Recurrent urinary tract infection (UTI) care in primary and secondary care settings appears to be characterized by low guideline adherence, with a substantial number of women still being treated with antibiotics and subjected to low-yield investigations, according to a study.
In a retrospective cohort of consecutive women referred to a general urology clinic for recurrent UTI in the UK, 43 percent received antibiotics—for acute treatment in 18.5 percent and prophylactic treatment in 24.5 percent—in primary care. Conservative measures were used in only 21.5 percent of women, reported one of the study authors Dr Virgiliu Bodean from Luton and Dunstable Hospital, Luton, UK. [EAU 2026, abstract A0060]
In secondary care, prophylactic antibiotics were prescribed in 31 percent of women, and conservative measures were used in 53 percent.
Methenamine hippurate was barely used in primary care at 1.5 percent and was somewhat prescribed in secondary care at 18 percent, Bodean noted.
Hormonal therapy was used in only 12.7 percent of women in primary care and 26.1 percent in secondary care, despite the fact that 74 percent of these patients were postmenopausal, he added.
In terms of investigations, prereferral urine cultures in primary care were positive in 61 percent of women. In secondary care, flexible cystoscopy was performed in 73 percent, renal ultrasound in 79 percent, and CT in 33 percent.
“These additional investigations had a low diagnostic yield,” according to Bodean, “[and] in the vast majority of cases, the findings were normal and did not change the management.”
He pointed out that in secondary care, only 73 percent had a confirmed recurrent UTI, suggesting a discrepancy between the diagnosis made in primary care and in secondary care, he continued.
Overall, 37.5 percent of women were discharged after the first clinic review.
“Of the women who had further follow-ups, only 26.9 percent reported a complete treatment response (ie, less than one episode at clinic presentation, which was about 3 months) after they were seen in our clinic, suggesting that we’re still struggling to provide them with appropriate treatment,” according to Bodean.
These findings indicate that “real-world practice remains misaligned with what we advocate in guidelines,” he said. “To translate evidence into practice, healthcare systems must adopt structured, audited care pathways that embed diagnostic accuracy, normalize nonantibiotic management, and reduce unnecessary investigations.”
The analysis included 107 women, of which 74 percent were postmenopausal, 13 percent were immunocompromised, 15 percent had diabetes, and 5 percent were catheter-dependent.