1. Editor reflections

The EAU has rightly dedicated this week to UTIs — a core problem that every urologist encounters when delivering care to millions of patients worldwide. UTIs drive hospital admissions, delay elective operations, prolong recovery in the postoperative period, and significantly impair patients’ quality of life.

As urology evolves into a super-speciality, UTI remains the common denominator — affecting functional urology, robotics, stone surgery, and beyond. Yet ironically, while the burden grows, our most familiar weapon — antibiotics — is losing its power. We must admit that part of the blame for rising resistance lies with us as urologists, in how freely antibiotics have been prescribed over the years.

It is not too late to change course. The future of UTI management lies beyond antibiotics: harnessing probiotics, adopting non-antibiotic preventive strategies, and addressing the underlying urological conditions that predispose to infection. Above all, it is our responsibility to prevent the rise of “super bacteria” and preserve effective treatment for generations to come.

— Mudassir Hussain, FCPS, FRCS (Urol), Editor

2. Community Voice

If I get another hour in a day, what will I do with it?

• Rest and Recover → 40%

• Follow Habits & Interests → 40%

• See Family & Friends → 20%

• Catch up on Clinical Tasks → 0%

• Professional Growth → 0%

The results speak clearly — none of us wanted extra time for clinical work or professional growth. Instead, the strongest priorities were rest, recovery, and personal passions, with family time close behind.

In the middle of clinics, operating lists, and deadlines, this poll reminds us that what we most value is the space to breathe, recharge, and connect with life beyond the hospital. It’s a timely nudge: balance isn’t a luxury, it’s a necessity for sustainable careers and healthier lives.

The results will be shared in next newsletter.

3. Guideline snippets

Non-Antibiotic Preventive Strategies (EAU 2025)

• Behavioural / Lifestyle measures

  • Adequate hydration is recommended.

  • Post-coital voiding may help in selected women, though evidence is limited.

  • Avoid unnecessary catheterisation.

• Vaginal oestrogen

  • In post-menopausal women with recurrent UTIs, local vaginal oestrogen is effective in reducing recurrence.

  • Systemic hormone replacement is not recommended for UTI prevention.

• Cranberry products

  • Some evidence of modest benefit in reducing recurrence, but results are inconsistent.

  • May be offered to motivated patients, but not a substitute for proven strategies.

• Probiotics

  • Evidence remains mixed; current guidelines do not recommend probiotics as standard care, though ongoing research is noted.

• Immunoactive prophylaxis (OM-89 / Uro-Vaxom)

  • Demonstrated reduction in recurrence rates in multiple RCTs.

  • Can be considered in selected patients with recurrent UTIs.

• Methenamine hippurate

  • Shown to be effective in preventing recurrent UTIs in women without renal tract abnormalities.

  • Considered a viable non-antibiotic prophylactic option.

4. Evidence update

1. Methenamine hippurate for prevention
   A 2025 Phase IV RCT in women ≥70 years with recurrent UTIs found that methenamine hippurate reduced the need for antibiotics during treatment (IRR = 0.75; p = 0.049). However, in the 6 months after stopping, recurrence was higher (IRR = 1.7).
   Take home: Methenamine is an effective non-antibiotic prophylactic, but stopping therapy may lead to relapse, so long-term strategies are key.
   Read more → PubMed

2. Machine learning for UTI prevention, Real-world urinalysis to predict culture positivity (2025)
   A study of 8,065 patients used machine learning (XGBoost) to predict urine culture results based on routine urinalysis and demographics. The model achieved AUROC 0.819 (up to 0.892 in cross-validation), with sensitivity 87.9% and NPV 96.4% at an adjusted threshold. Importantly, it could have reduced overtreatment by 56% compared with standard practice.
   Take home: AI models trained on everyday lab data may help clinicians rule out infection safely and cut unnecessary antibiotic use.
   Read more → PubMed

5. Wellbeing Corner

🌿Rediscovering Joy Beyond Work

In medicine, it’s easy to let our identity shrink to just “the clinician.” Yet the poll this month reminded us: when given an extra hour, most of us wanted rest, interests, and family.

Protecting time for joy outside the hospital isn’t indulgence — it’s a safeguard. Research shows that doctors with regular hobbies, exercise, or creative outlets report lower burnout rates and higher job satisfaction.

🎶 Listen to music on your commute
📚 Pick up a book unrelated to medicine
👨‍👩‍👧 Plan a small ritual with family — even a shared cup of tea in the evening
🌱 Revisit a hobby you left behind in training

Think of these not as “time off work,” but as “time that sustains work.”

6. BTS Updates

Next Webinar – 3rd October 2025
Topic: Urinary Tract Infections: Challenges & Evolving Solutions
Time: 9:30 PM (Pakistan Standard Time) / 5:00 PM (UK)

This session will cover:

• Case-based discussions on recurrent and complicated UTIs

• Practical updates from the EAU 2025 UTI Guidelines

• Insights into non-antibiotic preventive strategies

🔗 Registration here

✨Closing thoughts

As Urology Week draws to a close, the focus on UTIs serves as a powerful reminder: these infections are far more than “routine cases.” They test our discipline as clinicians. Every prescription we write, every decision to culture or not to culture, and every moment we spend explaining preventive strategies to a patient collectively shape the landscape of antimicrobial resistance.

The truth is uncomfortable — resistance is not solely an external problem; it is one we have contributed to through years of reflex antibiotic prescribing. But the good news is that it is not too late. By taking small, deliberate steps — limiting unnecessary antibiotics, embracing non-antibiotic preventive strategies, and involving patients in their own care — we can slow down resistance and improve outcomes.

The impact may seem modest on an individual level, but multiplied across clinics, hospitals, and countries, these choices can reshape the future of UTI care. The responsibility — and the opportunity — sits with us. Let us use this moment to commit to better habits, better stewardship, and ultimately, better care for our patients.

Until next time, stay curious, stay compassionate, and keep looking beyond the scope.

— Mudassir Hussain, FCPS, FRCS (Urol), Editor

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