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Is a pelvic examination contributory in the initial evaluation of women with recurrent urinary tract infections?

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Abstract

Introduction and hypothesis

Recurrent urinary tract infections (rUTIs) affect up to 44% of women; evidenced-based guidelines regarding the contributory role of a pelvic examination in these women are lacking. We hypothesize that routine pelvic examination has a limited role in evaluation and management of women with rUTI when appropriate symptoms-based screening is performed and normal post-void residual volume (PVR) is confirmed.

Methods

We performed a retrospective chart review of women ages 18–85 years presenting to Wake Forest Pelvic Health Center with two culture-proven UTIs in 6 months or three UTIs in 12 months with a documented pelvic examination. Pregnant women were excluded. Data extraction included demographics, medical history, screening assessment of vaginal bulge symptoms, urine culture results, imaging, physical/pelvic examination findings, PVR, treatment recommendations and outcomes within 1 year of initial assessment. Descriptive statistics and Fisher’s exact test were performed.

Results

Of 160 charts screened, 91 met the inclusion criteria. Nineteen (21%) had symptoms of vaginal bulge, and 14 (17%) had PVR > 100 ml. Pelvic examination provided new/contributory information in eight (8.8%) of women. The negative predictive value of absence of bulge symptoms and normal PVR was 89%. Within 1 year, 41 (46%) reported symptom resolution with rUTI treatment with no difference between those with or without a contributory pelvic examination (p value = 0.64).

Conclusions

In women with rUTI who report absence of vaginal bulge symptoms and have a PVR < 100 ml, a pelvic examination provides contributory information in < 10% of women and did not change treatment outcomes.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston Salem, NC, USA

    Olivia Hostetter

  2. Wake Forest School of Medicine, Winston Salem, NC, USA

    Kshipra Hemal

  3. Department of Urology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC, 27101, USA

    Katherine N. Hines & Catherine A. Matthews

Authors
  1. Olivia Hostetter
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  2. Kshipra Hemal
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  3. Katherine N. Hines
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  4. Catherine A. Matthews
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Contributions

O Hostetter: Project development, data collection, manuscript writing and editing.

K Hemal: Project development, data collection, data analysis.

K Hines: Data collection, manuscript editing.

C Matthews: Protocol and project development, data analysis, manuscript writing and editing.

Corresponding author

Correspondence to Catherine A. Matthews.

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Conflicts of interest

Dr. Matthews serves as an expert witness for Johnson& Johnson and has received grant support and consultant fees from Boston Scientific.

Hostetter O, MD, Hemal K, BS, and Hines K, MD, have no conflicts of interest to report.

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Hostetter, O., Hemal, K., Hines, K.N. et al. Is a pelvic examination contributory in the initial evaluation of women with recurrent urinary tract infections?. Int Urogynecol J 31, 1209–1214 (2020). https://doi.org/10.1007/s00192-019-04198-z

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  • DOI: https://doi.org/10.1007/s00192-019-04198-z

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