IMPORTANCE OF CYSTOSCOPY IN RECURRENT UTI IN POSTMENOPAUSAL WOMEN

A 70-year-old postmenopausal woman presented with a history of high grade fever and dysuria. She was a diabetic with fairly good control of sugars.We evaluated the patient - her USG KUB was normal and urine culture was E.Coli sensitive to imipenem group of drugs. 

The patient was started on meropenem and catheterised.Her sugar were brought to the normal with sliding scale of insulin regimen.

She was treated for recurrent UTI s with multiple antibiotics that's the reason probably she was having multi-drug resistant bacteria. 

The woman underwent cystoscopy under sedation. There was urethral stenosis which were dilated with Hegar’s dilators till Hegar 11/14. After dilatation we usually keep the Foley's catheter (20 Fr) for 24 hours.

CYSTOSCOPY AND URETHRAL DILATATION 

The patient was given a 5 days course of meropenem and was instructed to apply estrogen cream locally twice a week for 6 weeks. She was given nitrofurantoin as long term suppressive antibiotic for long term duration.She was also started on cranberry extract and D-Mannose tablets to prevent recurrence of UTI.

Etiological factors for recurrent UTI in adult women are senile vaginitis, hypoestrogenism, lack of sexual activity, and these factors leading to urethral stenosis.

CRANBERRY JUICE OR EXTRACT IS BENEFICIAL IN PREVENTING RECURRENCE TO SOME EXTENT

Treatment is most often conservative in the form of antibiotics and estrogen cream for hypoestrogenism and atrophic mucosa. It is beneficial to start the patient on long term suppressive antibiotics if the lady suffers from recurrent Febrile UTI.

WE USUALLY PREFER THE OESTROGEN CREAM FOR ALL POST MENOPAUSAL PATIENTS 

Cystoscopy is essential thing in recurrent febrile UTI as it can detect atrophic hypo-estrogenic vaginitis and potentially cure urethral stenosis.