{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T23:06:12Z","timestamp":1790895972530,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To undertake a systematic review and meta\u2010analysis to evaluate the efficacy, safety, and clinical applicability of intravesical instillations for preventing recurrent urinary tract infections (rUTIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed\/MEDLINE, Embase, Cochrane CENTRAL, Scopus, and Web of Science were searched from January 2000 to April 2025 for randomised and observational studies of intravesical instillations in rUTI treatment. The primary outcome was UTI recurrence, expressed as incidence rate ratio (IRR) or risk ratio (RR). Random\u2010effects meta\u2010analyses were performed for three intervention families: aminoglycosides, hyaluronic acid (HA) monotherapy, and HA with chondroitin sulphate (HA\u2009+\u2009CS) combined therapy. Subgroup analyses examined population type and antibiotic used; sensitivity analyses included leave\u2010one\u2010out re\u2010estimation. Other agents were narratively synthesised.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Total of 25 studies were included. Aminoglycoside instillations produced a marked reduction in recurrence (pooled IRR 0.23, 95% confidence interval [CI] 0.15\u20130.37;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), with consistent benefit across neurogenic and non\u2010neurogenic populations and across gentamicin and amikacin. HA monotherapy was also effective (pooled RR 0.15, 95% CI 0.05\u20130.43;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.011), although heterogeneity was high. HA\u2009+\u2009CS combined therapy showed favourable results in individual studies but an imprecise pooled effect (RR 0.41, 95% CI 0.04\u20134.77;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.465). Narrative evidence for heparin, povidone\u2010iodine and fosfomycin suggested potential benefit, but methods and outcome definitions were inconsistent. Serum aminoglycoside levels were undetectable where measured, and adverse events were mild and infrequent.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Intravesical instillations appear safe and effective for preventing rUTIs in select patients. The strongest evidence supports aminoglycosides while HA offers a non\u2010antibiotic alternative. HA\u2009+\u2009CS requires further study. Larger, high\u2010quality randomised trials with standardised outcomes are needed to optimise protocols and patient selection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70252","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T07:05:17Z","timestamp":1773990317000},"page":"33-44","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Intravesical therapy for recurrent urinary tract infection: a systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"138","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8798-8802","authenticated-orcid":false,"given":"Matthew","family":"Kwon","sequence":"first","affiliation":[{"name":"Department of Urology John Hunter Hospital  New Lambton Heights New South Wales Australia"},{"name":"Faculty of Medicine and Health The University of Sydney  Camperdown New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asaad","family":"Ahmad","sequence":"additional","affiliation":[{"name":"University of Newcastle  Callaghan New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Lott","sequence":"additional","affiliation":[{"name":"Department of Surgical Research John Hunter Hospital  New Lambton Heights New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Blatt","sequence":"additional","affiliation":[{"name":"Department of Urology John Hunter Hospital  New Lambton Heights New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"European Association of Urology.EAU guidelines on urological infections.2024. 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NIHR158130. Available at:https:\/\/fundingawards.nihr.ac.uk\/award\/NIHR158130. 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