Intravesical acetic acid in combination with prophylactic methenamine and ascorbic acid to decrease the incidence of...

Area of Science:

• Urology
• Infectious Diseases
• Neurology

Background:

• Recurrent urinary tract infections (UTIs) pose a significant challenge for individuals requiring intermittent bladder self-catheterization.
• Multiple sclerosis (MS) can exacerbate UTI risk due to neurogenic bladder dysfunction.
• Standard prophylactic measures may not always provide complete protection against UTIs in complex cases.

Observation:

• A post-menopausal female patient with multiple sclerosis, undergoing intermittent bladder self-catheterization, experienced persistent UTIs despite oral methenamine hippurate and vitamin C prophylaxis.
• The patient, a retired radiologist, self-administered a novel regimen to augment her existing UTI prevention strategy.
• This involved the daily addition of self-administered acetic acid bladder irrigation.

Findings:

• The combined regimen of oral methenamine hippurate, vitamin C, and twice-daily acetic acid irrigation demonstrated markedly improved efficacy in preventing UTIs.
• The patient reported a significant reduction in UTI frequency and severity following the implementation of the augmented prophylactic protocol.
• This case highlights the potential synergistic effect of combining oral agents with localized bladder irrigation.

Implications:

• Acetic acid bladder irrigation may represent a valuable adjunctive therapy for UTI prophylaxis in specific patient populations, particularly those with neurogenic bladder.
• This case report suggests a potential new strategy for managing recurrent UTIs in individuals with multiple sclerosis and those using intermittent self-catheterization.
• Further research is warranted to validate these findings and establish optimal protocols for acetic acid irrigation in UTI prevention.