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August 2026
Patients provide insight to advance UTI research
Recurrent UTIs can have a major impact on quality of life, including emotional well-being and everyday activities. In this study researchers developed and tested a new questionnaire designed specifically for postmenopausal women with recurrent UTIs. Women reported how UTIs affected their anxiety, depression, self-blame, and daily lives. The study found that the questionnaire was a reliable way to capture these life experiences. As the questionnaire is studied further to reduce its length to make it more user-friendly, it may help researchers better understand the full impact of recurrent UTIs and determine whether new treatments improve not only infection outcomes, but also women’s overall quality of life.
Helping every patient understand their care
Healthcare providers may overlook subtle difficulties with memory, thinking, or understanding medical information. In this study of women receiving specialized pelvic health care, providers often did not recognize mild cognitive impairment and sometimes overestimated patients’ understanding of common medical terms. As a result, some patients may leave appointments without fully understanding their condition or treatment plan. Our findings highlight the importance of using clear, easy-to-understand language and checking that patients understand their care. Because even small cognitive changes may impact healthcare decisions and surgical planning, the researchers are developing a short set of questions easy to administer in a busy practice to detect these critical communication issues.
D-mannose from our diet may not be sufficient
It turns out that the foods we typically consume in the mornings may contain more D-mannose, a supplement taken worldwide to help prevent more urinary infections. Along with glucose and fructose, D-mannose is a natural sugar present in our foods. But is supplementation with D-mannose powder or pills necessary if enough D-mannose is absorbed from a regular diet? In a recent study, Dr. Chavez and colleagues examined the diets of older women with a history of rUTIs. They determined that natural D-mannose intake was the lowest in the evening, supporting the practice of supplementing with D-mannose in the evening, rather than in the morning or midday. Future research will aim to better understand who might benefit most from taking supplemental D-mannose to prevent UTIs.
Among women with recurrent UTIs, many have acidic urine.
Most postmenopausal women in this study had naturally acidic urine (measure of urine pH), regardless of whether they had a history of UTIs. This suggests that Hiprex, which works best in acidic urine (pH<6), may be a good option for preventing recurrent UTIs in older women who want to avoid long-term antibiotic therapy. Women with more alkaline urine (pH >6) may benefit from other non-antibiotic approaches, such as D-mannose. To reach these conclusions, we compared urine acidity (pH levels) in three groups of postmenopausal women: those with a history of UTIs and an active infection, those with a history of UTIs and no active infection, and finally, a control group with no history of UTI. The results revealed that more than three-quarters of women with a history of UTI had acidic urine defined by a urinary pH less than 6, regardless of current UTI status. Consequently, women suffering from recurrent UTIs who want to avoid long-term antibiotics, should have their urinary pH tested to determine if Hiprex could be a valuable alternative to reduce their rates of UTIs.
Non-antibiotic alternative for rUTI prevention
The active factors in non-antibiotic alternative for recurrent UTI treatment, Hiprex, can be measured in the urine. This is important because antibiotic resistance (failure of antibiotic treatment to kill bacteria) is a growing concern worldwide. Hiprex is a non-antibiotic medication that is growing traction as it can help prevent rUTIs, but researchers are still learning exactly how it works. In this pilot study, older women taking Hiprex daily for a year had regular urine tests to measure levels of methenamine, the active ingredient in Hiprex, and formaldehyde, the bacterial-killing substance produced when methenamine breaks down in acidic urine. The researchers first confirmed the presence of methenamine and formaldehyde in the women’s urine, showing that Hiprex was breaking down as expected. But, the level of formaldehyde was lower than laboratory studies had suggested would be needed to kill bacteria directly, Thus, simply preventing bacteria from growing until the next time the bladder empties out may be sufficient to stay clear of infections. Of note, most study participants did not develop a UTI during the study and follow-up period, which lasted up to two years.
Digging down: how urine nutrients may affect the ability of a non-antibiotic UTI treatment to kill bacteria
Natural substances in urine may affect how well non-antibiotic treatment Hiprex works to prevent bacterial growth. In laboratory experiments, some urine nutrients and compounds reduced the ability of formaldehyde, the bacteria-fighting substance produced by Hiprex, to slow bacterial growth, which others had little effect. Formaldehyde also helped prevent biofilms, protective layers that allow bacteria to survive. These findings not only suggest that differences in the urinary environment may help explain why Hiprex works better in some women than in others, but also support continuing Hiprex therapy during antibiotic treatment for an active UTI, though this needs further study.
Study highlights the value of specialized bladder imaging
A specialized imaging test called a voiding cystourethrogram — VCUG for short — reliably helps clinicians determine whether the tube that carries urine out of the body (the ‘urethra’) is abnormally narrow or not. Symptoms that occur when the urethra narrows can overlap with those commonly associated with other conditions. This can make it challenging for clinicians to pinpoint whether such narrowing is the root cause. In this study, researchers found that four separate radiologists generally agreed on the location and severity of the urethral narrowing on VCUG images. Therefore, in women who have difficulty with voiding (passing their urine out) or who experience recurrent urinary tract infections (rUTIs), a VCUG test can objectively confirm the presence of a narrowed urethra. As a result of this successful study, research is now underway to assess whether AI can further refine our ability to measure the shape and diameter of the urethra during urination.
Zimmern named inaugural UTSW Medical Student Research Mentor of the Year
Dr. Zimmern was nominated for the first ever Mentor of the Year Award. Dr. Zimmern received 17 nominations between students and faculty.
Read the full story on CenterTimes Plus.
A home-based test kit for UTI?
Well, not just yet, but researchers at the University of Texas have tested a new device that – in a matter of minutes – measures three infection-related markers to identify urinary infection. Moreover, using machine learning, the researchers were able to assess risk of future infection. The device exhibited high accuracy, with 93% correct UTI diagnosis and over an 84% prediction of risk of recurrence. Further development of this device could not only offer fast answers from home, but also enhance the use of more appropriately targeted antibiotic prophylaxis.
Could removal of superficially-infected tissues in the bladder offer relief for women with tenacious recurring UTIs?
Some women harbor small fluid-filled blisters in the bladder wall which result in discomfort and recurring bladder infections. Researchers at the Cain Center for Bladder Health (CBC) found that gently eliminating these unhealthy areas on the bladder lining using a certain medical procedure (electrofulguration) offered 3-years of relief from recurring UTIs for roughly 71% of women. Approximately two-thirds of these women required only a single treatment and no need for follow-up procedures or antibiotics.
Novel biotechnologies could reshape how we find and treat urinary challenges
Technologies are rapidly evolving; let's leverage these to improve diagnostic accuracy, personalize treatment, and enhance outcomes for those struggling from urinary tract diseases. Four particularly interesting strategies are being explored by collaborators of Dr. Zimmern at the University of Houston: A) living-cell sensors that can monitor and detect specific stimuli and various biological chemicals; B) light to manipulate nerve or bladder cell activity; C) generating bladder-like tissues using an implanted lattice comprised of living cells; and D) 3-D printing of urinary tract components, layer-by-layer to match each individual’s needs.
Engineered gels release “good” bacteria in timely fashion
Using gel-like scaffolding, scientists collaborating with the CBC discovered they can release probiotics (good bacteria) in a controlled manner for at least 100 days. The speed of release may be altered by adjusting gel stiffness and how many bacteria are inside. This means we can design materials to deliver beneficial microbes over time to support bladder health.
Speaking of gels, implantable scaffolds could also monitor bladder health or deliver targeted therapy!
Colleagues at the University of Houston designed a silicone scaffold that can wrap around the bladder and stretch and contract with the bladder’s natural volume changes. These implants are compatible with living cells, thus rendering them candidates for long-term implantable devices that monitor bladder health or deliver targeted therapy to improve or restore bladder function.
Were you aware that stimulating certain nerves may improve bladder function following a spinal cord injury?
Researchers at Case Western (Cleveland, OH), who collaborate with the CBC, proposed that stimulating the nerve that runs from the brainstem to the abdomen could help retrain the nervous system after spinal cord injuries, improving bladder control without drugs. This could offer a new, less invasive option for people living with long-term urinary problems after injury.
Does diet matter when it comes to recurring UTIs?
It is believed that a more acidic urine (lower pH) could be protective against infection by hindering bacterial growth. Several researchers from the CBC tracked a collection of food logs to determine if diet with higher acidity would result in lower, more acidic urinary pH. They found that dietary differences did not seem to change urine pH, so perhaps the acidity of one’s diet doesn’t matter as much as focusing on hygiene habits, timely medical evaluation, and other lifestyle strategies linked to prevention.
How bacteria control surface structures and maintain their stickiness
Together, scientists at University of Texas at Dallas and Dr. Zimmern discovered how bacteria tightly regulate hairlike structures called pili (used to stick to surfaces) and other molecules. They determined that without sufficient levels of putrescine, which also causes urine odor, bacteria are unable to produce pili and lose the ability to stick to surfaces. Understanding these systems helps explain how bacteria survive in the body and could lead to better treatments for infections like UTIs.
Stubborn bacteria living in bladder walls increased risk of reinfection
Why is it that some postmenopausal women experience persistent bladder infections that return even after treatment? In collaboration with Dr. DeNisco and her team at UT Dallas, CBC researchers found that women who had higher levels of bacteria deep in their bladder tissue were more likely to get another infection within six months following electrofulguration, a procedure that gently removes infected tissues on the surface of the bladder. This suggests doctors may need to look beyond standard urine tests and consider hidden bacteria in bladder tissue when treating recurrent UTIs.
Repeat prolapse surgery can succeed, but may carry higher risk complications.
Researchers and clinicians at the Cain Bladder Center worked together to study women who had robotic-assisted mesh surgery to repair pelvic organ prolapse, a condition where the bladder, uterus, and rectum drop. They sought to determine whether prior prolapse surgery impacted clinical outcomes. While those with prior prolapse surgery experienced more complications during the procedure, the long-term outcomes were comparable to those without a prior prolapse surgery.
References
- Ganguly, A., Basu, U., Gunda, V., Krishnan, A., Ramesh, P., Jivnani, K., Raghuram, A., Bhagavatula, S., Khan, S., Zimmern, P., et al. (2025). USENSE : A proof‐of‐concept self‐screening tool for home‐based recurrent urinary tract infection management. Bioengineering & Transla Med, e70038. https://doi.org/10.1002/btm2.70038.
- Chao, T.-C., Christie, A.L., Alhalabi, F., and Zimmern, P.E. (2025). Midterm Follow-up of Electrofulguration for Vesicular Cystitis in Women With Recurrent Urinary Tract Infections. Urology 196, 102–109. https://doi.org/10.1016/j.urology.2024.10.072.
- Liu, C., Rivera Ruiz, A., Zhang, Y., Zimmern, P., and Li, Z. (2025). Emergent biotechnology applications in urology: a mini review. Front. Bioeng. Biotechnol. 13, 1539126. https://doi.org/10.3389/fbioe.2025.1539126.
- Kalairaj, M.S., George, I., George, S.M., Farfán, S.E., Lee, Y.J., Rivera-Tarazona, L.K., Wang, S., Abdelrahman, M.K., Tasmim, S., Dana, A., et al. (2025). Controlled Release of Microorganisms from Engineered Living Materials. ACS Appl. Mater. Interfaces 17, 40326–40339. https://doi.org/10.1021/acsami.5c11155.
- Wang, Y., Garmroudi, A., Liu, C., Zimmern, P., and Li, Z. (2025). Design of Soft, Stretchable Bladder‐Integrated Scaffolds for Advanced Bioelectronic Implants. Adv Materials Technologies, e00552. https://doi.org/10.1002/admt.202500552.
- Sargusingh, M.J., Addo, J.J.A., Damaser, M.S., Zimmern, P., Hays, S.A., and Hernandez-Reynoso, A.G. (2025). Enhancing Neuroplasticity via vagus nerve stimulation to improve urinary dysfunction after spinal cord injury: a perspective. Bioelectron Med 11, 15. https://doi.org/10.1186/s42234-025-00178-5.
- Chavez, J.M., Christie, A.L., and Zimmern, P.E. (2025). Deciphering the Complex Relationships Between Potential Renal Acid Load, Carbohydrate Intake, and Urine pH in Postmenopausal Women With Recurrent Urinary Tract Infections. American Journal of Lifestyle Medicine, 15598276251344486. https://doi.org/10.1177/15598276251344486.
- Mehta, I., Hogins, J.B., Hall, S.R., Vragel, G., Ambagaspitiye, S., Zimmern, P.E., and Reitzer, L. (2025). Control of pili synthesis and putrescine homeostasis in Escherichia coli. eLife 13, RP102439. https://doi.org/10.7554/eLife.102439.3.
- Gadhvi, J.G., Kenee, P.R.M., Lutz, K.C., Khan, F., Li, Q., Zimmern, P.E., and De Nisco, N.J. (2024). Bladder-resident bacteria associated with increased risk of recurrence after electrofulguration in women with antibiotic-recalcitrant urinary tract infection. Preprint, https://doi.org/10.1101/2024.07.03.24309902 https://doi.org/10.1101/2024.07.03.24309902.
- Guérin, S., Alhalabi, F., Lutz, K., and Zimmern, P. (2025). Impact of Previous Pelvic Organ Prolapse Repair on Outcomes of Robotic-assisted Mesh Sacrocolpopexy. Urology, S009042952500682X. https://doi.org/10.1016/j.urology.2025.07.008.
As Seen in the News
Dr. Zimmern was recently recieved the first ever Mentor of the Year award at UTSW. View this article on CenterTimes Plus.
Dr. Zimmern helped conduct a study that looked at the efficacy of a medication aimed at reducing reccurent urinary tract infections. View this article on JU Open Plus.
Dr. Zimmern presented his findings about electrofulguration for recurrent urinary tract infections to Urotoday. View this article on Urotoday.
Formerly In the News
- News Archive
2025 Articles
Have you ever wondered what foods you should stay away from when being treated for a urinary tract infection? Dr. Philippe Zimmern shared some insight in a recent Everyday Health article that reveals a closer look on foods patients may want to avoid. View this article on Everyday Health.
Dr. Philippe Zimmern sat down with TIME Magazine to discuss which bathroom habits are normal vs. abnormal. View this article on TIME Magazine's website.