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To evaluate factors associated with recurrent urinary tract infection (UTI) in postmenopausal women, we conducted a case-control study comparing 149 postmenopausal women referred to an infectious diseases outpatient clinic who had a history of recurrent UTI (case patients) with 53 age-matched women without a history of UTI (control patients). Each woman completed a questionnaire providing demographic data, history and clinical characteristics of prior infections, and information regarding risk factors for UTI. In addition, each patient underwent a gynecologic evaluation, renal ultrasound and urine flow studies, and blood group and secretor status testing. Three urologic factors—namely, incontinence (41% of case patients vs. 9.0% of control patients;P< .001), presence of a cystocele (19% vs. 0%;P< .001), and postvoiding residual urine (28% vs. 2.0%;P= .00008)—were all strongly associated with recurrent UTI. Multivariate analysis showed that urinary incontinence (odds ratio [OR], 5.79; 95% confidence interval [CI], 2.05-16.42;P= .0009), a history of UTI before menopause (OR, 4.85; 95% CI, 1.7-13.84;P= .003), and nonsecretor status (OR, 2.9; 95% CI, 1.28-6.25;P= .005) were most strongly associated with recurrent UTI in postmenopausal women. Prospective studies are needed to confirm these observations and to develop approaches for prevention.