Intravesical Treatment for Recurrent UTI

Intravesical Treatment for Recurrent UTI

What is Recurrent Urinary Tract Infection (UTI)?

A urinary tract infection is an infection in any part of your urinary system: kidneys, ureters, bladder and urethra.

When left untreated for too long, UTIs can develop into life-threatening conditions such as pyelonephritis and sepsis. Of course, some UTIs known as “uncomplicated UTI” can go away on their own. 

Conversely, UTIs can also be classified as “complicated”, or “uncomplicated”. You have a “complicated UTI” if:

  • UTI is recurrent.
  • You are a male and have UTI.
  • UTI occurs with the structural or functional abnormality of the genitourinary tract or an underlying disease.
  • Your UTI leads to more serious outcomes compared to UTI patients without any identified risk factors.
  • Antibiotic courses are less effective.

“Complicated” UTIs are also commonly found in older people, young children, sexually active people and diabetic patients.

Recurrent UTIs refer to urinary tract infections that occur twice or more within six months or thrice or more in a year.

Can Recurrent UTI be cured?

If the recurrent UTI is a result of an underlying condition, there is a chance of cure. Treatment also depends on the type of bacteria causing the infection. There are also a variety of treatment options available to effectively manage and reduce the frequency of recurrent UTI.

How is Recurrent UTI typically treated?

Treatment of a recurrent UTI includes taking a longer course of antibiotics compared to a normal UTI. The course of antibiotics prescribed depends on the underlying condition and the type and source of bacteria causing the infection. Drugs commonly recommended for uncomplicated recurrent UTIs include: 

  • Trimethoprim/sulfamethoxazole (Bactrim, Septra, others)
  • Fosfomycin (Monurol)
  • Nitrofurantoin (Macrodantin, Macrobid)
  • Ciprofloxacin (Ciprobay), levofloxacin (Cravit), ofloxacin (Floxin)
  • Ceftriaxone (Rocephin)
  • Amoxicillin/Clavulanic acid (Augmentin)

The antibiotics can be taken as pills or intravenously, where liquified antibiotics are directly injected into your bloodstream. 

However, if antibiotics do not work, other forms of treatment, such as intravesical treatment, can help as well.

Intravesical treatment

Prescription medication (e.g. hyaluronic acid) is filled into the bladder with a catheter (urine tube) and held for around 15-30 minutes before it is emptied. You might receive treatment weekly for six to eight weeks, followed by maintenance treatments monthly when needed.

The medication could also reduce inflammation of the bladder wall and prevent muscle spasms that cause pain, frequency, and urgency.

Hyaluronic acid is available at Aare Urocare.

Supplementary drugs 

Supplementary drugs may be taken as well to prevent UTI from recurring. Such supplements include:

  • Probiotics
      • Studies have shown that probiotics of the Lactobacilli family help prevent UTI 
      • Lactobacilli is the dominating bacteria in the urogenital area of healthy, premenopausal women. Hence, taking drinks like Yakult will help maintain the Lactobacilli population and reduce the risk of getting a UTI. 

  • Cranberry extracts
      • Cranberry extract contains A-type proanthocyanidins, which help prevent bacteria from sticking to the bladder wall.

  • Topical oestrogen cream
      • Usually recommended for postmenopausal females with vaginal dryness
      • Applying the cream helps the vaginal ecosystem reach pre-menopause conditions, reducing the risk of recurring UTIs.

  • Post-coital prophylaxis
    • For women whose recurrent UTIs are associated with sexual intercourse
    • A single dose of antibiotics to be taken immediately after sexual intercourse
    • Do also consult your urologist before starting to take this antibiotic to prevent developing antibiotic resistance bacteria


While these supplementary drugs are effective in preventing UTI, they may not be an effective treatment when UTI is already occurring. Hence, these supplements are normally concurrently used with antibiotics courses when required for those with recurrence.

When is Intravesical Treatment recommended by your Urologist?

Intravesical treatment is recommended for those who have been taking antibiotics orally or intravenously but still face recurrent UTI. This treatment is also suitable for men and women who have UTIs associated with underlying diseases since it is a non-antibiotic therapy.

How do you prepare for Intravesical Treatment?

Apart from peeing before each session, patients do not need to do any other preparation before Intravesical Treatment.

What can one expect during Intravesical Treatment?

Intravesical treatment takes place over a few weekly sessions. The procedure may take place in the following order:

  • You will need to pee before coming for each session.
  • Your urologist will ask you to lie down on a bed.
  • A catheter will then be inserted into your bladder via your urethra to empty residual urine.
  • Next, liquid drugs will be deposited into the bladder to about half of its full capacity.
    • Slight pain or discomfort may be felt when the catheter is inserted or when the drug is deposited.
    • If the pain or discomfort is unbearable, do inform your urologist.
  • You will then hold the drugs in your bladder for 15-30min if you can.
    • If you are unable to hold in the liquid, do inform your urologist, and they will make arrangements for a Foley catheter to be used instead.
  • During this period, your urologist may ask you to walk around.

As you will be put under general anaesthesia, you will not feel any pain during surgery. However, you may feel slight pain after your procedure, which will decrease in intensity for 7 – 10 days.


If UTI is left untreated, it puts you at risk of further complications, such as damage to your kidneys. Fortunately, recurrent UTI is often very treatable, with success rates of over 70% when using intravesical treatment. Hence, do not hesitate to undergo treatment for UTIs, and remember to persevere no matter how tedious the recovery journey may be.

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Dr. Fiona Wu 2

Dr Fiona Wu
Consultant Urologist

MBBS (S'pore), MRCS (Edin), MMED (Surg),
MMED (Clinical Investigation),
FRCS (Urol) (RCPSG), FAMS (Urology)

Dr Fiona Wu is an experienced Consultant Urologist and is the Medical Director of Aare Urocare.

Prior to her private practice, Dr Fiona Wu spent 15 years in public service. She was a Consultant in the Department of Urology at National University Hospital (NUH), Alexandra Hospital and Ng Teng Fong General Hospital. She was also the Programme Director of Surgery-in-Training at NUH and a core faculty member of postgraduate junior doctors. 

Dr Wu’s clinical interests lie in Female Urology, Neuro-urology, Urinary Incontinence, Reconstructive Urology and Voiding Dysfunction. She believes in treating incontinence in a holistic way using minimally invasive methods. She worked closely with the gynaecology and colorectal departments to treat complex pelvic floor conditions and continues to do so in her own practice. 

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