Validation of the best practice policy statement on urodynamic antibiotic prophylaxis for the high-risk patient in the era of antibiotic stewardship.

AIMS: To validate the recommendations of the Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) 2017 Best Practice Policy Statement (BPPS) for Urodynamic Antimicrobial Prophylaxis in high-risk patients. METHODS: After institutional review board approval, 489 patients who underwent urodynamics (UDS) in the absence of antibiotic prophylaxis were retrospectively reviewed. Patients were stratified according to the SUFU BPPS risk factors (neurogenic lower urinary tract dysfunction [NLUTD], elevated postvoid residual [PVR], immunosuppression, age over 70, catheter use, and orthopedic implants). χ2 , Fisher's exact test, Student t test, and univariate and multiple logistic regression analyses were used to assess the associations between these risk factors and postprocedural urinary tract infection (UTI). RESULTS: Twenty-two (4.5%) patients developed symptomatic postprocedural UTI. Univariate analysis revealed statistical differences in the incidence of UTI in patients with elevated PVR and NLUTD groups. The variables that were associated with UTI on multivariate analysis were elevated PVR (odds ratio [OR]: 4.91, 95% confidence interval [CI], 1.92-12.56, P = .001) and NLUTD (OR: 4.84, 95% CI, 1.75-3.37, P = .002). The data analysis for all other high-risk groups failed to show significant correlations with UTI on univariate or multivariate analysis. Patients with three risk factors were more likely to develop UTI than patients with 1 or 2 risk factors. No patient developed pyelonephritis, sepsis, or joint infection. CONCLUSIONS: Elevated PVR, NLUTD, and possessing three risk factors were significant predictors for post-UDS UTI. All other risk factors were not associated with postprocedural UTI. Morbidity associated with UTI was low. Antimicrobial prophylaxis for these conditions should be reconsidered.

The Effects of Listening to Music on Anxiety, Pain, and Satisfaction during Urodynamic Study: A Randomized Controlled Trial.

INTRODUCTION: To assess the influence of music therapy on perceived anxiety and pain during outpatient urodynamic study (UDS) in a prospective, randomized fashion. METHODS: Between January and December 2018, a total of 70 patients were randomized to either have music therapy (study) or not have (control) in a 1:1 ratio. To the study group, Sufi music was delivered at low tempo. All participants performed the State-Trait Anxiety Inventory evaluation after the procedure and assessed their degree of pain, satisfaction, and willingness to undergo an additional or repeat procedure using the Visual Analog Scale. RESULTS: Patient demographic and baseline characteristics were found to be similar between the 2 groups. Though music did not significantly alleviate pain (4.6 ± 1.2 vs. 4.4 ± 1.7; p = 0.76) and anxiety (47.7 ± 7.75 vs. 46.4 ± 6.5; p = 0.36), it had a positive impact on the patient's willingness to repeat UDS (3.4 ± 1.4 vs. 6.1 ± 1.3; p = 0.005) and provided overall satisfaction (4.6 ± 0.61 vs. 7.2 ± 1.33; p = 0.004). CONCLUSIONS: Music is a practical, harmless, and inexpensive non-pharmacological option that can be adopted during medical and surgical procedures, although according to this present study, listening to music during UDS had no effect on pain and anxiety levels.

The effects of a heating pad on anxiety, pain, and distress during urodynamic study in the female patients with stress urinary incontinence.

AIMS: Although generally well tolerated, a urodynamic study is an unpleasant and stressful procedure for some patients. This study evaluated the effects of a heating pad on anxiety, pain, and distress during urodynamic studies in female patients with stress urinary incontinence. METHODS: A total of 74 female patients with stress urinary incontinence who underwent a urodynamic study between May 2015 and October 2015 were randomized to either the experimental group using a heating pad (n = 37) or control group (n = 37). In the experimental group, a heating pad was applied on the patient's sacrum during the urodynamic study. All patients completed the State-Trait Anxiety Inventory (20-80) before and after the procedure and assessed their degree of pain and distress after the procedure by the visual analog scale (0-10). Systolic and diastolic blood pressure and pulse rate were also checked before and after the procedure. RESULTS: Demographic characteristics, mean age, procedure duration, pre and post-procedural systolic, and diastolic blood pressures, and pulse rate were statistically similar between the experimental and control groups. The mean State-Trait Anxiety Inventory was significantly lower in the experimental group than in the control group (30.9 ± 7.5 vs 42.5 ± 10.1, P < 0.001). The experimental group showed significantly lower pain and distress scores (Visual Analog Scale, 2.7 ± 1.5, 3.0 ± 1.5) compared with the control group (4.0 ± 1.6, 4.7 ± 2.0, both P < 0.001). CONCLUSIONS: Using a heating pad for female patients with stress urinary incontinence during a urodynamic study is a simple, economical, and effective therapy that enhances patient comfort and decreases anxiety, pain, and distress.

Best practice policy statement on urodynamic antibiotic prophylaxis in the non-index patient.

AIMS: Antibiotic prophylaxis before urodynamic testing (UDS) is widely utilized to prevent urinary tract infection (UTI) with only limited guidance. The Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) convened a Best Practice Policy Panel to formulate recommendations on the urodynamic antibiotic prophylaxis in the non-index patient. METHODS: Recommendations are based on a literature review and the Panel's expert opinion, with all recommendations graded using the Oxford grading system. RESULTS: All patients should be screened for symptoms of UTI and undergo dipstick urinalysis. If the clinician suspects a UTI, the UDS should be postponed until it has been treated. The first choice for prophylaxis is a single oral dose of trimethoprim-sulfamethoxazole before UDS, with alternative antibiotics chosen in case of allergy or intolerance. Individuals who do NOT require routine antibiotic prophylaxis include those without known relevant genitourinary anomalies, diabetics, those with prior genitourinary surgery, a history of recurrent UTI, post-menopausal women, recently hospitalized patients, patients with cardiac valvular disease, nutritional deficiencies or obesity. Identified risk factors that increase the potential for UTI following UDS and for which the panel recommends peri-procedure antibiotics include: known relevant neurogenic lower urinary tract dysfunction, elevated PVR, asymptomatic bacteriuria, immunosuppression, age over 70, and patients with any indwelling catheter, external urinary collection device, or performing intermittent catheterization. Patients with orthopedic implants have a separate risk stratification. CONCLUSIONS: These recommendations can assist urodynamic providers in the appropriate use of antibiotics for UDS testing. Clinical judgment of the provider must always be considered.

Iatrogenic urological triggers of autonomic dysreflexia: a systematic review.

STUDY DESIGN: This is a systematic review. OBJECTIVE: The objective of this study was to review the literature on iatrogenic urological triggers of autonomic dysreflexia (AD). SETTING: This study was conducted in an international setting. METHODS: A systematic review was conducted from PubMed search using AD/ autonomic hyperreflexia and spinal cord injury (SCI). Studies selected for review involved iatrogenic urological triggers of AD in individuals with SCI, including original articles, previous practice guidelines, case reports and literature reviews. Studies that did not report AD or blood pressure (BP) assessments during urological procedures were excluded. RESULTS: Forty studies were included for analysis and categorized into four groups: (1) urodynamics and cystometry; (2) cystoscopy and transurethral litholapaxy; (3) extracorporeal shock-wave lithotripsy (ESWL); and (4) other procedures. During urodynamics, the incidence of AD ranged from 36.7% to 77.8%. The symptomatic rate ranged from 50% to 65%, with AD symptoms seen predominantly in cervical SCI patients. The studies imply no consensus regarding the relationship between AD, neurogenic detrusor overactivity and detrusor sphincter dyssynergia. Without anesthesia, the majority of individuals develop AD during cystoscopy, transurethral litholapaxy and ESWL. The effectiveness of different anesthesia methods relies on blocking the nociceptive signals from the lower urinary tract (LUT) below the level of the neurological lesion. Other iatrogenic urological triggers were commonly associated with bladder filling. CONCLUSION: The LUT triggers of episodes of AD are often associated with iatrogenic urological procedures. AD was more prevalent in cervical SCI than in thoracic SCI. To detect this potential life-threatening complication following cervical and high thoracic SCI, routine BP monitoring during urological procedures is highly recommended.

[Dynamic infusion cavernosometry and cavernosography for the diagnosis and classification of venous erectile dysfunction].

OBJECTIVE: To explore the procedures of dynamic infusion cavernosometry and cavernosography (DICC) and their application in the diagnosis and classification of venous erectile dysfunction (VED). METHODS: This study included 103 ED patients, aged 20 to 43 years, highly suspected of VED, with disease courses of 4 months to 6 years. DICC was performed and analyses were made on the results, especially the parameters of flow-to-maintain (FTM) and pressure decay (PD) in the corpus cavernosum. RESULTS: Based on the parameters of FTM and PD, 21 of the patients were normal, 5 were suspected of VED, 39 had mild VED, 25 had moderate VED, and 13 had severe VED. Penile subcutaneous hematoma was found in 4 of the patients, all recovered after 3 to 5 days, with no other complications. CONCLUSION: DICC is a reliable, safe and minimally invasive method for the diagnosis and classification of VED.

Pain and embarrassment associated with urodynamic testing in women.

INTRODUCTION: Multichannel urodynamics is a series of interactive tests used to evaluate lower urinary tract dysfunction. We sought to describe symptoms and satisfaction in a cohort of women undergoing these procedures. METHODS: Females undergoing urodynamics completed questionnaires immediately (Q1) and 1 week (Q2) after their testing. Surveys utilized visual analog scales (VAS) from 0 to 10 to assess pain, embarrassment, anxiety, and satisfaction. Q2 also inquired about urinary symptoms in the days following the procedure. RESULTS: 100 women were analyzed. Regarding symptoms on the day of testing, VAS scores indicated low bother; with a median of 1.5/10 for pain, 0.4/10 for embarrassment, and 1.8/10 for anxiety. One week following, recall of pain (p = 0.169), and embarrassment (p = 0.722) were similar. Further analyses suggested that overactive bladder syndrome (OAB) might be associated with greater pain during and after the procedure (p = 0.04, p = 0.038 respectively), while depression was associated with greater embarrassment at those times (p = 0.018, p = 0.027 respectively). Painful bladder syndrome (PBS) was associated with a higher recall of pain (p = 0.018), and anxiety with more embarrassment (p = 0.033) on the second survey. Finally, younger age correlated with higher pain on both questionnaires (Q1: τ = - 0.148, p = 0.029; Q2: τ = - 0.171, p = 0.014). Following urodynamics, urgency was most common (43%), generally resolving within 1 day. Reassuringly, 86% would repeat urodynamics if necessary, and overall satisfaction was rated ≥9/10 at both time points. CONCLUSION: Urodynamic testing is well-tolerated in women. Nevertheless, younger age, anxiety or depression, and a diagnosis of OAB and PBS may lead to more negative experiences. Such information may be useful in counseling future patients.

Children and adolescents with ureteropelvic junction obstruction: is an additional voiding cystourethrogram necessary? Results of a multicenter study.

PURPOSE: The incidence of ureteropelvic junction obstruction (UPJO) and concomitant vesicoureteral reflux (VUR) ranges from 14 to 18 %. Therefore, different guidelines recommend a voiding cystourethrogram (VCUG) to identify cases of VUR early in the diagnostic process. Aim of this multicenter study was to reassess the incidence of concomitant VUR and the need for additional VCUG in a large cohort of patients with UPJO. Furthermore, we asked for clinical objectives that defined the need for VCUG with the intention of minimizing radiation exposure and the need for invasive diagnostic procedures. METHODS: Medical records for 266 patients (69 girls, 197 boys) with UPJO were analyzed retrospectively. Data were obtained on gender, clinical symptoms, results of pre- and postnatal ultrasound, VCUG and 99(m)Technetium-MAG3 (MAG3) scan. They were correlated with the incidence of concomitant VUR. RESULTS: One hundred and seventy-eight patients (67 %) underwent VCUG. Concomitant VUR was detected in 13 patients. Dilating VUR (dVUR) was observed in 11 patients. In our study, the overall incidence of a concomitant VUR was 7.3 %. In cases of proven VUR, we observed a positive predictive value for female gender, ureteral dilatation, renal insufficiency, and recurrent urinary tract infections (UTI). But there was no correlation between concomitant VUR and the severity of hydronephrosis. CONCLUSIONS: Our data suggest that the low incidence of concomitant VUR in cases of UPJO does not justify the routine use of VCUG as a routine diagnostic tool. Especially, ureteral dilatation and recurrent UTI have a positive predictive value for concomitant VUR.

Bacteriuria and safety of female urodynamic studies.

INTRODUCTION AND HYPOTHESIS: Our aim was to study the incidence of bacteriuria after urodynamic studies (UDS) and prevalence of asymptomatic bacteriuria before UDS. METHODS: In this prospective study between March and September 2011, 140 women undergoing UDS were subjected to urine culture before the investigation. Urine was collected aseptically with a sterile catheter transurethrally. Multichannel UDS were performed 3-5 days after urine collection. Prophylactic antibiotics were not administered to these women. A second urine sample was collected within 5-7 days after UDS. Significant bacteriuria was defined as 10(2) colony-forming units (cfu)/ml or more of a single organism cultured. RESULTS: Thirty (21.4 %) women had asymptomatic bacteriuria before UDS and were excluded from the main study group. Among the 110 women in the study group, 4 (3.6 %) acquired infection after UDS. Three grew organisms found in the vagina (group B Streptococcus and yeast-like organism) and one grew Proteus mirabilis. Age 60 years and above is a significant risk factor. In contrast to the study group, among 30 women who had infection before UDS, Escherichia coli was the commonest pathogen in 19 (63.3 %) and 30 % had diabetes. Eleven (36.7 %) had persistent infection after UDS and the rest resolved spontaneously. In addition, no other related complication was observed on the UDS. CONCLUSIONS: This study shows that risk of post UDS bacteriuria is low in women and screening for vaginal infections may be necessary before UDS. Women over 60 years old are significantly at risk of infection. Bacteriuria is nevertheless mostly asymptomatic and transient in nature.

Diagnostic accuracy of visual urethral mobility exam versus Q-Tip test: a randomized crossover trial.

OBJECTIVE: The objective of the study was to compare the diagnostic accuracy of a visual urethral mobility examination (VUME) with a Q-Tip test in the assessment of urethral hypermobility. STUDY DESIGN: Subjects were randomized to a VUME or Q-Tip test first, followed by the alternate assessment. Outcomes included hypermobile, not hypermobile, or indeterminate. Hypermobility was defined as 30° or greater from the horizontal. Pain perception and test preference were assessed. RESULTS: For the 54 subjects, 61.1% demonstrated hypermobility on VUME vs 72.2% on the Q-Tip test (P = .39). Assessment of hypermobility was correlated between the 2 tools (ρ = 0.47, P = .001). Positive and negative predictive value, sensitivity, and specificity for VUME were 88%, 56%, 78%, and 71%, respectively, with a Q-Tip test as the reference standard. Mean pain score on visual analog scale was 0.72 for VUME and 3.15 for Q-tip test (P < .001). VUME was preferred by 83% of subjects. CONCLUSION: VUME is a diagnostic alternative to the Q-Tip test for the assessment of urethral hypermobility and is preferred by subjects.

Urethral prolapse formation after urodynamic testing: a case report.

Urodynamic testing is a widely used modality for evaluation of lower urinary tract symptoms with minimal morbidity to the patient. We report a case of strangulated urethral prolapse in a 74-year-old female that occurred right after urodynamic evaluation. The urethral prolapse was managed conservatively and the patient fully recovered without the need for surgical intervention.

A randomised controlled trial to assess pain with urethral swabs.

BACKGROUND: Urethral swabs are uncomfortable due to the nature of the mucosa and may be a reason for non-attendance of men at sexually transmitted infection (STI) clinics. This randomised controlled trial describes the extent of discomfort associated with direct urethral sampling, and determines whether this varies by the type of swab used. METHODS: Male patients over the age of 16 years having swab tests were invited to participate and were randomly assigned to receive either a gonorrhoea dacron-tipped swab, a chlamydia rayon-tipped swab or a plastic 10 µl urethral loop first for urethral sampling followed by the others sequentially. Discomfort was measured using a 0-100 mm visual analogue scale (VAS). FINDINGS: 129 men having urethral swabs carried out as part of their screening tests for STI were invited to participate in the study and 121 were recruited. The median pain scores (IQR) regardless of sampling method, before and after the urethral sampling were, first 0 mm (0-0) and 50 mm (22-71) (p<0.001), second 9 mm (0-28) and 59.5 mm (38.3-78) (p<0.001) and third 10 mm (0-31) and 58 mm (29.3-80) (p<0.001). Direct urethral sampling was associated with a median pain score of 60.5 mm using a rayon swab, 52 mm using a dacron swab and 25.5 mm using a plastic loop. INTERPRETATION: Direct urethral sampling is associated with discomfort and/or pain in men, which was significantly greater with a swab than a plastic loop. Urine should therefore be the specimen type of choice. When direct urethral sampling is indicated a loop is preferable to a urethral swab.

New noninvasive methods to diagnose vesicoureteral reflux.

PURPOSE OF REVIEW: The undesirable nature of bladder imaging in children for vesicoureteral reflux detection makes the search for noninvasive bladder imaging methods and devices an urgent concern. RECENT FINDINGS: Ultrasound imaging of the bladder aided by contrast agents can be performed without ionizing radiation. However, urethral catheterization and contrast instillation is still necessary. The accuracy and reliability are still significant problems with this method. A new method of 'hiding' gadolinium in lysosomes followed by external energy application to rupture the lysosomes releasing the gadolinium for MRI holds future hope, but this research is in its infancy. A novel method to apply external microwave energy to warm the bladder urine with microwave kidney temperature monitoring is being developed. Temperature changes noted in the kidney after bladder warming would indicate vesicoureteral reflux. Further studies are ongoing. SUMMARY: Ultrasonography imaging of the bladder to find vesicoureteral reflux has yet to be refined enough to be accurate and reliable for clinical use. MRI studies are in their infancy but may hold future benefit. Noninvasive bladder heating and kidney temperature monitoring is showing promise in animal studies to be a completely noninvasive reflux detection device.

Noninvasive electrical impedance analysis to measure human urinary bladder volume.

AIM: To assess urinary bladder volume in a noninvasive manner using a portable and modified device that measures electrical impedance. METHODS: A novel method was attempted to measure electrical impedance and indirect bladder volume, and these data were used to calculate the actual bladder volume. RESULTS: An increase of 0.01 V in the abdominal voltage was observed with every 50 mL increase in the amount of physiological saline infused into the bladder. CONCLUSIONS: It is a simple procedure and can be used by technical staff or the patients themselves to obtain continuous, real-time urinary bladder volume data.

Periurethral Lidocaine Does Not Decrease Pain After Urodynamic Testing in Women: A Double-Blinded Randomized Control Trial.

OBJECTIVE: Urodynamic testing of women is a common procedure to evaluate lower urinary tract symptoms but may cause discomfort. The objective of our study was to determine the effect of externally applied periurethral 2% lidocaine gel on pain scores after complex urodynamic testing in women. METHODS: This prospective, double-blinded, placebo-controlled randomized trial compared 2% lidocaine gel to water-based lubricant applied to the periurethral area before urodynamic testing in women. Discomfort was measured using a visual analog pain scale (VAS) ranging from 0 to 100. The primary outcome was the difference in VAS from baseline to 4 to 6 hours after urodynamic testing. Secondary outcomes included: VAS difference from baseline to immediately postprocedure and 24 hours after urodynamic testing; VAS scores: at baseline, immediately postprocedure, after 4-6 hours, and after 24 hours; urodynamic testing results; and any adverse events. Sixty-four women per group were needed to provide a power of 80% to detect a 10-mm difference on a 100-point VAS. RESULTS: From January 2018 to March 2019, 134 subjects were randomized, 6 subjects were excluded, which resulted in 64 subjects in both the water-based lubricant group and 2% lidocaine gel group. There was no difference in baseline demographics. There was no significant difference in the change in VAS from baseline to 4 to 6 hours after UDT (0, 0 P = 0.88). No difference in secondary outcomes was noted. CONCLUSIONS: Topically applied 2% lidocaine gel does not decrease pain compared with water-based lubricant. For most women, complex urodynamic testing is not associated with any significant pain.Clinical Trial Registration:www.ClinicalTrials.gov,-NCT03390790, "Lidocaine for Pain After Urodynamic Testing".

Pediatric Urodynamic Study Without a Preprocedural Urine Culture, Is It Safe in Clinical Practice?

OBJECTIVE: To prove that incidence of UTI after a pediatric urodynamic study (UDS) is low, and that patients without urine culture (UC) analysis prior to a UDS will not have a significant increase in the incidence of UTI (post-UDS UTI). METHODS: Prospective cohort study including consecutive pediatric patients undergoing UDS in a single center for 1 year. Patients were divided in 2 groups: (G1) UDS with a previous negative UC and (G2) UDS without a previous UC analysis. A clean UC was obtained in all patients at the moment of the UDS (UDS-UC). Primary outcome was post-UDS UTI. Secondary outcome was to compare UC cost per patient and cancellation rates in each group. All patients were followed 15 days after the UDS to detect onset of UTI symptoms. RESULTS: Four hundred two patients were included, 198 patients in G1 and 204 patients in G2. Median age was 9 years old. Both groups were similar in terms of demographic and clinical records data except for a proportion of patients on CIC which was larger in G2 (P <.008). Overall incidence of post-UDS UTI was 0.7% (3/402), G2 incidence (0.98%) being slightly higher than G1 (0.50%; P <.58). UDS-UC was positive in 32% of G1 vs 55% in G2 (P <.001). About 98% of patients with positive UDS-UC did not progress to symptomatic UTI. G1 cost was 140% higher than G2. CONCLUSION: Overall incidence of post-UDS UTI is low (0.7%). Patients without UC prior to UDS did not have a significant increase in post-UDS UTI.

Antibiotic prophylaxis after total joint replacements.

OBJECTIVES: To review the latest evidence on antibiotic prophylaxis for patients with total joint replacements to prevent prosthesis infections. DATA SOURCES: Literature search of Medline and PubMed until June 2009. STUDY SELECTION: Studies of patients with total joint replacements from around the world, studies concerning antibiotic prophylaxis, as well as chemoprophylaxis guidelines from orthopaedic associations were searched. DATA EXTRACTION: Literature review, original articles, case reports, best practice guidelines. DATA SYNTHESIS: With the rising incidence of patients with total joint replacements, subsequent deep infection of the implants is a rare but dreaded complication which has immense physiological, psychological, financial, and social implications. Guidelines from urologists, gastroenterologists, and dental surgeons attempt to identify high-risk patients who may be more susceptible to prosthetic joint infections. These patients are provided with prophylactic antibiotics before any invasive procedure that may cause bacterial seeding to prosthetic joints. Most orthopaedic associations around the world adopt a similar policy to provide prophylaxis to cover any anticipated chance of bacteraemia. The American Association of Orthopaedic Surgeons adopts the most cautious approach in which all patients with total joint replacements who undergo any procedure that breaches a mucosal surface receive prophylactic antibiotics. CONCLUSION: The guidelines from the American Association of Orthopaedic Surgeons seem to have an all-encompassing policy when it comes to providing prophylactic antibiotics. Nonetheless, physicians must still exercise their judgement and customise the treatment to each patient. The benefits of prophylactic antibiotics must be balanced against the risks of drug side-effects and the emergence of antibiotic resistance.

Female urinary incontinence - urodynamics: yes or no?

The National Institute for Clinical Excellence (NICE) recommends that cystometry need not be performed prior to conservative therapy for incontinence in women, nor is cystometry routinely recommended in the small group of women with a clearly defined diagnosis of pure stress incontinence. This review highlights the arguments for and against this recommendation and also looks at the place of cystometry and pressure flow studies in the assessment and management of women with lower urinary tract dysfunction.

Effectiveness of D-mannose, Hibiscus sabdariffa and Lactobacillus plantarum therapy in prevention of infectious events following urodynamic study.

INTRODUCTION AND AIM: The urodynamic study is an invasive examination that allows a thorough evaluation of the functional activity of the lower urinary tract (bladder, urethra). The execution of urodynamic study exposes the patient to the risk of contracting infections of the lower urinary tract. Prevention of urinary tract infections consists in the avoidance of risk factors and prophylaxis with antimicrobial and non-antimicrobial measures. In this article, we aimed to evaluate the effectiveness of a phytotherapeutic product composed of D-mannose, Hibiscus sabdariffa, and Lactobacillus plantarum in the prevention of infectious events following invasive urodynamic examination. MATERIALS AND METHODS: We selected 100 female consecutive patients (age 19-87 years) that underwent urodynamic invasive procedure. We prescribed 14-day therapy with D-mannose, H. sabdariffa, and L. plantarum to these 100 patients after urodynamic invasive test. After that, we have examined urine cultures and urinary symptoms through telephone interviews and hospital outpatient visits to evaluate the possible presence of urinary tract infections. RESULTS: Urinary tract infections were observed through urine culture in 13% of the selected patients; of the 13 urinary tract infections, 9 were observed in patients with urinary tract recurrent infections in the last year and the other 4 cases were associated with patients with no urinary infection in the last year. Three women reported some urinary symptoms and underwent antibiotic therapy. The other 10 cases were classified as asymptomatic bacteriuria. Three cases were related to patients presenting with pelvic organ prolapse. Eight cases were instead related to significant post-voiding residue (>100). Six patients with urinary tract infection reported constipation in the last year. All patients completed the prescribed therapy due to the affordable price of the product and no side effects have been reported. CONCLUSION: Our study about the administration of D-mannose, H. sabdariffa, and L. plantarum after invasive urodynamic examination underlined how this phytotherapeutic product can reduce the risk of bacteriuria and urinary tract infection in women.