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Routine prophylactic stenting reduces the incidence of major urological complications in kidney transplant recipients

Kidney transplantation is the treatment of choice for end‐stage kidney disease, improving quality of life and extending the recipient's life expectancy. Interventions aimed at reducing the burden of post‐transplant complications are a major area of research amongst the transplant community. Major urological complications (MUCs) (e.g. urine leak, obstruction) can occur in the immediate post‐transplant period. This review aimed to determine the benefit and harms of the use of routine stenting in kidney transplant recipients in the prevention of urological complications. Seven studies (1154 patients) were identified. The incidence of MUCs were significantly reduced by the use of prophylactic stenting. Urinary tract infections (UTIs) were more common in stented patients however the addition of antibiotic prophylaxis resulted in no difference in the incidence of UTIs between the two groups. More studies are needed to investigate the use of selective versus universal prophylactic stenting for the unresolved issues of quality of life and cost.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Newborn circumcision for the prevention of urinary tract infections in infancy

Routine neonatal circumcision is a fairly common surgical procedure that may be carried out for medical or religious reasons. The incidence of urinary tract infection (UTI) is greater in uncircumcised babies. Circumcision is a relatively simple procedure and is associated with minimal complications when carried out in neonates rather than in later life. We did not find any trials to support or refute the effectiveness of routine neonatal circumcision to prevent UTI in infancy. Although limited data from previous studies have shown that this intervention might be beneficial, questions regarding the safety and effectiveness of routine neonatal circumcision for the prevention of UTIs in infancy remain unanswered.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

No evidence that oral antibiotic therapy is less effective for treating urinary tract infection than intravenous antibiotics

Severe urinary tract infection (UTI) is a common infection in adults and children, causing acute disease with a variety of symptoms such as fever and flank pain. This may lead to kidney damage, kidney failure or hypertension. Standard therapy involves antibiotics given at least initially by injection. This review identified 15 studies (1743 participants). The results of this review suggest oral therapy is equally effective in treating UTI and preventing long‐term damage. This might reduce costs but also inconvenience for the patient.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Short courses of antibiotics (2‐4 days) are as effective as longer treatment for bladder infections in children.

Bladder and kidney infections (urinary tract infections ‐ UTI) are common in children. Bladder infections cause pain on passing urine and frequency of urination. Some children keep getting repeat bouts. Standard courses of antibiotics (7‐10 days) are used to clear the infection. Shorter courses may reduce adverse effects and costs, but there has been concern that they might reduce the chances of clearing the infection and increase the risk of recurrence. A review of studies found that short courses of antibiotics (2‐4 days) used for bladder infections are as effective as standard courses at clearing UTI, with no increase in recurrence.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Oestrogens for preventing recurrent urinary tract infection in postmenopausal women

Recurrent urinary tract infection (RUTI) is defined as three episodes of urinary tract infection (UTI) in the previous 12 months or two episodes in the last six months. In postmenopausal women the prevalence rate for having one episode of UTI in a given year varies from 8% to 10%. This increased risk is associated with a decrease in oestrogen levels. The use of oestrogens (orally or vaginally) has been proposed as a preventive strategy. This review identified nine studies (3345 women) treated with oestrogens versus placebo, no treatment or antibiotics. Vaginal oestrogens reduced the number of UTIs when compared to placebo. All studies reported adverse events for the oestrogen treatment groups. These included breast tenderness, vaginal bleeding or spotting, vaginal discharge, vaginal irritation, burning and itching.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Long‐term antibiotics for preventing recurrent urinary tract infection in children

Bladder and kidney infections (urinary tract infection ‐ UTI) are common in children, especially girls. They cause an uncomfortable illness that can include vomiting, fever and tiredness. In some children kidney damage may occur, as can repeat illnesses. With repeated infections the risk of kidney damage increases. Some doctors prescribe long‐term antibiotics to try to prevent infections recurring, but this may cause the child to be unwell in other ways, e.g. vomiting. This review of randomised controlled trials (RCTs) found evidence that long‐term antibiotics did reduce the risk of more symptomatic infections but the benefit is small and must be weighed against the likelihood that future infections may be with bacteria that are resistant to the antibiotic given.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Antimicrobial agents for treating acute uncomplicated urinary tract infection in women

Acute uncomplicated lower urinary tract infection (UTI), also know as cystitis, is characterised by burning on urination and frequent urination without fever or flank pain. It is a common event in otherwise healthy, non‐pregnant adult women. A large range of antimicrobials are used in the treatment of cystitis. Twenty one good quality studies, enrolling 6016 participants, which used different classes of antimicrobials for treating acute cystitis in women for 3 up to 10 days, were included in this review. The classes of antimicrobials included in the review proved equally effective for the symptomatic cure. Fluoroquinolones proved more effective than beta‐lactams for the short‐term bacteriological cure, but the significance of this finding is doubtful. Fewer rashes developed in patients treated with fluoroquinolones. Nitrofurantoin caused fewer rashes than TMP‐SMX while having similar rates of any adverse events. Given the small number of studies included in each comparison and for each outcome it is recommended that further randomised controlled trials be conducted.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Interventions for primary vesicoureteric reflux

Vesicoureteric reflux (VUR) is the backflow of urine from the bladder up the ureters to the kidney. People with VUR are thought to be more likely to get urinary tract infections (UTIs) involving the kidney tissue, which may cause permanent kidney damage. Current treatment options include reimplantation of the ureters or endoscopic surgery, long‐term antibiotics, endoscopic correction (injection of a substance around the entry of the ureter into the bladder) using different materials, or a combination of interventions. This review found no strong evidence that long‐term antibiotic prophylaxis prevented repeat UTIs in children with VUR. Associated side effects were infrequent and minor, but prophylaxis was associated with a threefold increased risk of bacterial resistance to the treatment drug in subsequent infections. Surgery decreased the number of UTIs with fever, but did not change the number of children developing symptomatic UTI or kidney damage.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Antibiotic prophylaxis for transrectal prostate biopsy

Prostate cancer is the second most commonly diagnosed cancer in men and transrectal prostate biopsy is the procedure to obtain tissue for the histological diagnosis of carcinoma of the prostate. Despite the fact that infective complications after transrectal prostate biopsy are well known, there is uncertainty about the necessity and effectiveness of routine prophylactic antibiotics and a clear lack of standardization in antibiotic prophylaxis for transrectal prostate biopsy. In nine trials we observed that antibiotic prophylaxis is effective in preventing infectious complications (bacteriuria, bacteremia, fever, urinary tract infection, sepsis) and hospitalization following prostate biopsy. Several classes of antibiotics are effective for prophylaxis in prostate biopsy, with the quinolones the best analysed class. There are no definitive data to confirm that antibiotic for long‐course is superior to short‐course treatment, or that multiple‐dose treatment is superior to single‐dose treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Intermittent catheterisation for long‐term bladder management

Intermittent catheterisation is a common treatment used by people who have bladder emptying problems. A hollow tube (catheter) is passed through the channel to the bladder (urethra) or through a surgically made channel to the skin surface to regularly empty the bladder, usually several times every day. This treatment is used by people who have difficulty emptying their bladders themselves. However, this treatment often causes urine infections resulting in school or work absences or even hospitalisations.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Cranberries for preventing urinary tract infections

Cranberries (usually as cranberry juice) have been used to prevent urinary tract infections (UTIs). Cranberries contain a substance that can prevent bacteria from sticking on the walls of the bladder. This may help prevent bladder and other UTIs. This review identified 24 studies (4473 participants) comparing cranberry products with control or alternative treatments. There was a small trend towards fewer UTIs in people taking cranberry product compared to placebo or no treatment but this was not a significant finding. Many people in the studies stopped drinking the juice, suggesting it may not be an acceptable intervention. Cranberry juice does not appear to have a significant benefit in preventing UTIs and may be unacceptable to consume in the long term. Cranberry products (such as tablets or capsules) were also ineffective (although had the same effect as taking antibiotics), possibly due to lack of potency of the 'active ingredient'.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Interventions for preventing recurrent urinary tract infections during pregnancy

Recurrent urinary tract infections (RUTI) are common in women generally, and particularly in pregnant women. A urinary tract infection (UTI) is an infection of the urinary tract (bladder, kidneys) due to the presence of bacteria in the urine (bacteriuria). During pregnancy, UTI may be a serious complication that is associated with adverse pregnancy outcomes for both mother and child including preterm birth and small‐for‐gestational‐age babies. Therefore, it is important to define the optimal intervention for preventing RUTI during pregnancy to improve pregnancy outcomes. Interventions used to prevent RUTI in pregnant women can be pharmacological (antibiotics) or non‐pharmacological (cranberry products, acupuncture, probiotics and behavioural modifications). So far, little is known about the best way to prevent RUTI in pregnant women.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Still waiting for evidence about whether cranberries are a useful treatment for urinary tract infections

Cranberries contain a substance that can prevent bacteria from sticking on the walls of the bladder. This may help reduce bladder and other urinary tract infections (UTIs). Cranberries (usually as cranberry juice) have been used to try and treat UTIs, particularly in high risk groups such as older people. Cranberries have few adverse effects. The review found no evidence from studies about the effects of cranberry juice or other cranberry products on UTIs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Urinary catheter policies for long‐term bladder drainage

Some people use catheters to help them manage their bladder problems (such as leaking urine or not being able to pass urine). Catheters may be permanent urethral catheters (in the tube draining the bladder), suprapubic catheters (via the abdomen) or intermittent catheters (when a catheter is inserted via the urethra several times a day). No trials were found comparing these different methods with each other. Sometimes people using the catheters develop urinary tract infections. There was some weak evidence that using antibiotics all the time reduced the chance of having a urinary tract infection while using intermittent catheters, but there was not enough information about side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Treatments for symptomatic urinary tract infections during pregnancy

Antibiotics are very effective at clearing urinary tract infections in pregnancy, and complications are very rare.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Non‐pregnant women who have had several urinary tract infections are less likely to have another infection if they take antibiotics for six to 12 months

Urinary tract infections (UTI) are infections of the bladder and kidneys. They can cause vomiting, fever and tiredness, and occasionally kidney damage. The review found that non‐pregnant women who had two or more UTIs in the past year had less chance of having a further UTI if given a six to 12 month treatment with antibiotics. The most commonly reported side effects are digestive problems, skin rash and vaginal irritation. More research is needed determine the optimal duration for antibiotic treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Antibiotics for lower urinary tract infection in children

Urinary tract infection (UTI) is one of the most common bacterial infections in infants and children. The most commonly presenting infection of the urinary tract is known as cystitis and in the majority of cases can be easily treated with a course of antibiotic therapy with no further complications. This review identified 16 studies investigating antibiotics for UTI in children. Results suggest that 10‐day antibiotic treatment is more likely to eliminate bacteria from the urine than single‐dose treatments; there was not enough data to draw conclusions about other treatment durations, or effectiveness of particular antibiotics. Although antibiotic treatment is effective for children with UTI, there are insufficient data to recommend any specific regimen.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Methenamine hippurate for preventing urinary tract infections

Bladder and kidney infections (urinary tract infections ‐ UTI) can cause vomiting, pain, dysuria, septicaemia, fever and tiredness, and occasionally kidney damage. Some people are at high risk of repeated UTIs, and they are also more likely to have serious complications (including people with kidney problems, or people who have catheters to release urine). Long‐term use of antibiotics can lead to resistance, so methenamine salts (methenamine or hexamine hippurate) are often used. This review identified 13 studies (2032 participants). Methenamine hippurate may be effective in preventing UTI in patients without renal tract abnormalities particularly when used for short term prophylaxis. It does not appear to be effective for long term prophylaxis in patients who have neuropathic bladder. There were few adverse effects.Additional well controlled randomised controlled trials are necessary in particular to clarify effectiveness for longer term prophylaxis in those without neuropathic bladder.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Pregnancy and birth: What are the benefits of routinely screening for bacteria in the urine of pregnant women?

It is not clear whether it would be beneficial to routinely test the urine of pregnant women for bacteria (bacteriuria screening). It is also not possible to say whether antibiotics should be used if high levels of bacteria are detected in the urine but there are no noticeable urinary tract problems.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 16, 2015

Duration of antibacterial treatment for uncomplicated urinary tract infection in women

Uncomplicated urinary tract infection (UTI) is a common disease occurring frequently in young women. It is caused by bacteria multiplying in urine, and the patient usually complains of urgency and burning pain while urinating. The present practice is to treat the patient with antibiotics for three days. In this review we included all studies that compared three‐day therapy with longer treatment (five days or more). Three days of treatment were adequate to achieve symptomatic relief for most patients, but it appears that longer therapy is better in terms of bacteria elimination from the urine, no matter what antibiotic is used. Longer therapy for UTI is related to higher rate of adverse reactions to the antibiotics used. Pending further research, it could be considered for women in whom eradication of bacteria in the urine is important.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

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