GAG Replacement vs URethral DIlAtatioN
GAG Replacement vs URethral DIlAtatioN
The aim of this randomised parallel trial is to compare the efficacy of Glycosaminoglycan
 layer replacement against cystoscopy and urethral dilatation in the treatment of recurrent
 urinary tract infection in pre-menopausal women.

 The women will be randomised to 1 of 2 arms.Arm 1 patients will receive standard treatment
 from the Urologists. This will involve rigid cystoscopy and urethral dilatation, under
 general anaesthetic.

 Arm 2 patients will receive standard treatment from the Gynaecologists.
Recurrence of a Urinary Tract Infection (UTI) is defined as infection, following complete
 resolution of a previous UTI.Recurrent UTI (rUTI) is defined as 3 or more microbiologically
 confirmed UTI within 12 months. rUTI is an economic problem for healthcare services. rUTI is
 also detrimental to the quality of life (QoL) of women who suffer the disease. 61% of women
 who suffer rUTI report symptoms of depression and an associated decrease in their reported
 QoL scores. QoL was found to improve significantly with successful treatment.

 E-coli is the most common bacteria causing UTI and 10% are thought to be antibiotic
 resistant. Consequently, new treatment strategies are required.

 The Glycosaminoglycans (GAG) layer is thought to be instrumental as a defence mechanism
 against uro-pathogens.

 GAG's are polysaccharides forming a gel like substance on the apical surface of the bladder
 wall and act as a barrier to uro-pathogens. There is now strong evidence that a reduction in
 the impermeability of the GAG layer is linked to rUTI. Urethral dilatation is an alternative
 treatment to GAG replacement in the management of rUTI. It is a treatment option more widely
 adopted by Urologists, although there is a paucity of data to support its use.

 Currently there is no standardised strategy for the management of women with rUTI. Treatments
 vary between GAG layer replacement (intravessical therapy with hyaluronic acid and
 chondroitin sulphate) or a cystoscopy and urethral dilatation. Evidence for each regime
 varies greatly and is of poor quality. This is a randomised study comparing GAG layer
 replacement with cystoscopy and urethral dilatation.
Inclusion Criteria:

 1. Female

 2. Pre-menopausal 3 - 3 episodes of cystitis in the last 12 months as defined by:

 1. 3 symptoms from dysuria, frequency, urgency, suprapubic tenderness, haematuria,
 polyuria

 2. Or less than 2 symptoms from the above list, but with cloudy urine 4 - Normal
 flow studies with bladder residual <150ml 5 - Normal renal tract on USS

 Exclusion Criteria:

 1. - Anatomical anomalies of urinary tract

 2. - Neurological condition

 3. - Diabetes mellitus

 4. - Pregnancy

 5. - Use of Immunosuppressants

 6. - Symptomatic of UTI at time of treatment