Skip to main content

Advertisement

SpringerLink
Log in

Recurrent Urinary Tract Infections in Females and the Overlap with Overactive Bladder

  • Lower Urinary Tract Symptoms & Voiding Dysfunction (J Sandhu, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

There are an estimated 33 million men and women with overactive bladder (OAB) in the USA. Despite the prevalence of OAB, it remains a frequently misdiagnosed condition. OAB has shared symptomatology with other common urologic conditions, namely recurrent urinary tract infections (UTIs). Here, we will review key distinguishing features of OAB that aid in establishing an accurate diagnosis and recent advances in OAB management.

Recent Findings

Recent studies have shown that among women presenting with lower urinary tract symptoms, the majority were diagnosed with UTIs and treated without performing a urine culture as routine care. The authors found that when urine cultures were obtained, less than half of women had a positive urine culture, suggesting that empiric treatment of UTIs without cultures commonly led to a misdiagnosis of UTI. The symptoms of OAB have overlap with other common conditions, most notably UTI, BPH, and bladder cancer/carcinoma in situ. Despite the shared symptomatology of OAB and UTI, the timing of symptom onset is usually very different between the two. UTI symptoms are generally acute, whereas those of OAB are generally chronic. OAB and UTI share the common features of urgency, frequency, and nocturia. However, dysuria and hematuria are not features of OAB, while they are frequently seen in UTI. Of note, urgency, frequency, and nocturia are rarely seen in bladder cancer/carcinoma in situ; when these symptoms do occur, it is generally in the setting of microhematuria. One study of patients with carcinoma in situ found that 41% had macroscopic hematuria and 44% had microscopic hematuria at presentation. In patients with lower urinary tract symptoms, it is important to perform a urinalysis (UA) to evaluate for microhematuria to rule out the possibility of malignancy. First-line treatment of OAB (outside the setting of UTI) involves behavioral modification, including bladder training, fluid management, and pelvic floor exercises. Numerous studies have supported behavioral modification strategies as the most efficacious initial step in treatment. Although routinely given for recurrent UTIs and vaginal atrophy in postmenopausal women, several review articles have shown that vaginal estrogen is an effective treatment of lower urinary tract symptoms.

Summary

The importance of distinguishing OAB from other conditions presenting with similar symptoms is key in preventing misdiagnosis, treatment delays, and antibiotic overuse. Here, we have reviewed key parameters distinguishing OAB from UTI, the most commonly misdiagnosed condition among those presenting with lower urinary tract symptoms (LUTS). Given that UTI is the most commonly misdiagnosed condition among women with OAB, we recommend relying on urine cultures and the constellation of acute-onset dysuria, frequency, and urgency as more important diagnostic factors in distinguishing these conditions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Stewart WF, Van Rooyen JB, Cundiff GW, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20(6):327–36.

    CAS  PubMed  Google Scholar 

  2. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.

    Article  PubMed  Google Scholar 

  3. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167–78.

    Article  PubMed  Google Scholar 

  4. Griebling TL. Urologic diseases in America project: trends in resource use for urinary tract infections in women. J Urol. 2005;173(4):1281–7.

    Article  PubMed  Google Scholar 

  5. Foxman B. Recurring urinary tract infection: incidence and risk factors. Am J Public Health. 1990;80(3):331–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000;182(4):1177–82.

    Article  CAS  PubMed  Google Scholar 

  7. Raz R. Urinary tract infection in postmenopausal women. Korean J Urol. 2011;52(12):801–8.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Raz R, Gennesin Y, Wasser J, Stoler Z, Rosenfeld S, Rottensterich E, et al. Recurrent urinary tract infections in postmenopausal women. Clin Infect Dis. 2000;30(1):152–6.

    Article  CAS  PubMed  Google Scholar 

  9. Raz R. Role of estriol therapy for women with recurrent urinary tract infections: advantages and disadvantages. Infect Dis Clin Pract. 1999;8:64–6.

    Article  Google Scholar 

  10. Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med. 1993;329(11):753–6.

    Article  CAS  PubMed  Google Scholar 

  11. Thomas TM, Plymat KR, Blannin J, Meade TW. Prevalence of urinary incontinence. Br Med J. 1980;281(6250):1243–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Haspels AA, Luisi M, Kicovic PM. Endocrinological and clinical investigations in post-menopausal women following administration of vaginal cream containing oestriol. Maturitas. 1981;3(3–4):321–7.

    Article  CAS  PubMed  Google Scholar 

  13. Tomas ME, Getman D, Donskey CJ, Hecker MT. Overdiagnosis of urinary tract infection and underdiagnosis of sexually transmitted infection in adult women presenting to an emergency department. J Clin Microbiol. 2015;53(8):2686–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Lindback H, Lindback J, Sylvan S, et al. Low frequency of antibiotic resistance among urine isolates of Escherichia coli in the community, despite a major hospital outbreak with Klebsiella pneumoniae producing CTX-M-15 in Uppsala County. Scand J Infect Dis. 2010;42(4):243–8.

    Article  CAS  PubMed  Google Scholar 

  15. Aisen CM, Ditkoff E, RoyChoudhury A, Corish M, Rutman MP, Chung DE, et al. Utility of catheterized specimens in reducing overdiagnosis of urinary tract infections in women. Neurourol Urodyn. 2018;

  16. Wein A. Symptom-based diagnosis of overactive bladder: an overview. Can Urol Assoc J. 2011;5(5 Suppl 2):S135–6.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Cheng L, Cheville JC, Neumann RM, Leibovich BC, Egan KS, Spotts BE, et al. Survival of patients with carcinoma in situ of the urinary bladder. Cancer. 1999;85(11):2469–74.

    Article  CAS  PubMed  Google Scholar 

  18. Propert, K.J., A.J. Schaeffer, C.M. Brensinger, et al., A prospective study of interstitial cystitis: results of longitudinal followup of the interstitial cystitis data base cohort. The Interstitial Cystitis Data Base Study Group. J Urol, 2000. 163(5): p. 1434–1439.

    Article  CAS  PubMed  Google Scholar 

  19. Messing EM, Stamey TA. Interstitial cystitis: early diagnosis, pathology, and treatment. Urology. 1978;12(4):381–92.

    Article  CAS  PubMed  Google Scholar 

  20. Oravisto KJ. Epidemiology of interstitial cystitis. Ann Chir Gynaecol Fenn. 1975;64(2):75–7.

    CAS  PubMed  Google Scholar 

  21. Driscoll A, Teichman JM. How do patients with interstitial cystitis present? J Urol. 2001;166(6):2118–20.

    Article  CAS  PubMed  Google Scholar 

  22. Schmiemann G, Kniehl E, Gebhardt K, Matejczyk MM, Hummers-Pradier E. The diagnosis of urinary tract infection: a systematic review. Dtsch Arztebl Int. 2010;107(21):361–7.

    PubMed  PubMed Central  Google Scholar 

  23. Hessdoerfer E, Jundt K, Peschers U. Is a dipstick test sufficient to exclude urinary tract infection in women with overactive bladder? Int Urogynecol J. 2011;22(2):229–32.

    Article  PubMed  Google Scholar 

  24. Forde JC, Davila JL, Marks BK, Epstein M, Tsui JF, Weiss JP, et al. Urogynecological conditions associated with overactive bladder symptoms in women. Can Urol Assoc J. 2017;11(3–4):E83–e87.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Mayfield MP, Whelan P. Bladder tumours detected on screening: results at 7 years. Br J Urol. 1998;82(6):825–8.

    Article  CAS  PubMed  Google Scholar 

  26. Britton JP, Dowell AC, Whelan P, Harris CM. A community study of bladder cancer screening by the detection of occult urinary bleeding. J Urol. 1992;148(3):788–90.

    Article  CAS  PubMed  Google Scholar 

  27. Rovner ES, Gomes CM, Trigo-Rocha FE, et al. Evaluation and treatment of the overactive bladder. Rev Hosp Clin Fac Med Sao Paulo. 2002;57(1):39–48.

    Article  PubMed  Google Scholar 

  28. Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol. 2012;188(6 Suppl):2455–63.

    Article  PubMed  Google Scholar 

  29. Rahn DD, Carberry C, Sanses TV, Mamik MM, Ward RM, Meriwether KV, et al. Vaginal estrogen for genitourinary syndrome of menopause: a systematic review. Obstet Gynecol. 2014;124(6):1147–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Beerepoot MA, Geerlings SE, van Haarst EP, et al. Nonantibiotic prophylaxis for recurrent urinary tract infections: a systematic review and meta-analysis of randomized controlled trials. J Urol. 2013;190(6):1981–9.

    Article  CAS  PubMed  Google Scholar 

  31. Cody JD, Jacobs ML, Richardson K, et al. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev. 2012;10:Cd001405.

    PubMed  Google Scholar 

  32. Ellington DR, Szychowski JM, Malek JM, Gerten KA, Burgio KL, Richter HE. Combined tolterodine and vaginal estradiol cream for overactive bladder symptoms after randomized single-therapy treatment. Female Pelvic Med Reconstr Surg. 2016;22(4):254–60.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Farnoosh Nik-Ahd

  2. Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    A. Lenore Ackerman & Jennifer Anger

Authors
  1. Farnoosh Nik-Ahd
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Lenore Ackerman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jennifer Anger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer Anger.

Ethics declarations

Conflict of Interest

Farnoosh Nik-Ahd declares no potential conflicts of interest. A. Lenore Ackerman reports a 1-year research support grant from Pfizer. Jennifer Anger is an expert witness for Boston Scientific, Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nik-Ahd, F., Lenore Ackerman, A. & Anger, J. Recurrent Urinary Tract Infections in Females and the Overlap with Overactive Bladder. Curr Urol Rep 19, 94 (2018). https://doi.org/10.1007/s11934-018-0839-3

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-018-0839-3

Keywords

Search

Navigation