Electrofulguration Revealed: A Decade of Improving Menopausal recurrent UTIs

Urinary tract infections (UTIs) are among the most common bacterial infections, particularly in women, with a significant proportion developing recurrent UTIs (RUTIs). In postmenopausal women, the changes in the urogenital flora, along with physiological changes like decreased estrogen levels, contribute to an increased risk of UTIs. The repeated use of antibiotics for RUTIs leads to concerns about antibiotic resistance, making alternative treatments essential. Electrofulguration is a procedure that involves the use of high-frequency electrical currents to destroy tissue, typically abnormal or unwanted tissue. The process involves the application of an electrode to the target area, where the electrical current produces heat that causes the tissue to disintegrate or coagulate, leading to its destruction. Electrofulguration is known for its precision and ability to minimize damage to surrounding healthy tissue, making it a valuable tool for certain types of surgical procedures. In the context of RUTIs, electrofulguration involves the cauterization of the bladder lining to remove areas of inflammation, and has emerged as a potential alternative for cases where antibiotics fail.

In a new study published in Journal of Urology by Shivani Gaitonde, Alana Christie, Priya Garigipati, Feras Alhalabi, and led by Professor Philippe Zimmern from the Department of Urology at University of Texas Southwestern Medical Center, the authors evaluated the long-term outcomes of electrofulguration in the treatment of antibiotic-refractory RUTIs in a cohort predominantly composed of menopausal women. The study spanned from 2006 to 2012 and involved a follow-up period extending up to 11 years, with some participants having more than a decade of post-treatment observations. The authors included nonneurogenic women who had experienced three or more symptomatic RUTIs per year, all of whom exhibited inflammatory lesions on cystoscopy indicative of cystitis. The women chosen had a history of RUTIs that were unresponsive to conventional antibiotic treatments. Patients with less than a 5-year follow-up, significant comorbidities, or those who had undergone associated urological surgeries were excluded to maintain focus on the efficacy of electrofulguration in a specific patient population. Electrofulguration was performed as an outpatient procedure. The process they used involved the use of a fine-tip monopolar Bugbee electrode to specifically fulgurate areas of the bladder identified during cystoscopy as having chronic cystitis. The procedure aimed to disrupt and remove the nidus of infection within the bladder lining. The team collected detailed data on the number of UTI episodes, antibiotic usage, and any subsequent electrofulguration procedures post-initial treatment. They also conducted telephone interviews to capture data on UTI symptoms, recurrences, and additional treatments for patients not recently seen in clinics.

At the end of the follow-up period, the researchers observed a significant portion of the cohort (72%) experienced a complete resolution of UTI symptoms. An additional 22% of participants showed improvement, with a reduction in the frequency of UTIs, while only 6% did not benefit from the procedure. Moreover, there was a notable decrease in the reliance on continuous antibiotic therapy post-electrofulguration. Before electrofulguration, 74% of the participants were on continuous antibiotics, which reduced to 5% at the last follow-up, showcasing a substantial reduction in antibiotic dependency.  A minority of the participants (19%) underwent a repeat electrofulguration procedure, indicating that while electrofulguration was largely effective, some cases required additional interventions for optimal outcomes. In conclusion, the study by Professor Philippe Zimmern and colleagues represents an important contribution in the management of RUTIs in postmenopausal women. The very long-term outcomes of electrofulguration highlight its potential as a durable and effective alternative to antibiotics, offering hope to those suffering from antibiotic-refractory RUTIs. Future research, ideally in the form of randomized controlled trials with diverse populations, is needed to further validate these findings and explore the full potential of electrofulguration in the management of RUTIs.