EAU Section of Infections in Urology: Update in the management of recurrent urinary tract infection

Hello, everybody.

Today, I'm going to talk about fetal therapy in the prevention and management of a current urinary tract infections.

So urological infections have always been really popular and even caused some fashion trends like the cockpeas in the time of Henry VIII to cure and probably hide local symptoms of the syphilis.

or the Vicks during the time of the Sun King to hide the alopecia caused by syphilis.

And urological infections remained really popular until Alexander Fleming discovered the penicillin beginning of last century.

More and more antibiotics were then brought to the market, however, not in the last decades.

And antibiotics seem to be an inseparable pair with resistances.

And sometimes only short after antimicrobials are on the market, first resistances develop.

And that is a growing threat.

By 2050, there will be around 10 million deaths annually due to antimicrobial resistance, which is even more than cancer death.

And in this study, E. coli is the primary bacteria and urinary tract infections are among the top 10 of localizations.

So antimicrobial stewardship becomes more and more important.

So what are measures of antimicrobial stewardship? Do we actually have a bacterial infection that needs to be treated by antibiotics? We need non-antimicrobial alternatives.

We need to minimize the focus, especially as urologists or surgeons.

We need a reduction of duration and doses of antimicrobials, de-escalation.

We need to choose the correct antibiotics.

And of course, we need to generate evidence, need guidelines.

And today, I want to focus on the non-antimicrobial alternatives.

And of course, also a bit on guidelines and generating evidence.

With this pharmaceutical industry

unlikely to deliver new antibiotics anytime soon, we are going back to our roots.

Literally back into the woods to collect herbs, just like our great-great-great-grandparents did.

But because herbal remedies are often viewed either as magic potion or as complete hocus-pocus, the EAU took on the task of separating fact from fiction and bring some evidence-based clarity into that field.

And in July 2024, a systematic review was performed on the role of nutraceuticals in managing cystitis.

995 abstracts were identified, 44 were selected for full-text review.