ACR Appropriateness Criteria® Recurrent Lower Urinary Tract Infections in Females.

Area of Science:

• Urology
• Radiology
• Infectious Diseases

Background:

• Urinary tract infections (UTIs) are highly prevalent in women, with over 50% experiencing them in their lifetime.
• Recurrent UTIs are defined as at least three episodes within 12 months post-resolution.
• Distinguishing between uncomplicated and complicated UTIs is crucial for appropriate management.

Framework:

• Uncomplicated recurrent UTIs in women typically do not necessitate routine cystoscopy or imaging.
• Recurrent complicated UTIs warrant consideration for cystoscopy and imaging.
• Imaging modalities like CT urography or MR urography are recommended for recurrent complicated lower UTIs or specific patient groups.

Implementation:

• The American College of Radiology Appropriateness Criteria provide evidence-based guidelines for imaging procedures.
• These guidelines are annually reviewed by a multidisciplinary panel, incorporating extensive literature analysis.
• Methodologies like RAND/UCLA and GRADE are used to assess the appropriateness of imaging and treatment.

Implications:

• Appropriate use of imaging can guide treatment decisions for complex UTI cases.
• Guidelines support informed clinical practice, especially when evidence is limited or equivocal.
• Expert opinion may supplement evidence in recommending imaging or treatment for challenging scenarios.