Risk of Recurrent UTIs Following Urethral Bulking Procedures: QI Review

Objectives: Stress urinary incontinence (SUI) in females is a common issue. Although the mid-urethral sling continues to be the gold standard for surgical management of SUI, the use of transurethral bulking agents has gained popularity in recent years. The objective of this quality improvement review was to evaluate the risk of recurrent urinary tract infections (UTI) following transurethral bulking procedures at a single academic institution.

Methods: We performed a retrospective observational study, which included all patients treated with urethral bulking by Urogynecologic surgeons, for the treatment of SUI between 1/1/2023 and 12/31/20203 at a single academic institution. Demographic and medical history was collected. The primary outcome was incidence of postoperative UTI defined by positive urine culture (>100,000 CFU) within 6 weeks following the procedure. Preoperative recurrent UTI (rUTI) was defined as > 3 positive urine cultures in the previous 12 months or > 2 positive urine cultures in the previous 6 months in the electronic medical chart’s results section, or diagnosis of recurrent UTI present in the problem list.

Results: In total, 94 patients who underwent urethral bulking between 1/1/2023 and 12/31/20203 were included. 48 (51%) of these patients had bulking performed in the operating room. Of those 48, 10 (21%) had a concomitant pelvic floor repair or other surgery performed. 15 (16%) total patients were discharged with a catheter. Of these 15, 14 (93%) had bulking performed in the operating room and 5 of these patients had concomitant pelvic floor surgery. Postoperative UTI was diagnosed in 9 (10%) patients. Of these, 4 (44%) occurred following procedures performed in the operating room and 5 (56%) in the office setting. 27% of patients discharged with a catheter were diagnosed with a postoperative UTI; these all occurred in the OR group and 3 of the 4 patients met the diagnostic criteria for preoperative rUTI. 6 (67%) patients with postoperative UTI met diagnostic criteria for preoperative rUTI. Following the bulking procedure, 7 (78%) of the patients with a postoperative UTI met criteria for rUTI with more than 2 UTIs diagnosed within the next 6 months. 6 of the 7 with rUTI after the bulking procedure met diagnostic criteria for preoperative rUTI.

Conclusions: Transurethral bulking does not increase the risk of developing new onset rUTI. Patients can be counseled that the risk of UTI within 6 weeks following the procedure is approximately 10% and may be increased if they are discharged with a catheter or if they have a preoperative diagnosis of rUTI. Future research could include a multi-center study.