Intravesical Therapies for Recurrent Urinary Tract Infections: A Systematic Review

Recurrent urinary tract infections (rUTIs) present a significant clinical challenge, particularly due to the associated overuse of antibiotics and the rise in antimicrobial resistance. This systematic review evaluates the current literature on the use of intravesical therapies as an alternative treatment for rUTIs. Two established primary therapies are reviewed: glycosaminoglycan (GAG) instillations and intravesical antibiotic instillations. Both therapies offer localised treatment, reducing systemic antibiotic exposure and targeting infection sites more directly. A literature search was conducted using PubMed and Cochrane Controlled Register of Trials (CENTRAL), yielding 5,963 relevant articles, of which seven studies met the inclusion criteria. The review indicates that both GAG and antibiotic instillations significantly reduce UTI recurrence rates and improve symptoms such as pain and urinary urgency. However, significant variations in treatment schedules and dosages exist, and no direct comparative studies between GAG instillations and intravesical antibiotics were found. Moreover, intravesical antibiotics show great potential in minimising antimicrobial resistance, though further large-scale studies are needed to confirm these findings. While intravesical therapies are generally well-tolerated, GAG instillations can cause mild irritation. Further research is required to optimise therapy regimens and to perform cost-benefit analyses, particularly considering the high costs of these therapies compared to traditional antibiotic prophylaxis. Randomised controlled trials comparing different intravesical treatments are crucial to inform future clinical practice.