Urine acidity is thought to be preventative against UTIs (urinary tract infections). Electrofulguration (EF) is an outpatient procedure during which chronic sites of infection in the bladder are cauterized in patients who have failed other methods of treating recurrent UTIs (RUTIs). The rate of recurrent urinary tract infections (RUTIs) after EF tends to decline [1,2]; however, the effect of urine pH in women undergoing EF has not been studied. Our goal was to evaluate the effect of urine pH on the rate of UTI recurrence over time after EF in 3 groups of women with different urine pH ranges.

In a prior IRB-approved prospective study [3], women were provided urine dipsticks and asked to record their urinary pH 4 times a day for a week as well as their food intake for a week. Three urinary pH trend groups were identified: never below 6 (group 1), never above 6 (group 2), and above and below 6 (group 3). Patients who underwent EF procedure for antibiotic-recalcitrant RUTI and had complete urine pH and food diaries were included. Data on demographics, UTI history, and culture information was collected from an electronic medical record. The rate of yearly UTI after EF was compared between the urine pH groups.

Of 27 patients participated in the diary study, 22 also underwent EF. Twenty were managed with a single EF treatment, while one underwent two and another three. Median duration of follow-up was 6 years for groups 1 and 2, and 4 years for group 3. Median time between the last EF and the food and pH diary recordings was 4.5 years. No difference was found between urine pH groups for median number of UTIs treated (figure), median number of UTIs treated per year, and culture characteristics during each UTI (including frequency of E. coli, presence of multiple organisms, and resistance to fluoroquinolones and Bactrim).  There was no difference between the stable and fluctuating pH groups and either UTI’s treated per year (p = 0.16) or UTI’s treated in last year (p = 0.21).

During long-term follow-up, no association was found between urine pH groups and rates of UTIs after EF, possibly because EF already provokes an important reduction in rates of UTIs per year.

This pilot study allows us to power a study with a larger sample size in the future to provide more conclusive results on if low urinary pH decreases the risk of UTI recurrence after EF.

Crivelli, J et al.  IUJ 2019
DeNisco, N et al. JMB 2019
Chavez, J et al. FPMRS 2020