Vaginal Estrogen Application Techniques for Prevention of Urinary Tract Infection: A Randomized Trial.
Stephanie W Zuo, Erin E Mowers, Shea Hem et al.
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In 30 seconds
This single-center, nonblinded randomized noninferiority trial compared periurethral with intravaginal estradiol cream for preventing recurrent urinary tract infections in postmenopausal individuals. Among 114 randomized participants, the proportion who were UTI-free at 6 months was similar with periurethral and intravaginal application (50.9% vs 52.6%; risk difference, -1.75 percentage points; 95% CI, -20.0 to 17.0 percentage points). Both groups had lower vaginal pH, and vaginal itching after 3 months was more frequent with intravaginal application (24.0% vs 2.4%, P <.01).
Key findings
- At 6 months, 50.9% of the periurethral group and 52.6% of the intravaginal group were UTI-free (risk difference, -1.75 percentage points; 95% CI, -20.0 to 17.0 percentage points).
- Vaginal pH decreased in both groups, with no significant difference between application methods (-1.2 intravaginal vs -0.8 periurethral, P =.30).
- Vaginal itching after 3 months was more common with intravaginal than periurethral application (24.0% vs 2.4%, P <.01).
Why it matters
The trial compares two ways of applying vaginal estradiol for recurrent UTI prevention and reports similar six-month UTI-free proportions. The findings may be useful when discussing application options with postmenopausal patients, while the observed difference in itching provides a relevant tolerability consideration. The results concern this trial population and do not establish that either method prevents UTIs in other groups.
What to keep in mind
The trial was single-center and nonblinded. The confidence interval for the risk difference was wide, and the study assessed the primary outcome at 6 months.