Transposition of Distal Urethra in Female Patients with Recurrent Lower UTI Associated with Sexual Intercourse

The treatment of recurrent lower urinary tract infections in young female patients remains controversial (Naber, 2000; Stamatiou, 2005; Wagenlehner, 2009). Recurrent lower UTI is often associated with sexual intercourse. The association of UTI with sexual intercourse poses both medical and psychological problems for these patients (Stamatiou, 2005). Usually these patients are young females. Repeated courses of antibiotic therapy and postcoital antibiotics prophylactic help some, but not all patients. Conventional antimicrobial therapy has limited success and often has to be repeated (Naber, 2000). A remarkable increase of antibiotic resistance is also noted in uncomplicated UTI (Wagenlehner, 2009). “Intravaginal urethral displacement” during sexual intercourse appears to play a role in both the development of these symptoms and the recurrence of UTI symptoms by contamination of microbial agents in the distal urethra (Stamatiou, 2005), which may often lead to cystitis. The repositioning of the distal part of the urethra may potentially minimize microbial contamination in this area. The operation makes it possible to withdraw the meatus from the area concerned. Careful mobilization of the distal part of the urethra with modern technology and fine absorbable suture materials provides minimal invasion and may be considered an option for patients with recurrent UTI associated with sexual intercourse. In this chapter we shall present detailed surgical techniques and long-term results of distal urethral transposition in female patients with recurrent UTI associated with sexual intercourse.