Electrofulguration shows long-term efficacy for UTIs in menopausal women

Treatment with electrofulguration, a minimally invasive outpatient procedure, was shown to provide a durable clinical cure and improvement with a decreased need for long-term antibiotics in menopausal women with antibiotic-refractory recurrent urinary tract infections (UTIs), according to findings from a study conducted by investigators at UT Southwestern Medical Center in Dallas, Texas.^1,2

At the time of the last follow-up, 72% of women were considered to be cured of their recurrent UTIs.

The procedure involves targeting areas of chronic infection inside the bladder wall.

Data from the study showed that at the time of the last visit following treatment with electrofulguration, 72% of women were considered to be cured of their recurrent UTIs (no more than 1 UTI annually), and 22% showed improvement in their condition (fewer than 3 UTIs annually). Further, antibiotic usage was significantly decreased following treatment, with only 5% of patients on continuous antibiotics at last follow-up from the procedure, compared with 74% of patients before electrofulguration (P < .05).

“These findings demonstrate that electrofulguration provides a durable clinical cure that enables many postmenopausal women to remain UTI-free with minimal to no continued need for antibiotic therapy. Just as important, electrofulguration is a well-tolerated procedure. Given the rise in recurrent UTIs among an aging population and the growth in antibiotic-resistant bacteria, electrofulguration could help treat this condition much earlier in many patients and prevent the cascade of events leading to extensive lesions of cystitis,” said senior author Philippe E. Zimmern, MD, in a news release on the findings.² Zimmern is a professor of urology and the director of the John and Felecia Cain Center for Bladder Health at UT Southwestern Medical Center.

For the study, the investigators reviewed medical record from 96 women who were treated with electrofulguration for symptomatic recurrent UTIs (3 or more per year) from 2006 to 2012. The median age of patients included in the study was 64.

The median length of follow-up among all patients was 11 years (IQR, 10-13.5), with all patients having at least 5 years of follow-up. Among the 96 women included in the study, 71 had follow-up longer than 10 years. Women who had not been seen by a physician recently were contacted via a telephone interview by a third-party investigator.

The primary outcome measures were clinical cure (0 to 1 UTIs per year), improvement (fewer than 3 UTIs per year), or failure (3 or more UTIs per year) at the time of last follow-up. Secondary outcome measures were the number of women who needed antibiotics or a repeat electrofulguration following the initial procedure.

In total, 19% of patients included in the study underwent a repeated electrofulguration procedure. Treatment failure, defined as seeing no change in the frequency of UTIs annually, was reported in 6% of patients.

References

1. Gaitonde S, Christie AL, Garigipati P, Alhalabi F, Zimmern PE. Very long-term outcomes after electrofulguration for antibiotic-refractory recurrent urinary tract infections in a predominantly menopausal cohort of women. J Urol. 2023;210(4):649-658. doi:10.1097/JU.0000000000003612

2. Stopping the cycle of recurrent urinary tract infections in women. News release. UT Southwestern Medical Center. October 10, 2023. Accessed October 11, 2023. https://www.newswise.com/articles/stopping-the-cycle-of-recurrent-urinary-tract-infections-in-women