Hello urologists, gynaecologists, primary care doctors and all of you who have to deal with urinary tract infections. Urinary tract infection management and prevention is one of the activities on a routine basis for all caregivers. This Newsletter intends to review the last recommendation for managing and preventing urinary infections. Our focus is reducing the number of infections, avoiding antibiotic use when not indicated to prevent resistance and reviewing the evidence about innovative non-antibiotic measures to prevent infections. Scientific support of the evidence and practice guidelines recommendations will be the key to all the information in the Newsletter.

The focus of this issue is the revision of three articles that review the usefulness of an innovative non-antibiotic treatment for the prevention of recurrent-urinary tract infections with the focus on a novel molecule such as xyloglucan and gelose. 

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Non-antibiotic prophylaxis is the preferred approach for preventing recurrent urinary tract infections (UTIs). This article presents a systematic review and meta-analysis comparing the effectiveness and safety profile of a new non-antibiotic prophylactic product containing xyloglucan in women with uncomplicated cystitis. The clinical efficacy of xyloglucan in uncomplicated cystitis and in preventing recurrence is attributed to their mucoprotective effect, which acts as a mechanical barrier on the intestinal mucosa, as well as their ability to inhibit bacterial proliferation in the urinary tract.

The review included three preclinical studies (one in vitro study and two animal model studies) that assessed the efficacy of xyloglucan in an in vivo rat model of extraintestinal urinary tract infections. These studies also evaluated the ability of xyloglucan to form a bioprotective barrier that prevents the adhesion of uropathogenic Escherichia coli (E. coli) strains to intestinal and uroepithelial cells (derived from normal human prostate epithelium) and investigated E. coli adherence and intracellular invasion in intestinal epithelial cells in vitro. The findings demonstrated that xyloglucan enhance the integrity of cell tight junctions, protect against E. coli adherence, and reduce E. coli colonization, thereby preventing UTI development. Additionally, this compound exhibited antibiotic-like activity and formed a physical bioprotective film on the intestinal mucosa.

Furthermore, the review included three clinical studies involving a total of 178 women with uncomplicated cystitis, comparing the effects of a xyloglucan-containing product with placebo. The product demonstrated a statistically significant difference in clinical and microbiological outcomes (odds ratio [OR]: 0.13; 95% confidence interval [CI]: 0.05–0.33; p < 0.0001). No clinically significant adverse effects were reported.

Therefore, products containing xyloglucan may serve as adjuvant therapy alongside first-line antimicrobials for the treatment of uncomplicated UTIs in adults. Their use may reduce the need for antibiotic therapy and help prevent the recurrence of uncomplicated cystitis.

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This clinical study focuses on the efficacy of Utipro^® Plus containing xyloglucan (a soluble hemicellulose) and gelose in reducing symptomatic episodes of urinary tract infections (UTIs). The prescription of antibiotics is associated with increasing antimicrobial resistance and may also have detrimental effects on the microbiome. Xyloglucan reduce the adhesion and proliferation of uropathogens in the intestinal lumen, preventing their migration from the urethra to the bladder. 

This study is a retrospective, cross-sectional analysis conducted in Germany, including 3,586 patients diagnosed with UTIs who were managed with Utipro^® Plus with a follow-up period of 12 months. Among the participants, 94.2% were female, with a mean age of 57.7 years. 

The findings indicate a reduction in the proportion of patients with at least one UTI diagnosis, from 79.4% prior to treatment to 36.4% following the prescription of Utipro^® Plus. The number of infections decreased from an average of 1.3 to 0.7 UTI diagnoses per patient at 12 months post-treatment, with the greatest reduction (0.8 diagnoses per patient) observed in female patients aged 31–40 years. Furthermore, antibiotic prescriptions declined from 33.5% to 22.1%, and the proportion of patients requiring at least one day of sick leave decreased from 4.1% to 2.7%

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This study is a multicenter, randomized, parallel-group, double-blind clinical trial evaluating the efficacy and safety of a product containing xyloglucan and gelose as an adjuvant therapy to first-line antimicrobials for the treatment of uncomplicated urinary tract infections (UTIs) in adults. The study compared this treatment with a placebo, and its primary strength lies in its evaluation of patients with acute cystitis.

The study protocol involved administering xyloglucan-gelose or placebo in combination with an antimicrobial agent (e.g., ciprofloxacin) for five days, followed by monotherapy with either xyloglucan-gelose or placebo for another five days. Subsequently, from day 30 of the study, treatment was administered for 15 days per month over a two-month period.

Treatment with xyloglucan-gelose reduced uroculture positivity from 100% of patients at baseline to 0% by day 11, compared with 45% in the placebo group. The recurrence of positive cultures by day 76 was 15% in the xyloglucan-gelose group, compared with 70% in the placebo group. Furthermore, this product significantly reduced the frequency of urinary incontinence and urgency of micturition compared with placebo, with complete symptom resolution in all patients at the three-month follow-up.

The incidence of adverse events was 5% in the group treated with xyloglucan-gelose compared with 45% in the placebo group. Thus, the study demonstrated that the product is safe, well-tolerated, and effective in reducing both bacteriological and symptomatic parameters in adults with uncomplicated UTIs.