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Urinary tract infection (lower) - women - Management
When should I refer a woman with recurrent cystitis?

  • Refer urgently, to a team specializing in the management of urological cancer, if urological cancer is suspected (for example if haematuria persists after successful treatment of acute cystitis).
  • Refer the woman if:
    • Risk factors for recurrent cystitis (such as urinary tract abnormalities, stones, vesicoureteric reflux, papillary necrosis) are present or suspected.
    • There is any known abnormality on ultrasound of kidneys, ureters, and bladder.
    • The response to preventive treatments and lifestyle measures is ineffective.
Basis for recommendation

These recommendations are in line with guidelines issued by the Scottish Intercollegiate Guidelines Network (SIGN) and are based on expert opinion [SIGN, 2006]. Given the evidence supporting the use of prophylactic antibiotics and cranberry products, SIGN recommends that these strategies should be explored before referring the woman for specialist investigation.

Urgent referral for urological cancer

  • The recommendation to refer women with suspected urological cancer is based on criteria in guidelines from the National Institute for Health and Clinical Excellence (NICE) [NICE, 2005b].

Referral for assessment of risk factors for recurrent cystitis

  • The recommendation to refer for specialist assessment of risk factors for recurrent cystitis is based on expert opinion [Harris et al, 2008].

Poor response to preventive measures

  • The recommendation to seek specialist opinion when preventive measures have failed is pragmatic.

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