Synopsis
Confirm recurrent symptomatic infection, choose investigations that answer a specific anatomical or diagnostic question and select prevention only after the patient’s eligibility is established.
- Recurrent UTI generally means at least two episodes in six months or three in twelve months; confirm that the episodes were symptomatic infections.
- Compare culture organisms, susceptibility, treatment and symptom-free intervals to distinguish likely relapse from separate reinfections.
- Investigate an indicated contributor such as poor emptying, stones or obstruction; routine cystoscopy and extensive imaging have low yield in otherwise typical uncomplicated recurrent cystitis.
Key red flags
Upper tract episodes, colicky pain, repeated urease-producing organisms, significant voiding symptoms, persistent haematuria or renal dysfunction point towards a specific underlying problem. Active fever with obstruction signs requires urgent care before an elective recurrent-UTI workup.
Investigation priorities
Confirm infection and identify a pattern that changes the workup.
Management branches
A sixty two year old woman has three culture-confirmed lower infections in six months.
- The record shows separate symptomatic Escherichia coli episodes with temporary recovery. She also describes a weak stream and incomplete emptying. A postvoid scan is therefore arranged rather than automatically ordering cystoscopy; she has no fever or current systemic illness, and recurrent-infection referral is organised.
- The residual is repeatedly about 280 ml, with no hydronephrosis and preserved renal function. Urological assessment confirms clinically important emptying dysfunction. The team addresses the residual with a supervised intermittent catheterisation plan and teaches technique, while treating any active infection on its own culture-guided merits.
Key medicines
Methenamine hippurate 1 g tabletsAfter treating active UTI and finding applicable behavioural, vaginal oestrogen or trigger measures insufficient or unsuitable, an eligible nonpregnant adult woman can take 1 g orally twice daily; review within six months and then annually.Check the exact Hiprex product contraindications: hepatic dysfunction, renal parenchymal infection, severe dehydration, metabolic acidosis, gout and severe renal failure with clearance or GFR below 10. Avoid sulphonamides because of crystalluria and avoid alkalinising citrate UTI sachets or acetazolamide because they reduce efficacy. Pregnancy and complicated or upper recurrence require specialist advice. Counsel that new acute symptoms still need assessment and treatment; this regimen does not treat sepsis.