Relación entre la infección urinaria de repetición y la fertilidad femenina

Abstract

ABSTRACT: Relationship between Urinary Tract Infection and female fertility. INTRODUCTION: The Urinary Tract Infections (UTI) are a group of pathologies affecting the different parts of the urinary system. UTI is the second most frequent cause of infection after respiratory infection. In women, the risk of suffering UTI is over 50% during their life and about 20% will suffer a Urinary Tract Recurrent Infection (UTRI). The clinical profile of UTI during pregnancy is subdivided into three main categories: Asymptomatic Bacteriuria (2-11%), Cystitis (1.5%) and Acute Pyelonephritis (AP) (1-2%). The physiological changes involving the urinary tract during pregnancy, facilitate the development of UTI and increase its recurrence and persistence. There is a lot of information about gravidic modifications in the adaptation of the cardiovascular, pulmonary, metabolic and genital systems. It is of interest to know the changes that occur in the soft, muscular or nervous tissues of the pelvic floor related to gestation. Pregnancy and delivery are two stages in a fertile woman’s life which have a negative influence in the static and functionality of the pelvic floor. Despite the investigation of the UTRI causes related to the estrogenic state and the pelvic floor function, the relationship between the obstetric history and the occurrence of the UTRI is not known. HYPOTHESIS: There could be a relationship between the UTRI and the obstetric events and female fertility. OBJECTIVES: 1) Know the epidemiology of the obstetric history in women with UTRI. 2) Determine the relationship between the obstetric events and the presence of UTRI. Secondary aim: to evaluate the relationship between the distribution of most frequent secondary diagnoses and the presence of UTRI. MATERIAL AND METHODS: A retrospective multicentric study reviewing the clinical history of 714 patients was carried out: Case group A (n=588): patients studied and treated by UTRI and Group B - control group (n=126): patients treated, by nephrectomy, for kidney cancer. The results were analyzed with descriptive statistics, student’s t test, chi2 test, Fisher’s exact test, ANOVA analysis of variance (Scheffe’s test for normal sample and Kruskal Wallis for other distributions), Pearson and Spearman correlation studies. A significance level of p-value < 0.05 was accepted. The data was analyzed by the static software NCSS277/GESS2007. RESULTS: The control group (women without UTRI) presented: Arterial Hypertension in all the obstetrics history studied, most of the groups presented more dyslipemia and obesity. When there is hysterectomy with adnexectomy Diabetes mellitus (DM) is more frequent in the control group. In the case group (women with UTRI): patients have less secondary diagnoses, they are generally healthy women. Regarding DM, it has greater weight in the association with UTRI in nulliparous women, while it has no weight in women with obstetric history. Therefore, the DM is an important factor in the nulliparity while the obstetric history equals its distribution. CONCLUSIONS: Among women diagnosed of UTRI we found 3.4% are nulliparous, 70.74% have a history of eutocic deliveries, 9.86% have a history of dystocic deliveries, 17.34% have undergone surgery for abortion, 17% have undergone hysterectomy without adnexectomy and 17% hysterectomy with bilateral adnexectomy. The antecedent of nulliparity is associated more to the control group, while the clinical history of eutocic delivery is associated with the case group, women with UTRI. The antecedent of dystocic birth was associated with a worse state of health compared to the other antecedents in relation to women with and without UTRI, being in this group the most frequent secondary diagnosis of pelvic floor, Urinary Incontinence (UI). The interrelation between the obstetric antecedents and the presence of DM in women with UTRI does not associate positive correlation, except in nulliparous women where the DM determines by itself the increase of UTRI. DM itself is a more powerful risk factor for UTRI than the obstetric / gynecological history. The most prevalent gynecological / obstetric history in women with UTRI is the eutocic birth associated with a good state of health. In women with a more deteriorated state of health the antecedent associated with UTRI is dystocic delivery, the concomitant UI is much more prevalent.