63 | WOMEN AFFECTED BY RECURRENT LOWER URINARY TRACT INFECTIONS UNDERGOING URODYNAMIC INVESTIGATIONS: THE ROLE OF DETRUSOR UNDERACTIVITY, POST‐VOID RESIDUAL URINE, LOWER URINARY TRACT DISORDERS AND SYMPTOM

Introduction and aim of the study: Aim of the study was to assess the relationship between recurrent lower urinary tract infection (UTI) and detrusor un- deractivity (DUA), post‐void residual (PVR) urine, lower urinary tract symptoms (LUTS) and disorders, in women underwent urodynamic (UD) investigations.Materials and methods: This was a prospective study enrolling women with age >18 y.o. undergoing UD between January 2018 and April 2021 for re- current lower UTI, defined as a frequency of 2 or more UTI episodes in the last 6 months or 3 or more UTIs in the last 12 months. The diagnosis of recurrent UTI was confirmed by positive urine culture (European Association of Urology guidelines on urological in- fections). Women underwent medical and urological history, and physical examination. Associated condi- tions and disorders such as symptomatic pelvic organ prolapse (POP ≥ Stage 2 according to POP‐ Quantification system), neurogenic bladder, hemor- rhagic cystitis, vaginitis, stress and urgency urinary incontinence, and abnormal posture for micturition were also evaluated. Due to the lack of standardized UD parameters for female DUA, we considered DUA women the patients with UD characteristics who met at least one of the following criteria, which are the main ones reported in the literature: i) Pdet@Qmax ≤10 cm H2O and Qmax ≤12 mL/s (Jeong et al.); ii) Pdet@Qmax<30 cm H2O and Qmax<10 mL/sABSTRACTS(Abarbanel and Marcus); iii) Pdet@Qmax<20 cm H2O and Qmax<15 mL/s and BVE<90% (BVE cri- teria); iiii) Pdet@Qmax<20 cm H2O + Qmax (PIP1 Griffiths). Women could be included in multiple DUA groups according to used DUA criteria. LUTS and both PVR and PVR‐Ratio (PVR‐R) as the ratio of PVR to bladder volume (BV: voided volume (VV) + PVR) were recorded. Qmax, VV, and PVR/PVR‐R were as- sessed after a free uroflowmetry (UF), while Pdet/ Qmax and cystometric capacity were measured by UD. Two control groups (CG) were enrolled. The CG for DUA (CG‐1) was comprised by women with re- current UTI and non‐DUA. The CG for bladder emptying condition (CG‐2) included prospectively enrolled group of asymptomatic women (age 18‐35 y.o.) with no associated urological and pelvic dis- orders/surgeries, who underwent free UF with the evaluation of Qmax, VV, and PVR/PVR‐R by bladder scan. Subjective reproducibility of the UF was re- ported as a VAS scale score >6, and LUTS were evaluated by ICI‐Q‐FLUTS. Statistical analysis in- cluded: T‐test and Fisher exact Test.Results: We assessed 72 women (mean±SD age 55.9±17.7 y.o.) with recurrent lower UTI undergoing UD. Women who met at least one of the DUA criteria were 42 (58.3%). Table 1 reports UD data on overall population, DUA women and CG‐1. Overall, mean Qmax was low (11.9 ml/s), and PVR/PVR‐R were high (144.1ml and 30.6%). In DUA group, Qmax was significantly lower, and PVR/PVR‐ R were statistically greater. In CG‐2 were enrolled 76 healthy females (mean±SD age 26.7±6.4 y.o.), with UF reproducibility (VAS >6) reported in 97.4%, and mean ICIQ‐FLUTS score of 2.7±3.6. Compared to CG‐2, women with UTI showed significantly lower mean Qmax (p<0.01), and significantly higher mean PVR/PVR‐R (p<0.01), Table 2. Rates of associated disorders and LUTS in overall population, DUA women and CG‐1 are reported in Table 3. POP was the concomitant condition more commonly un- covered in the UTI population (43.1%). Rate of main storage and voiding LUTS was high in UTI population. None of the investigated disorders or LUTS were significantly associated to DUA women.Interpretation of results: Women with recurrent UTI showed abnormal findings at UF and UD (low Qmax, high PVR/PVR), significantly worse than those of healthy females, and a great rate of detrusor un- deractivity (>50%). In this latter subgroup, all the UF and UD parameters got significantly worse. Due to the high prevalence of DUA in women with UTIs, and its significant negative influence on bladder emptying, it is likely that this detrusor impairment may be one of the main causes of UTIs. POP was discovered in ap- proximately half of the UTI patients (43.1%), and this prevalence raised to 50% in DUA females with re- current UTIs. Therefore, POP could be another re- levant cause of UTIs, due to its well‐known obstructive effect on the bladder outlet. Women with recurrent UTI were very symptomatic. Surprisingly, voiding symptoms were approximately as high as storage symptoms. This finding could be due to the high rate of women with DUA and to the high pre- valence of POP.Conclusions: Recurrent UTIs are related to sev- eral predisposing factors. We demonstrated that fe- males with history of recurrent UTIs had abnormal UF and UD results, significantly different from asymptomatic healthy women, and that DUA and POP may play a crucial negative role in promoting UTIs. In women with recurrent UTI, UD investigation may aid to better recognize the underlying patho- physiological mechanisms.