The Bladder Centre – an important component in the adequate sourcing of a bladder infection.

Dr Ziviello Yuen – you have worked at the Zürich Bladder Centre by the Stadelhofen for 12 years – what do you do there?

I conduct a urogynaecological consultation and see women of all ages with the typical urogynaecological problems such as urinary incontinence, recurring bladder infections and prolapse complaints. Here, we support prevention for women with slight complaints and also provide advice regarding various therapies including different operations, be it due to incontinence, drive complaints or a troublesome prolapse finding.

We are urogynaecologists; consequently, we do not see or examine men or children.

In general, how long does an initial consultation with you last?

Concerning recurring bladder infections, an initial consultation lasts approximately 30-45 minutes; the subsequent examination lasts about 10 minutes.

Who do you advise – or better: when is the right time to seek your advice?

The right time is different for each woman. However, as soon as the personal level of suffering is high, it is worth getting help. When repeated bladder infections occur, many women are understandably very worried and concerned. Ideally, the consultation regarding the bladder infections should be carried out in the infection-free interval. Of course, we are also there when an acute bladder infection occurs and the question arises as to how it ought to be treated.

Recurring urinary tract infections are a vexatious topic. What are the main causes and why are there so frequently relapses?

We do not yet know all the causes. Certainly, the female anatomy favours the ascending of the gut bacteria. The mechanical stimulus through sexual intercourse can be a main cause, especially in the case of younger women. However, co-factors such as vaginal dryness in the menopause or urinary incontinence with permanently moist and wet underwear or inlays can also promote infections. Anal incontinence is also among the important risk factors.

The repeated intake of antibiotics can lead to an increased frequency of infections.

Which treatment options are available? What distinguishes the treatment of older patients from that of younger patients?

There are various options. We focus on developing an individual therapy concept together with the patient. Antibiotic-free and herbal alternatives are discussed, as is symptom-orientated therapy. Antibiotic therapy always takes place only according to the current resistance situation. Upon Menopause, the effects of a hormonal deficiency and the possibility of local hormonal therapy are discussed.

Early prophylactic measures are also part of our treatment concept.

What do you recommend to women who experience acute bladder infections for the first time?

Even if urinating causes pain, women with an acute bladder infection should drink plenty of fluids in order to flush out the pathogens with the urine. If this does not help, antibiotic-free medication such as D-mannose or high-does bearberry leaf extracts (Cystinol®) can be used as phytotherapy. The use of symptomatic therapy, i.e. the treatment of pain with NSAR, or the intake of bladder-relaxing medication have also shown good results.

What do you recommend to prevent a urinary tract infection?

It is important to administer moisturising skin care in order to achieve a protective barrier on the skin (barrier measures), to urinate after sexual intercourse and to use antibiotic-free products and D-mannose early and in high dosage, already on a prophylactic basis.

Where do you stand on the use of antibiotics for UTI? Can their use be reduced?

Whenever possible, the use of antibiotics should be reconsidered, especially by healthy young women. Also helpful is so-called delayed use, where phytotherapeutics or painkillers are used but an antibiotic is also at hand “just in case”. In general, antibiotics should be used only according to the current resistance situation and for as brief a period as possible. Whenever possible, they should not be used; however, sometimes they are unavoidable. In the event of pyelonephritis (pyelitis), there is of course no other choice.

Are there rules of behaviour or non-medication-related tips you can pass on to women with recurring UTIs?

The regular bladder flow should be ensured; we therefore recommend a drinking quantity of 1.5-2L/day. Since sexual intercourse can cause bacteria to settle on the urethra, going to the toilet thereafter should become a routine. Additionally, close-fitting thong underwear should not be used and the frequency of intimate care, especially shaving, should be reduced. The use of spermicidal contraception is not recommended, as this is also harmful to the vaginal flora. Post-menopausal women should find out about the use of local estrogens. The use of a Urovaxom immunisation or local estrogens as well as probiotics in prophylaxis can also help.

What do you recommend for women after successful UTI therapy?

In addition to the above-mentioned measures, a preparation that can restore the healthy vaginal flora is also recommended. Through the weekly use of a combination of low-dosage oestriol (0.03 mg) and lactobacilli, the natural environment can be restored, thus minimising the risk of a new infection. Alternatively, a long-term phytotherapy regime can also be helpful.

Information about the Zürich Bladder Centre

Founded in 2001

Managing Director Dr D. Perucchini

Location Stadelhoferplatz, Gottfried-Keller Str. 7, 8001 Zürich

The Bladder Centre – an important component in the adequate sourcing of a bladder infection.

The Bladder Centre – an important component in the adequate sourcing of a bladder infection.