This document seeks to guide the evaluation and management of patients with rUTIs to prevent inappropriate antibiotic use, decrease the risk of antibiotic resistance, reduce adverse effects of antibiotics, provide guidance on strategies for rUTI prevention, and improve outcomes and quality of life for women with rUTIs.

Materials And Methods: In 2024, this Guideline was reviewed via the AUA Update Literature Review process, which identified 87 studies for full-text review published between June 1, 2021 and November 1, 2024.

Urinary tract infection symptom management in postmenopausal women: a qualitative exploration.

Objective: We sought to complete focus groups with postmenopausal women to discuss their past experiences with urinary tract infections and other lower urinary tract symptoms to source input on how to improve patient care.

Methods: We convened 5 focus groups among postmenopausal women with previous experience of treatment for urinary tract infection symptoms. Participants were asked to describe their experiences of urinary symptoms and to make recommendations on how to improve patient education.

Role of Operative Reports in Surgical Learning and Memory: A Randomized Controlled Trial.

Objective: To evaluate the effect of operative report documentation on surgeons' ability to remember procedural steps.

Methods: We conducted a randomized controlled trial of obstetrician-gynecologist trainee and attending surgeons at University of Pittsburgh Magee-Womens Hospital. During the learning phase, participants were guided through a 50-step procedure that used a Montessori lockbox, lighted switchboard, and simple tools.

Periurethral versus intravaginal application of vaginal estrogen for the prevention of urinary tract infections in postmenopausal women: Design of a randomized non-inferiority trial.

Background: Recurrent urinary tract infections (UTIs) disproportionately affect older women. Vaginal estrogen is the only non-antibiotic therapy with a Grade A recommendation for the prevention of UTIs in postmenopausal women, but it is associated with a high rate of non-adherence due to reported difficulties with vaginal application and concerns about exogenous hormone exposure. To alleviate these challenges, some women apply estrogen cream periurethrally, although evidence supporting this approach is lacking.

International Urogynecological Consultation Chapter 2.2: Imaging in the Diagnosis of Pelvic Organ Prolapse.

Introduction And Hypothesis: This section of Chapter 2.2 of the International Urogynecology Consultation on Pelvic Organ Prolapse (POP), reviews the literature on the role of imaging in the diagnosis of POP.

Methods: An international group of nine urogynecologists and one university-based medical librarian adhered to the framework of the scoping review.

Type of Social Support for Smoking Cessation Among Low-Income Postpartum Women.

Background: Efficacious programs to sustain smoking cessation are limited for postpartum women, particularly for those who are low-income. Social support may help enhance cessation efforts. However, the specific types of support potentially associated with cessation success are not well evaluated.

Histopathology of the tongue in a hamster model of COVID-19.

Objective: With altered sense of taste being a common symptom of coronavirus disease 2019 (COVID-19), the main objective was to investigate the presence and distribution of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) within the tongue over the course of infection.

Methods: Golden Syrian hamsters were inoculated intranasally with SARS-CoV-2 and tongues were collected at 2, 3, 5, 8, 17, 21, 35, and 42 days post-infection (dpi) for analysis. In order to test for gross changes in the tongue, the papillae of the tongue were counted.

A Qualitative Exploration of Women With Cystic Fibrosis and Urinary Incontinence.

Importance: Women with cystic fibrosis (CF) historically experience a high prevalence of urinary incontinence (UI). However, this area is understudied, especially in the modern era of highly effective modulator therapy (HEMT).

Objective: This study aimed to explore the UI experiences, knowledge, care-seeking behavior, and treatment preferences of women with CF.

Do Prophylactic Postoperative Antibiotics Prevent Sacral Neuromodulation Infections?

Importance: There are no definitive guidelines for use of postoperative antibiotics after sacral neuromodulation (SNM) leading to practice pattern variation among health care professionals.

Objectives: The objectives of this study were to determine if additional antibiotics beyond preoperative intravenous antibiotics and surgical preparation decrease postoperative infections and to determine if additional antibiotics are associated with other postoperative complications.

Study Design: This was a single-center, retrospective cohort study of all SNM procedures from 2014 to 2023 performed by 12 surgeons.

Histopathology of the Tongue in a Hamster Model of COVID-19.

Objective: With altered sense of taste being a common symptom of coronavirus disease 2019 (COVID-19), our objective was to investigate the presence and distribution of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) within the tongue over the course of infection.

Methods: Golden Syrian hamsters were inoculated intranasally with SARS-CoV-2 and tongues were collected at 2, 3, 5, 8, 17, 21, 35, and 42 days post-infection (dpi) for analysis. In order to test for gross changes in the tongue, the papillae of the tongue were counted.

Preoperative prolapse phenotype is predictive of surgical outcome with minimally invasive sacrocolpopexy.

Background: The gold-standard treatment for advanced pelvic organ prolapse is sacrocolpopexy. However, the preoperative features of prolapse that predict optimal outcomes are unknown.

Objective: This study aimed to develop a clinical prediction model that uses preoperative scores on the Pelvic Organ Prolapse Quantification examination to predict outcomes after minimally invasive sacrocolpopexy for stages 2, 3, and 4 uterovaginal prolapse and vaginal vault prolapse.

Online Search Strategies and Results From a Crowdsourced Survey on Asymptomatic Bacteriuria.

Importance: Despite the prevalence of asymptomatic bacteriuria (ASB), what proportion of the population is aware of this condition and the quality of internet resources are currently unknown.

Objective: This study aimed to use an online crowdsourcing platform to explore general knowledge and internet search strategies, along with the quality of information, on ASB.

Study Design: An online survey was administered through a crowdsourcing platform to women 50 years or older via Qualtrics, which is a sophisticated online survey tool.

Decision-making and Treatment Preferences Surrounding Bacteriuria in Nonpregnant Women: A Qualitative Investigation.

Introduction And Hypothesis: Best practices suggest nontreatment for asymptomatic bacteriuria in a nonpregnant population, yet there is little literature on patient preference or understanding of asymptomatic bacteriuria treatment. We hypothesize that there might be core factors that affect antibiotic preferences and care-seeking decisions for urinary tract infection and asymptomatic bacteriuria in a postmenopausal population.

Methods: We performed semi-structured interviews with postmenopausal individuals who had been previously treated for at least one patient-reported urinary tract infection.

Acute Asthma Exacerbations: Management Strategies.

Asthma exacerbations, defined as a deterioration in baseline symptoms or lung function, cause significant morbidity and mortality. Asthma action plans help patients triage and manage symptoms at home. In patients 12 years and older, home management includes an inhaled corticosteroid/formoterol combination for those who are not using an inhaled corticosteroid/long-acting beta2 agonist inhaler for maintenance, or a short-acting beta2 agonist for those using an inhaled corticosteroid/long-acting beta2 agonist inhaler that does not include formoterol.

Denosumab versus pamidronate in the treatment of osteolytic bone metastases secondary to breast cancer: a multi-institutional analysis.

Background: Breast cancer is the most common cancer in women and most often metastasizes to the bone, resulting in skeletal-related events (SREs). Bone-modifying agents (BMAs) including denosumab, a monoclonal antibody against the receptor activator of nuclear factor kappa-b ligand (RANKL), and pamidronate, a bisphosphonate, are used to prevent these adverse events.

Methods: To analyze the efficacy of denosumab versus pamidronate, we used the TriNetX research platform and compared the outcomes of pathologic fracture, spinal cord compression, and overall 5-year survival rate between each pharmacotherapy.

Risk of postoperative mesh exposure following sacrocolpopexy with supracervical versus total concomitant laparoscopic hysterectomy.

Introduction And Hypothesis: The primary objective was to compare rates of mesh exposure in women undergoing minimally invasive sacrocolpopexy with concurrent supracervical vs total hysterectomy. We hypothesized there would be a lower risk of mesh exposure for supracervical hysterectomy.

Methods: This was a retrospective cohort study using the Premier Healthcare Database.

Dysregulated wound healing in the pathogenesis of urogynecologic mesh complications.

To test the hypothesis that dysregulated wound healing is associated with Urogynecologic mesh complications, we collected vaginal cell secretions using vaginal swabs after polypropylene mesh implantation in patients with (N = 39) and without (N = 40) complication. A customized multiplex immunoassay measured markers of inflammation (MCP-1, IGFBP-1, IL-2, IL-10, IL-17, PDGF-BB, bFGF, IL-1b, IL-6, IL-12p70, TNF-α), neuroinflammation (IL-1RA, TGF-β, IL-15, IL-18, IL-3, M-CSF), angiogenesis (VEGF), and matrix proteins (fibronectin, tenasin c, thrombospondin-2, lumican) between groups. Patients with complications were younger, heavier, implanted with mesh longer, and more likely to be ever smokers.

Distinguishing Fibroepithelial Lesions Requires Clinical, Imaging, and Pathology Correlation.

Phyllodes tumor (PT) is a rare tumor that can present as benign, borderline, or malignant. These tumors arise from the breast stroma, similar to fibroadenomas. Phyllodes tumors and fibroadenomas often have overlapping features in both radiological imaging and pathologic analysis.

Antibiotic utilization and symptom improvement in a retrospective cohort of women with urinary tract infection symptoms.

Introduction And Hypothesis: Urinary tract infections (UTIs) are one of the most common bacterial infections in women. We hypothesized that over half of those treated empirically would receive inappropriate antibiotics, those treated expectantly would have lower symptom improvement without antibiotics, and that overall progression to sequelae would be uncommon.

Methods: In this retrospective cohort study of women with UTI symptoms, we quantified the proportion who received inappropriate antibiotics in those treated empirically, defined as those with a negative urine culture or antibiotics that were changed according to culture sensitivities, and identified factors associated with symptom improvement during expectant management.