2023-10-16 21:42:00
The prolonged use of antibiotics, a growing concern, finds a possible counterbalance in innovative treatments
(HealthDay News) – For some older women, recurrent urinary tract infections and the antibiotics usually prescribed to combat them become a part of life, but a new study offers a novel treatment that may provide relief.
Called electrofulguration, the minimally invasive procedure basically burns away inflamed and infected bladder tissue. In the study, it was found to be effective for several women suffering from this problem.
The study’s corresponding author, Dr. Philippe Zimmern, director of the John and Felecia Cain Center for Bladder Health at UT Southwestern Medical Center in Dallas, said he was interested in finding solutions because he saw so many patients who had taken antibiotics for bladder infections repeatedly before being referred to him.
“It was kind of a puzzle. I was like, ‘Where are these infections coming from?'” Zimmern said.
Zimmern was inspired to try electrofulguration after reading the work of another researcher who found in animal studies that infections had attacked the surface of the bladder, allowing bacteria to adhere to a deeper layer. After that, those bacteria were able to persist in the bladder because they were protected by a biofilm, he explained.
The balance of bacteria in the bladder, a delicate ecosystem that researchers seek to understand and protect Getty
“Once we had shown that the bacteria were there, then the idea arose that fulguration could actually be a definitive treatment for these patients,” Zimmern said. Fulguration has been used in the past to remove tumors from the bladder, according to the US National Institutes of Health.
In this study, researchers reviewed the medical records of 96 postmenopausal women treated with electrofulguration for recurrent urinary tract infections (UTIs) between 2006 and 2012.
About 72% of women were considered to have had successful treatment. That meant they had no more than one UTI per year during follow-up. Another 22% had fewer than three UTIs per year. About 6% had not changed.
Only about 5% of women were still taking antibiotics continuously after their last follow-up, compared with 74% before electrofulguration, according to the report.
UTIs, a constant challenge for many women, now have a new treatment approach Getty
The concern about taking antibiotics continuously or repeatedly for infections is that resistant strains of bacteria can build up over time, which can make UTIs even more difficult to treat. Sometimes that can lead to the dangerous blood infection known as sepsis. Sometimes, it requires surgical removal of the bladder, the researchers said.
“It’s a complicated story between the type of bacteria that invade the bladder. And that’s something we need to figure out. There are different bacteria, they have different abilities to adhere to tissues,” Zimmern said. “The fascinating part of this story is that half of the women do not have infection.”
Another study Zimmern is involved in is investigating what happens to women who don’t have these chronic infections, how they are protected, but that is still ongoing.
After electrofulguration, doctors have a variety of tools to help prevent germs from re-entering the bladder, which may include hormone cream and probiotics, Zimmern said.
Electrofulguration, a topic of academic interest that could change the landscape of the treatment of urinary infections Getty
The findings were published in the October issue of The Journal of Urology. Dr. Louis Kavoussi, chairman of urology at Northwell Health in New Hyde Park, N.Y., had reservations about whether this type of procedure should be recommended to women instead of standard treatment.
“Does it deserve more study? Yes, it is deserved, but it is by no means a panacea or a standard of care,” Kavoussi said.
Postmenopausal women may struggle with recurrent UTIs due to changes in estrogen levels, which help keep tissues strong in the pelvis, vagina and urethra, Kavoussi explained. Tissues become thinner with less estrogen, she said.
Someone may be prescribed antibiotics for a UTI, but it may take longer than a course of antibiotics for a natural barrier against infection to repopulate and prevent bacteria from sticking to the surface of the bladder.
“What happens if the bacteria get in while the layer is even weaker, then they have another infection, something called a cluster infection,” Kavoussi said.
Bacteria in the bladder, an enigma that Dr. Zimmern seeks to decipher through pioneering research credit iStock
Kavoussi noted that study volunteers were also prescribed antibiotics for a long time after electrofulguration and wondered if that might have played a disproportionate role in the healing.
She suggested some alternatives for women with recurrent UTIs.
“Some of them are very simple. One is just drinking a lot of water,” Kavoussi said. Research studies have examined cranberry products, including cranberry juice.
Estrogen cream applied to the opening of the urinary tract three times a week can help build tissue and is not absorbed systemically, he added. “And then the fourth is just taking a long, low dose of antibiotics, for about four to six weeks,” Kavoussi said. “All of these methods have proven to be useful. This, I think, is of academic interest,” Kavoussi said of electrofulguration.
More information. The US Centers for Disease Control and Prevention has more information about urinary tract infections.
SOURCES: Philippe Zimmern, MD, professor, urology, and director, John and Felecia Cain Center for Bladder Health, University of Texas (UT) Southwestern Medical Center, Dallas; Louis Kavoussi, MD, chair, urology, Northwell Health, and professor, urology, Zucker School of Medicine, New Hyde Park, New York; The Journal of Urology, October 2023.
*Cara Murez. Health Day Reporters © The New York Times 2023
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