Abstract
Lower urinary tract dysfunction (LUTD) is becoming more common in aging societies
worldwide. In patients with LUTD, the risk of urinary tract infection (UTI) rises
due to several distinct mechanisms, including easy bacterial access to the urinary
tract, impaired bacterial washout, and an impaired innate defense system. The pathophysiology
of LUTD varies depending on whether it is neurogenic or non-neurogenic, as well as
by gender; therefore, the etiology and characteristics of UTI differ according to
the type of LUTD. Patients with neurogenic LUTD, especially those with spinal cord
injury, have a high risk of febrile UTI, and strict bladder management is required
to prevent UTI. Clean intermittent catheterization with or without appropriate pharmacological
therapy is also strongly recommended for patients with neurogenic LUTD at risk of
febrile UTI, unable to void, or with high post-void residual volume. In contrast,
both male and female patients with non-neurogenic LUTD have a lower risk of symptomatic
UTI. There is insufficient evidence for non-neurogenic LUTD regarding the association
between symptomatic UTI but not asymptomatic bacteriuria and LUTD severity, including
the presence of post-void residual volume, or whether therapeutic intervention for
LUTS reduces the incidence of UTI, particularly in male patients. In this narrative
review, we aimed to highlight the pathogenesis, epidemiology, and management of UTI
in patients with LUTD.
Keywords
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Article info
Publication history
Published online: May 05, 2023
Accepted:
April 30,
2023
Received in revised form:
April 18,
2023
Received:
March 21,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
