{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T14:20:56Z","timestamp":1778682056190,"version":"3.51.4"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recurrent UTIs (rUTI) contribute to significant morbidity and impaired quality of life. Electrofulguration (EF) of chronic cystitis harboring deep-seated bacteria is an outpatient procedure increasingly considered in antibiotic-refractory rUTI; however, its long-term effectiveness remains understudied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>To evaluate UTI-free and rUTI-free survival following EF we conducted a retrospective cohort study of women with culture-confirmed symptomatic and antibiotic-refractory UTIs who underwent EF between 2006 and 2024. Post-EF UTI and rUTI were defined using standard guideline-based criteria. Kaplan-Meier survival analyses compared survival outcomes by age group and cystitis stage at time of cystoscopy. Multivariable Cox proportional hazards models evaluated independent associations of age and stage with each outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the follow-up period, 291 of 601 patients (48.4%) developed a post-EF UTI. Median time to first UTI was 50 months (95% CI: 40.8\u201364.8). Increasing age was associated with higher risk of post-EF UTI (aHR = 1.01 per year; 95% CI: 1.00\u20131.02; P = .013). Compared with patients with Stage 1 cystitis, patients with Stage 4 had a significantly shorter median post-EF UTI-free survival (24.5 vs 69.3 months; adjusted HR (aHR): 1.90, 95% CI: 1.33\u20132.71; P &amp;lt; .001). Post-EF rUTIs occurred in 87 patients (14.5%), with a median time of recurrence at 153 months. Older age (aHR: 1.02; 95% CI: 1.00\u20131.04; P = .019) and Stage 4 cystitis (aHR = 3.23, 95% CI: 1.78\u20135.85; P &amp;lt; .001) were independently associated with higher risk of post-EF rUTI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Electrofulguration was associated with prolonged UTI-free and rUTI-free survivals among women with antibiotic-refractory rUTI; its effectiveness influenced by cystitis stage and patient age.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag231","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T11:50:35Z","timestamp":1776858635000},"source":"Crossref","is-referenced-by-count":0,"title":["Urinary Tract Infection (UTI)-free and Recurrent UTI (rUTI)-Free Survivals Following Bladder Electrofulguration in Women With a History of Antibiotic-Refractory rUTI"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5407-658X","authenticated-orcid":false,"given":"Stephanie V","family":"Armstrong","sequence":"first","affiliation":[{"name":"Peter O\u2019Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center , Dallas, Texas ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4875-9916","authenticated-orcid":false,"given":"Amyn A","family":"Malik","sequence":"additional","affiliation":[{"name":"Peter O\u2019Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center , Dallas, Texas ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feras","family":"Alhalabi","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7612-2042","authenticated-orcid":false,"given":"Philippe","family":"Zimmern","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"2026051309495529700_ofag231-B1","doi-asserted-by":"crossref","DOI":"10.1177\/1756287219832172","article-title":"An introduction to the epidemiology and burden of urinary tract infections","volume":"11","author":"Medina","year":"2019","journal-title":"Ther Adv Urol"},{"key":"2026051309495529700_ofag231-B2","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.1093\/cid\/ciae653","article-title":"State-of-the-art review: recurrent uncomplicated urinary tract infections in women","volume":"80","author":"Advani","year":"2025","journal-title":"Clin Infect Dis"},{"key":"2026051309495529700_ofag231-B3","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1001\/jama.2014.303","article-title":"Urinary tract infections in older women: a clinical review","volume":"311","author":"Mody","year":"2014","journal-title":"JAMA"},{"key":"2026051309495529700_ofag231-B4","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofw281","article-title":"The increase in hospitalizations for urinary tract infections and the associated costs in the United States, 1998\u20132011","volume":"4","author":"Simmering","year":"2017","journal-title":"Open Forum Infect Dis"},{"key":"2026051309495529700_ofag231-B5","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1038\/nrurol.2010.190","article-title":"The epidemiology of urinary tract infection","volume":"7","author":"Foxman","year":"2010","journal-title":"Nat Rev Urol"},{"key":"2026051309495529700_ofag231-B6","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/bju.15756","article-title":"Guideline of guidelines: management of recurrent urinary tract infections in women","volume":"130","author":"Kwok","year":"2022","journal-title":"BJU Int"},{"key":"2026051309495529700_ofag231-B7","first-page":"Doc01","article-title":"Psychosocial burden of recurrent uncomplicated urinary tract infections","volume":"10","author":"Naber","year":"2022","journal-title":"GMS Infect Dis"},{"key":"2026051309495529700_ofag231-B8","doi-asserted-by":"crossref","first-page":"e103","DOI":"10.1093\/cid\/ciq257","article-title":"International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European society for microbiology and infectious diseases","volume":"52","author":"Gupta","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2026051309495529700_ofag231-B9","doi-asserted-by":"crossref","first-page":"4368","DOI":"10.1016\/j.jmb.2019.04.008","article-title":"Direct detection of tissue-resident Bacteria and chronic inflammation in the bladder wall of postmenopausal women with recurrent urinary tract infection","volume":"431","author":"De Nisco","year":"2019","journal-title":"J Mol Biol"},{"key":"2026051309495529700_ofag231-B10","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/JU.0000000000003943","article-title":"Electrofulguration for women with uncomplicated recurrent urinary tract infections and chronic cystitis. Time for Trials!","volume":"212","author":"Zimmern","year":"2024","journal-title":"J Urol"},{"key":"2026051309495529700_ofag231-B11","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.urology.2022.07.040","article-title":"Role of flexible cystoscopy in the management of postmenopausal women with recurrent urinary tract infections","volume":"169","author":"Ordonez","year":"2022","journal-title":"Urology"},{"key":"2026051309495529700_ofag231-B12","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1111\/iju.13963","article-title":"Electrofulguration in the advanced management of antibiotic-refractory recurrent urinary tract infections in women","volume":"26","author":"Crivelli","year":"2019","journal-title":"Int J Urol"},{"key":"2026051309495529700_ofag231-B13","volume-title":"Complicated urinary tract infections. StatPearls [internet]","author":"Sabih","year":"2024"},{"key":"2026051309495529700_ofag231-B14","doi-asserted-by":"crossref","DOI":"10.1177\/1756287218814382","article-title":"Risk factors and predisposing conditions for urinary tract infection","volume":"11","author":"Storme","year":"2019","journal-title":"Ther Adv Urol"},{"key":"2026051309495529700_ofag231-B15","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1007\/s00192-022-05360-w","article-title":"Electro-fulguration for extensive inflammatory bladder lesions in post-menopausal women with antibiotic-recalcitrant recurrent urinary tract infections","volume":"34","author":"Ma","year":"2022","journal-title":"Int Urogynecol J"},{"key":"2026051309495529700_ofag231-B16","first-page":"424","article-title":"Definition of recurrent urinary tract infections in women: which one to adopt?","volume":"24","author":"Malik","year":"2018","journal-title":"Urogynecology"},{"key":"2026051309495529700_ofag231-B17","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1080\/13697137.2018.1551871","article-title":"The etiology and management of recurrent urinary tract infections in postmenopausal women","volume":"22","author":"Jung","year":"2019","journal-title":"Climacteric"},{"key":"2026051309495529700_ofag231-B18","doi-asserted-by":"crossref","first-page":"f3140","DOI":"10.1136\/bmj.f3140","article-title":"Diagnosis and management of recurrent urinary tract infections in non-pregnant women","volume":"346","author":"Gupta","year":"2013","journal-title":"BMJ"},{"key":"2026051309495529700_ofag231-B19","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1097\/JU.0000000000003612","article-title":"Very long-term outcomes after electrofulguration for anitbiotic-refractory recurrent urinary tract infections in a predominantly menopausal cohort of women","volume":"210","author":"Gaitonde","year":"2023","journal-title":"J Urol"},{"key":"2026051309495529700_ofag231-B20","doi-asserted-by":"crossref","DOI":"10.1002\/nau.70200","article-title":"Is there adequate evidence for intracellular bacteria being a significant cause of rUTIs and thereby justifying targeted treatments such as bladder fulguration or intravesical therapies? ICI-RS 2025","author":"Harding","year":"2025","journal-title":"Neurourol Urodyn"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/5\/ofag231\/68251893\/ofag231.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/5\/ofag231\/68251893\/ofag231.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T13:50:06Z","timestamp":1778680206000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofag231\/8673226"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":20,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,4,28]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofag231","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,4,28]]},"article-number":"ofag231"}}