Korean J Urol.  2011 Dec;52(12):801-808.

Urinary Tract Infection in Postmenopausal Women

• Raz R

Abstract

Urinary tract infection (UTI) is the most common bacterial infection in women in general and in postmenopausal women in particular. Two groups of elderly women with recurrent UTI should be differentiated regarding age and general status: healthy, young postmenopausal women aged 50 to 70 years who are neither institutionalized or catheterized and elderly institutionalized women with or without a catheter. Bacteriuria occurs more often in elderly functionally impaired women, but in general it is asymptomatic. However, the risk factors associated with recurrent UTI in elderly women are not widely described. In a multivariate analysis it was found that urinary incontinence, a history of UTI before menopause, and nonsecretor status were strongly associated with recurrent UTI in young postmenopausal women. Another study described the incidence and risk factors of acute cystitis among nondiabetic and diabetic postmenopausal women. Independent predictors of infection included insulin-treated patients and a lifetime history of urinary infection. Borderline associations included a history of vaginal estrogen cream use in the past month, kidney stones, and asymptomatic bacteriuria at baseline. Another important factor in postmenopausal women is the potential role that estrogen deficiency plays in the development of bacteriuria. There are at least two studies showing a beneficial effect of estrogen in the management of recurrent bacteriuria in elderly women. One of these studies showed that vaginal estrogen cream reduced vaginal pH from 5.5+/-0.7 to 3.6+/-1.0, restored lactobacillus, and decreased new episodes of UTI. Another study reported similar results using an estriol vaginal ring. However, contradictory results are found in the literature. For example, additional studies found that the use of estriol-containing vaginal pessaries was less effective than oral nitrofurantoin macrocrystals in preventing UTI in postmenopausal women. Two other studies also did not find any benefit in the reduction of UTI by oral estrogen therapy. Unfortunately, the use of estrogen in preventing UTI in postmenopausal women remains questionable. New strategies have been researched for reducing the use of antibiotics in the prevention and treatment of UTI. Two of them are probiotics and cranberry juice or capsules. Although several studies regarding probiotics and cranberry juice or capsules have reported a reduction of episodes of UTI, there is no conclusive evidence that they are useful in the prevention of UTI in postmenopausal women. As for the optimal drug, dosage, and length of treatment for UTI in the elderly, there are no studies comparing these data with the treatment for young women.

Keyword

Bacteriuria elderly women; Postmenopausal women; Urinary tract infections

MeSH Terms

Aged
Anti-Bacterial Agents
Bacterial Infections
Bacteriuria
Capsules
Catheters
Contraceptive Devices, Female
Cystitis
Estriol
Estrogens
Female
Humans
Hydrogen-Ion Concentration
Incidence
Kidney Calculi
Lactobacillus
Menopause
Multivariate Analysis
Nitrofurantoin
Pessaries
Probiotics
Risk Factors
Urinary Incontinence
Urinary Tract
Urinary Tract Infections
Vaccinium macrocarpon
Anti-Bacterial Agents
Capsules
Estriol
Estrogens
Nitrofurantoin

Figure

• 

  FIG. 1 Relationship between estrogen and the vaginal flora and pathophysiology of urinary tract infections in elderly women [17].

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