The Efficacy of Diathermy for Recurrent Urinary Tract Infections (UTIs)

ABSTRACT

ConditionRecurrent urinary tract infections;Symptoms of recurrent urinary tract infections with negative urine culture (also referred to a irritative bladder symptoms).;
Recurrent urinary tract infections
Symptoms of recurrent urinary tract infections with negative urine culture (also referred to a irritative bladder symptoms).;Renal and Urogenital - Other renal and urogenital disorders

InterventionThe intervention in our study involves the diathermy of the trigone procedure, administered by an experienced urologist, Dr. Dirk Drent. The procedure is a one-time intervention, initiated after an initial hour-long appointment with the urologist, encompassing a comprehensive assessment, including a medical history, clinical examination, bladder ultrasound, flow study, and post void residual volume measurement. During this appointment, details of the diathermy procedure are discussed thoroughly, allowing the patient to make an informed decision. If the patient opts for the intervention, they are scheduled for the procedure, which requires an approximately one-hour session and an overnight hospital stay for observation. A Coviden ValleyLab FT10 mono polar diathermy in used, initially on Cut (Pure, 20W, peak voltage 1287V) for removal of the lesions and followed by Coag (Fulgurate, 20W, peak voltage 3448V) for haemostasis. These two diathermy steps take a combined total of approximately 15minutes, Subsequently, an 8-week follow-up appointment lasting around 30 minutes involves additional assessments, including ultrasound, flow, residual volume measurement, and a urine dipstick test. One year post-procedure, patients complete a survey to evaluate the intervention's long-term outcomes. The intervention is provided individually, and informational materials are supplied to facilitate informed decision-making. During the process we will obtain consent to access the patient medical records and have contact with the patients GP to cross reference past medical history, positive urine tests and antibiotics courses/previous treatments.

Primary outcome:The primary outcome to be assessed is the change in quantity and severity of irritative bladder symptoms experienced before and following the procedure.[A patient completed symptom questionnaire has been specifically designed for the study. Global Response Assessment (GRA) and Patient Satisfaction Questionnaire (PSQ) on a 7 point scale have been utilised to quantify the outcomes. Prior to surgery or the initial consultation and one year following the surgical intervention.]

CriteriaInclusion criteria 1. Women with symptoms of recurrent UTIs (three or more times in the last year) or persistent symptoms of bladder irritation.
2. Women with confirmed Trigone pathology (Squamous metaplasia, Cystitis Cystica, Cystitis Glandularis, or Follicular Cystitis) on Cystoscopy.


Exclusion criteria 1. Women with less than one year of follow-up.
2. Women found to have other potential causes for symptoms (e.g., kidney or bladder stones, bladder malignancy, vaginal infection, sexually transmitted infections, etc.).