LAUSR

OBJECTIVES To review the available data related to the prevention of recurrent urinary tract infection (rUTI) in postmenopausal women with vaginal estrogen preparations and provide the urologic community with the confidence to identify and treat genitourinary syndrome of menopause (GSM). MATERIALS AND METHODS A literature search of MEDLINE and the Cochrane Central Register of Controlled Trials databases was performed to identify studies utilizing vaginal estrogen in the treatment of urological conditions related to rUTI and GSM. RESULTS In the setting of untreated GSM, the etiology of rUTIs, at least three episodes of UTIs in twelve months or at least two episodes in six months, is not fully elucidated, but estrogen deficiency is a contributing factor. The diagnosis of GSM is primarily a clinical diagnosis supported by other objective findings including: a vaginal pH >5, decreased content of superficial cells, and/or increased proportion of parabasal cells on vaginal maturation index. Local vaginal estrogen, DHEA (prasterone), and ospemifene are commonly used GSM treatments. 31 trials were identified utilizing estrogen preparations for rUTI in postmenopausal women. CONCLUSIONS Overall, multiple randomized clinical trials have successfully been completed to show the efficacy of local estrogen preparations for the treatment of rUTIs. This high yield review provides a framework for assessing GSM, prescribing recommendations for local vaginal hormone preparations, and a summary of the substantial evidence supporting the new 2019 AUA/CUA/SUFU Guidance for local vaginal estrogen use for rUTI.