Maimonides Evening of Research
Resident Winner
Arshia Sandozi, DO, MPH
Division: Urology | Department: Surgery
PIVoT: Prevention Of Recurrent Urinary Tract Infection Using Vaginal Testosterone Versus Placebo Cream
Objectives
Vaginal testosterone (VT) cream has been shown to improve signs and symptoms of genitourinary syndrome of menopause in postmenopausal women. The effects of VT on prevention of bacteriuria and recurrent urinary tract infections (rUTIs) are unknown. The objective of this study was to assess whether VT is more effective than placebo in reducing the incidence of symptomatic urinary tract infections.
Methods
This randomized, double blind study enrolled postmenopausal women with rUTIs who were unwilling to use vaginal estrogen. A total of 35 patients for each treatment group were necessary to detect a difference in UTI-free survival of 35%. Patients were randomized to VT or placebo. Urine cultures were collected at the initial, four-month, and nine-month visits and in case of symptoms.
Results
A total of 52 patients have been enrolled. Analysis excluded 20 patients due to loss to follow-up or discontinued use of study cream. There was no difference between those who completed the study and those who were not included in the analysis. The VT group had 18 positive urine cultures, (66.67% symptomatic, 33.33% asymptomatic). The placebo group had 12 positive urine cultures (75% symptomatic, 25% asymptomatic). While there was no statistically significant difference between the two groups, the VT group had proportionally fewer symptomatic UTIs and more asymptomatic bacteriuria compared to placebo.
Conclusion And Implication
Although there was no statistically significant difference in bacteriuria between groups, the VT group had proportionally fewer symptomatic urinary tract infections. This suggests VT may be clinically useful for prevention of rUTI in patients unwilling to use vaginal estrogen. Increased patient enrollment and longer follow-up will further our understanding of the role of VT in preventing symptomatic UTI.