Ep. 324 Recurrent UTI: Diagnostics & Management Strategies with Dr. Glenn Werneburg

What should you do differently when a UTI becomes a recurring problem? In this episode of the Backtable Podcast, host Dr. Anjali Kapur is joined by physician-scientist Dr. Glenn Werneburg to discuss the latest approaches to recurrent urinary tract infections, including key updates from the 2025 AUA, CUA, and SUFU guidelines. They use real clinical cases to explore diagnosis, prevention, antibiotic selection, and the management of complex patients. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Medtronic https://www.medtronic.com/en-us/e/patients-caregivers/urinary/overactive-bladder.html --- Timestamps 00:00 - Introduction 04:05 - Case One: Recurrent UTIs 05:19 - Workup Basics 08:50 - Non-Antibiotic Prevention 11:42 - Antibiotic Prophylaxis Options 15:16 - Case Two: Asymptomatic Bacteriuria 19:14 - Case Three: Complex Patients 19:58 - Male vs. Female UTIs 21:22 - Neurogenic Bladder Workup 22:52 - Elderly Patients and ID Consults 25:01 - Case Four: Transplant ESBL 25:23 - Machine Learning for Antibiotics 29:49 - Catheter Biofilms 31:55 - Embedded Bladder Reservoirs 35:23 - Recurrent UTI Vaccine 36:23 - Future of Recurrent UTIs 39:04 - Wrap Up --- More about this episode The doctors define recurrent UTI and outline the standard workup, including history, physical and pelvic exam, urinalysis, urine culture, and antibiotic sensitivities. They also review occasions where additional testing may be warranted. The discussion covers interpretation of urinalysis, non-antibiotic prevention options, and antibiotic prophylaxis strategies, with consideration of antibiotic resistance and microbiome disruption. They address asymptomatic bacteriuria and when treatment is indicated, along with management considerations for men, patients with neurogenic bladder or CIC, and elderly patients. Dr. Werneburg also discusses his work with machine learning tools to predict antibiotic susceptibility earlier, catheter biofilms, the concept of embedded bladder bacteria reservoirs, and his multidisciplinary complex UTI clinic. --- Resources Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025) https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app