Bladder Wall–Embedded Bacteria Associated With Increased Risk of Recurrence After Electrofulguration in Women With Antibiotic-Recalcitrant Urinary Tract Infection
Gadhvi, Jashkaran G.1,2,*; Kenee, Parker R.M.3,*; Lutz, Kevin C.4,5; Khan, Fatima1; Li, Qiwei4; Zimmern, Philippe E.2; De Nisco, Nicole J.1,2 Author Information
JU Open Plus 3(7):e00077, July 2025. | DOI: 10.1097/JU9.0000000000000315
Abstract
Purpose:
Antibiotic-recalcitrant recurrent urinary tract infection (rUTI) is increasingly observed in postmenopausal women. When standard therapies fail, some elect electrofulguration (EF) of areas of chronic cystitis detected on office cystoscopy. EF is believed to remove tissue-resident bacteria within the bladder walls of women with rUTI. We hypothesized that increased bladder wall bacterial burden may be associated with incomplete rUTI resolution after EF.
Materials and Methods:
After obtaining institutional review board approval, bladder biopsies were obtained from 34 consenting menopausal women electing EF for the advanced management of rUTI. 16S rRNA fluorescence in situ hybridization was performed using both Universal and Escherichia probes, and tissue-resident bacterial load was quantified. Time to UTI relapse after EF was recorded during a 6-month follow-up period, and the association of bladder wall bacterial burden and clinical covariates with UTI relapse was assessed.
Results:
We observed bladder wall–embedded Escherichia in 52% of all participants and in 92% of participants with recent Escherichia coli UTI. Time-to-relapse analysis revealed that women with high bladder wall bacterial burden as detected by the Universal probe had a significantly (P = .035) higher risk of UTI within 6 months of EF (hazard ratio [HR] = 3.15, 95% confidence interval [CI]: 1.09-9.11). Interestingly, bladder wall–resident Escherichia was not significantly associated (P = .26) with a higher risk of UTI relapse (HR = 2.14, 95% CI: 0.58-7.90).
Conclusions:
We observed that total bladder wall bacterial burden was associated with a 3.1× increased risk of rUTI relapse within 6 months. Continued analysis of the relationship between bladder wall–embedded bacteria and rUTI outcomes may provide insight into the management of these challenging patients.