Intravesical instillations for the treatment of refractory recurrent urinary tract infections

Abstract

Background: Treatment options for refractory recurrent urinary tract infections (UTI) are limited; therefore, we sought to determine if intravesical instillations with heparin effectively treat recurrent UTIs. Methods: Patients at an academic medical center who received intravesical instillations with heparin for recurrent UTIs/chronic cystitis between January 2011 and December 2015 were identified via International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) procedure codes. All cases were analyzed for frequency of UTIs during the treatment phase as well as for the subsequent 6 months after completion of therapy. Demographic, clinical and treatment related factors were then collected from the medical records to draw associations with success or failure of treatment. Results: Thirty-nine women were treated with heparin intravesical instillations for recurrent UTIs. The average age of the cohort was 68.38 years [range 25–88, standard deviation (SD) 12.92], with mean parity 2.38 (range 0–7, SD 1.55) and mean body mass index 27.85 (range 19.5–37.9, SD 4.84). A total of 84.6% completed the recommended 6-week treatment course while 69.2% went on to an additional maintenance phase. Twelve patients (30.8%) had a culture-proven UTI during the treatment phase. In the 6-month follow-up period, 46.2% of patients had at least one UTI with only seven patients (17.9%) meeting criteria for recurrent UTIs (two or more UTIs in 6 months). On univariable assessment, development of recurrent UTIs after completion of instillation therapy was associated with increasing age and vaginal estrogen use during the instillation treatment course. Conclusions: Intravesical instillation with heparin is an effective option to consider for the treatment of refractory recurrent UTIs.