Urinary Tract Infection (UTI)-free and Recurrent UTI (rUTI)-Free Survivals Following Bladder Electrofulguration in Women With a History of Antibiotic-Refractory rUTI

Abstract Background Recurrent UTIs (rUTI) contribute to significant morbidity and impaired quality of life. Electrofulguration (EF) of chronic cystitis harboring deep-seated bacteria is an outpatient procedure increasingly considered in antibiotic-refractory rUTI; however, its long-term effectiveness remains understudied. Methods To evaluate UTI-free and rUTI-free survival following EF we conducted a retrospective cohort study of women with culture-confirmed symptomatic and antibiotic-refractory UTIs who underwent EF between 2006 and 2024. Post-EF UTI and rUTI were defined using standard guideline-based criteria. Kaplan-Meier survival analyses compared survival outcomes by age group and cystitis stage at time of cystoscopy. Multivariable Cox proportional hazards models evaluated independent associations of age and stage with each outcome. Results During the follow-up period, 291 of 601 patients (48.4%) developed a post-EF UTI. Median time to first UTI was 50 months (95% CI: 40.8–64.8). Increasing age was associated with higher risk of post-EF UTI (aHR = 1.01 per year; 95% CI: 1.00–1.02; P = .013). Compared with patients with Stage 1 cystitis, patients with Stage 4 had a significantly shorter median post-EF UTI-free survival (24.5 vs 69.3 months; adjusted HR (aHR): 1.90, 95% CI: 1.33–2.71; P < .001). Post-EF rUTIs occurred in 87 patients (14.5%), with a median time of recurrence at 153 months. Older age (aHR: 1.02; 95% CI: 1.00–1.04; P = .019) and Stage 4 cystitis (aHR = 3.23, 95% CI: 1.78–5.85; P < .001) were independently associated with higher risk of post-EF rUTI. Conclusions Electrofulguration was associated with prolonged UTI-free and rUTI-free survivals among women with antibiotic-refractory rUTI; its effectiveness influenced by cystitis stage and patient age.