泌尿道感染是婦女最常見的細菌性感染疾病之一，而在停經後泌尿道感染的機率更是隨之上升。頻繁發作的泌尿道感染會顯著影響到病患的生活品質，長期的抗生素使用更可能出現抗藥性及藥物副作用等等問題。根據之前的研究發現，在一些反覆泌尿道感染的婦女膀胱中可能產生發炎性病灶，而這些病灶有可能是潛在的細菌reservoir，進而與泌尿道感染的復發息息相關。本文為針對停經後復發型泌尿道感染(一年三次以上且皆有症狀)的婦女進行膀胱內病灶電燒後治療效果的長期追蹤，追蹤時間至少達五年以上。其primary outcomes定義為臨床上治癒 (0-1 泌尿道感染次數/年), 改善 (>1 and <3 泌尿道感染次數/ 年) 或是失敗 (≥3 泌尿道染次數/年)，Secondary outcomes 則包含需要抗生素治療及重複的膀胱病灶電燒。根據本研究結果，發現在進行膀胱內病灶電燒之前，74%的婦女需要每天使用抗生素進行壓制性療法、5%需要在性行為後進行抗生素預防性投藥、14%需要使用 self-start抗生素治療、7%沒有使用任何預防治療。而在進行膀胱內病灶電燒後的最後一次返診則發現，72%的病患被治癒、22%改善、而6%失敗。電燒顯著的降低抗生素的使用(P< 0.05)，跟電燒前有74%比較起來，僅有5%病患在電燒的最後一次返診時仍使用持續性抗生素。此外本研究也有發現19%的病患需要再進行重複的膀胱內病灶電燒。根據本研究結果可歸結膀胱內病灶電燒對停經後婦女的復發性泌尿道感染有持久的治療效果，更能夠有效的降低須長期使用抗生素的比例，進而解決病患長期以來的困擾並提升其生活品質。

Purpose: Antibiotic-refractory recurrent urinary tract infections (rUTI) are challenging to manage. Prior studies have shown that, in selected patients, electrofulguration (EF) of cystitis may disrupt potential nidus of rUTI. We report on long-term outcomes of EF in women with at least 5 years of follow-up.

Materials and methods: Following IRB approval, we analyzed a cohort of non-neurogenic women with ≥3 symptomatic UTI/yr and inflammatory lesions on cystoscopy who underwent EF, excluding those with alternate identifiable etiology for rUTI or less than 5yr follow-up. Preoperative characteristics, antibiotic regimens, and annual UTIs were reported. Primary outcome was clinical cure (0-1 UTI/yr), improvement (>1 and <3/yr) or failure (≥3/yr) at last follow-up. Secondary outcomes included need for antibiotics or repeat EF. A sub-analysis was performed for women with >10yr follow-up.

Results: From 2006 to 2012, 96 women met study criteria with median age 64. Median follow-up was 11 years (IQR: 10-13.5); 71 women had >10yr follow-up. Prior to EF, 74% used daily antibiotic suppression, 5% used post-coital prophylaxis, 14% used self-start therapy, and 7% were not on prophylaxis. At last post-EF visit, 72% of women were cured, 22% improved, and 6% failed. Antibiotic usage decreased post-EF (P < .05). Five percent were on continuous antibiotics at last follow-up as compared to 74% on continuous antibiotics pre-EF (McNemar P < .05). Nineteen percent of women underwent a repeat EF.