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New England Section of the American Urological Association

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Anovaginal Distance and UTI Frequency inOlder Women: Does Distance Matter?
Brooke Moore, BS, Garen Kroshian, BS, Kirstin Lee, BS, Paula Bellin, MD.
UMassMemorial Medical Center, Worcester, MA.

Background: Short urethral length and anovaginal distances are often cited as factors that increase a woman's risk of developing UTIs. However, little data exists to support either of these conclusions. Given the high prevalence of UTIs along with the severity of the associated sequelae, particularly in older patients, it is important to understand the multifactorial etiology of this disease. To determine how perineal anatomy may impact the development of recurrent UTIs, we measured anovaginal distance in post-menopausal women. Methods: An IRB-approved, case-control study was performed in the department of Urology at an academic medical center. The selected patient population was women over 55 years of age. Patients were deemed ineligible for our study if they had any of the following: history of GU anatomic anomalies, > 1 kidney stone since menopause, history of gender affirmation surgery, current/recent urinary catheter use, history of colostomy, immunocompromised, active GU/gynecologic cancer, or current anticholinergic, SGLT-2 inhibitor, 1st generation antihistamine, or antipsychotic use. Eligible patients were identified through a pre-visit EMR review and were sorted into two study groups based on the presence or absence of recurrent UTIs, as defined by ≥ 3 culture-positive UTIs over the course of one year. Patients were consented appropriately and asked to complete a questionnaire regarding potential confounders, such as alcohol use and sexual activity. Anovaginal distance was measured from the posterior vaginal introitus to the anterior aspect of the anus. Measurements were taken using a Pop-Q exam stick (Marina Medical Instruments) that contained millimeter markings. Data was stored in the REDCap secure online system and analyzed using Microsoft Excel 2019. Results: To date, the results from thirty-three patients have been evaluated. The mean anovaginal distance was 33.3 mm (SD: 8.3) for cases and 39.5 mm (SD: 6.3) for controls (p=0.02). With the exception of sexual activity, which was significantly greater in the control group (p = 0.03), there was no difference in potential confounders across the two groups, including diabetes and BMI (Table 1). Conclusions: Variations in perineal anatomy may contribute to the development of UTIs. This initial study demonstrates that women with recurrent UTIs have significantly shorter anovaginal distances than women without recurrent UTIs. These findings should be emphasized during clinical encounters, as behavioral modifications, such as front-to-back wiping and post-coital voiding, may be preventative for at-risk patients. Interestingly, sexual activity was also significantly greater in the control group, suggesting a secondary finding of unclear etiology. Although it is unlikely that sexual activity is protective, further research is needed to better understand the value of this outcome. As more data is collected, we hope to gain greater insight into how anatomy and sexual activity impact UTI risk.


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