Watson RA. Enlisting probiotics to combat recurrent urinary tract infections in women—a military strategy for meeting the challenge. Antibiotics (Basel). 2023;12(1):167.

Special thanks to Dr Richard Watson at the Hackensack Meridian School of Medicine.

“Enlisting Probiotics to Combat Recurrent Urinary Tract Infections in Women” employs a military frame of reference–applying terms such as “battlefield,” “enemy,” “weapon,” and “target” to aid in conceptualizing a more effective attack on the problem of chronic cystitis in women.

A revolution in the understanding of recurrent urinary tract infections is upon us. What everyone has always known is no longer a certainty. Urine in the healthy bladder is not sterile. In fact, bladder health depends on the presence of a complex, dynamically interactive “repertoire” of intravesical bacteria, the urobiome. At the same time, within the bowel, a complementary repertoire, the gut microbiome, is also exercising significant influence on bladder well-being.

Antibiotic therapy provides a quick fix for the short-term treatment of acute bladder infections at the cost of a profound, long-term disruption in the homeostasis of interactions between the urobiome and the gut microbiome.

Probiotics, lactobacilli in particular, have been shown to have therapeutic activity against bacterial uropathogens. However, the activity varies significantly between probiotic species and strains. Ingesting large amounts of randomly selected probiotics orally has met with limited success. Selection of a specific lactobacillus with demonstrated activity against the infecting bacteria within the individually targeted patient, cura personalis, offers the hope of both immediate and long-term benefits for the chronically infected bladder.

Bioengineering may lead to development of “designer lactobacilli” specifically crafted for individualized patient care. Direct instillation of the selected lactobacillus strain into the targeted patient’s bladder may provide optimal treatment results with impressive immediate and long-term benefits.

While no easy task lies ahead, events seem to be bringing us to the brink of a major leap forward. Many important pieces are falling into place. We might have at hand an extraordinary opportunity to spearhead a major advance in the prevention and control of recurrent urinary tract infections in women. Probiotic intravesical organic therapy may prove pivotal to this radically new approach.

O’Connor EM, Croghan SM, Baird O, et al. A prospective multi-institutional study using a novel safety valve for the prevention of catheter balloon inflation injury of the urethra. J Urol. 2023;210(1):179-185.

Special thanks to Drs Andrew Lai and Mahmoud Mima at the University of Illinois at Chicago.

We urologists have all had a consult for urinary retention where physical examination revealed the Foley catheter to be neatly secured to the patient’s knee cap. Urethral injuries from catheter balloon inflation are often a source of great frustration for the urologist, anxiety for the nurse or other practitioner placing a catheter, and of course, significant pain and morbidity for the patient. The authors of this study aimed to evaluate the efficacy of a transurethral catheterization safety valve in preventing these types of balloon injuries. The valve is attached to the balloon-inflating syringe that avoids urethral injury by venting the syringe fluid if there is too much pressure on the balloon when it is not in the bladder. Over a 12-month period across multiple institutions with this device, there were no balloon-related injuries. In contrast, in just a 3-month period during the study when the valve was not used, 18 balloon-related injuries were reported. Clearly, this innovative device is promising and unsurprisingly was associated with significantly lower costs and improvement of patients’ quality-adjusted life years. It is only a matter of time until this device is widely adopted.

Masterson TA, Molina M, Ledesma B, et al. Platelet-rich plasma for the treatment of erectile dysfunction: a prospective, randomized, double-blind, placlinical trial. J Urol. 2023;210(1):154-161.

Special thanks to Drs Rabun Jones and Mahmoud Mima at the University of Illinois at Chicago.

Platelet-rich plasma is a restorative therapy used in sports medicine and orthopedics and is gaining popularity as a treatment for erectile dysfunction. It’s created by centrifuging a patient’s own blood and collecting the layer that contains platelets and growth factors, resulting in a concentrated sample that can be injected anywhere to promote tissue regeneration. There are clinics throughout the United States that currently offer platelet-rich plasma treatments for erectile dysfunction, although only limited data support its use. The authors of this study examined the safety and efficacy of a protocol involving intracavernosal injection of 5 mL of platelet-rich plasma compared to a sham injection of normal saline. Injections were administered twice and 1 month apart. Patients had mild to moderate erectile dysfunction as determined by scores of 11-25 on the International Index of Erectile Function. The investigators observed no clinically significant difference in either the primary outcome of International Index of Erectile Function scores or a secondary outcome of penile vascular parameters 6 months after 2 sessions of treatment. There was no difference noted in the rate or severity of adverse events, which included a hematoma and new plaque formation. This randomized, double-blind, placebo-controlled trial supported that platelet-rich plasma therapy with the studied protocol is safe but failed to demonstrate clinical efficacy. Certainly, the current protocols for platelet-rich plasma vary widely, so there might be some recipe out there that may prove useful. Until then, this particular protocol doesn’t appear to make a difference.