Female urodynamics and lower urinary tract infection

Abstract

Objectives: To determine the incidence of unsuspected urinary tract infection (UTI) before cystometry, to evaluate reports of a greater tendency to abnormal cystometry in the presence of asymptomatic bacteriuria, and to determine the incidence of iatrogenic significant bacteriuria after cystometry.

Patients and methods: A prospective study was carried out in the gynaecology department of a district general hospital in collaboration with the medical microbiology department of a university teaching hospital. The period of investigation was 1 year and the study population was a sample of women undergoing urodynamic investigations during this period. Data were collected on age, menopausal status, parity, cystometric diagnosis and voiding dysfunction.

Results: In all, 117 patients provided a urine sample before cystometry; 12 of these patients had a positive culture, giving an incidence of 10.3% for unsuspected asymptomatic bacteriuria before cystometry. There was a significant association between age and the presence of UTI before cystometry (P = 0.003) and between this UTI and sensory urgency (P = 0.01). There was no similar significant association with detrusor instability or genuine stress incontinence. Nineteen of the 97 patients who had negative bacteriology before cystometry had a positive urine culture afterward. Compared with patients who had a negative sample, there was no significant association with age, parity, menopausal status, abnormal cystometry or voiding dysfunction.

Conclusion: These results do not support a policy of universal screening for bacteriuria before urodynamic investigation. Asymptomatic bacteriuria did not influence the urodynamic outcome except in patients with sensory urgency. However, we recommend that screening and treatment be considered individually in older women who are being investigated for irritative bladder symptoms. About 20% of the present patients developed UTI after the urodynamic investigation. This information should be included in the counselling before urodynamic investigation and should be incorporated into the patient information leaflet as part of good clinical practice.