Expert: Urologists must engage with primary care regarding recurrent UTIs

In this video, Caroline Dowling, MBBS, MS, FRACS (Urol), shares the take-home message from the BJU International research letter “Management of recurrent urinary tract infections: re-education is required.” Dowling is co-director of Medical Student Programs and an adjunct clinical associate professor at Eastern Health Clinical School, Monash University, Melbourne, Australia.

Transcription:

What is the take-home message for the practicing urologist?

I think it's about engaging with primary care. Primary care physicians need us to provide them with good education and good back-up. They need to be confident to follow an algorithm that allows them to have women on non-antibiotic therapy. And then we need to support them when women fail some sort of non-antibiotic therapy, or need further investigation. And I think that 1 of the messages from our audit was that patients weren't even being appropriately triaged. We were seeing complex women as quickly as non-complex women, which really doesn't work out. The wait times in Australia for a specialist appointment are very long; 640 days was our mean. So I think if we can get urologists to engage with primary care and give them better education, women can be treated efficiently and then won't have to come down the path of specialist care.

Is there anything you would like to add?

I think the one thing that I always say to women is there's the analogy of the "4 horsemen" of recurrent urinary tract infections, which are poor bladder emptying, poor continence, poor bowel function, and genitourinary symptoms of menopause or post menopausal changes. They are all issues that can be very simply addressed if they're recognized in primary care. The other resource that we have is physical therapy or physiotherapy. In Australia, the pelvic floor physiotherapist can manage a lot of these problems for women and improve the things that are precipitating their infection.

This transcription was edited for clarity.