Is Methenamine Prophylaxis for Urinary Tract Infection After Midurethral Sling as Effective as Antibiotic Prophylaxis? A Randomized Controlled Trial
Atlantic Health System
Summary
Stress urinary incontinence (SUI) affects at least 40% of women in the United States. Synthetic polypropylene mid-urethral slings (MUS) are the gold standard treatment for SUI. Post-operative urinary tract infections (UTI) are one of the most common complications after MUS placement. Some studies have demonstrated that MUS placement can increase the risk of UTI up to 21-34%. Post-operative UTI can lead to significant healthcare and patient burden. This additional burden further contributes to an estimated annual cost of $1.6 billion for UTI management in the United States. With increased antibiotic usage, there is simultaneous increase in bacterial resistance leading to treatment refractory UTI. The investigators prescribe post-operative antibiotics prophylactically for 3 days after MUS placement with or without concurrent pelvic reconstructive surgery based on prior literature recommending post-operative prophylaxis. There is a greater emphasis on limiting antibiotic use given the trend of development of bacterial resistance. There are studies supporting alternatives such as methenamine for recurrent UTI prophylaxis treatment, but there are limited studies evaluating methenamine for UTI prophylaxis after MUS.
Description
Synthetic polypropylene mid-urethral slings (MUS) are the gold standard for treatment of stress urinary incontinence (SUI). The most common post-operative complications are urinary tract infection (UTI), bladder injury, bleeding, and mesh erosion. Amongst these complications, post-operative urinary tract infections are the most common complication with incidences up to 21-34%. With high incidences in post-operative UTI, previous studies have shown evidence for the use of prophylactic antibiotics after MUS placement. Previous studies have demonstrated prophylactic antibiotics after MUS placemen…
Eligibility
- Age range
- 18–100 years
- Sex
- Female
- Healthy volunteers
- Yes
Inclusion Criteria: 1. Female 2. Age ≥ 18 3. Patients undergoing mid-urethral sling procedure Exclusion Criteria: 1. Medication intolerance or allergy to study medications 2. Renal impairment with GFR \<30 3. Breast feeding 4. Pregnancy 5. Recurrent urinary tract infections 6. Active urinary tract infection 7. Immunosuppressive disease 8. Interstitial cystitis
Interventions
- DrugMethenamine Hippurate 1g BD
Antibiotic prophylaxis
- OtherAntibiotic prophylaxis
Antibiotic prophylaxis
Location
- Atlantic HealthMorristown, New Jersey