Chronic, recurrent UTI sufferers may find new hope with UTSW urologist

By Renee Yan

UTIs are among the most common bacterial infections worldwide, totaling more than 400 million cases annually, according to a 2022 World Journal of Urology study. Cases dramatically skew toward women. In the U.S., an estimated 40%-60% of women will experience a UTI at least once in her lifetime compared to just 12% of men.

The standard treatment for a UTI is a round of antibiotics. But roughly 25% of patients will develop recurring infections due to the bacteria’s resistance to drugs. In such cases, Dr. Zimmern explained, chronic bacterial reservoirs have embedded into the bladder wall and adopted a defense against antibiotics. Some patients are also considered antibiotic-recalcitrant, which means they have developed side effects from previous antibiotic exposure or resistance. Therefore, their options for antibiotic treatment have been considerably reduced.

“Data showed us that bacteria can attach to the bladder and develop a protective biofilm that insulates it from the effects of antibiotics. Even if the infection clears, there’s a high chance it will return, which means more rounds of antibiotics, and the pattern repeats itself,” Dr. Zimmern said.

He began studying this phenomenon about 20 years ago when he read a research paper that investigated how such infections persist. Since then, he has treated patients from around the globe by offering electrofulguration as a more effective treatment over medication. He is one of the most prolific clinicians researching the use of this technique to treat recurrent or chronic UTIs.

“Electrofulguration essentially destroys chronic bacterial reservoirs with targeted heat treatment,” he explained.

Despite the prevalence of recurrent or chronic UTIs, there is a notable lack of research in this area of medicine. Dr. Zimmern said he often sees women in his clinic in tears, having gone from one antibiotic to another without any relief. Many patients who opt for electrofulguration – also referred to as bladder fulguration – have typically exhausted all other options and are coping with severe symptoms that interfere with their daily lives.

“Some of them have been septic or hospitalized,” Dr. Zimmern said. “That's why I'm so passionate about trying to help them.”

Using electrofulguration to treat recurrent UTIs

“We found the best doctor in Dr. Zimmern,” said Eileen, who privately feared she would one day die of sepsis – a legitimate concern and potential complication of a bacterial infection. She recalled getting eight UTIs one year, with pain levels reaching as high as 20 on a 1-to-10 scale. “I didn’t know where else to turn, and it was a blessing to find someone of his skill and compassion who had a solution that actually worked.”

During Eileen’s first assessment, Dr. Zimmern performed a cystoscopy, which involves examining the inside of her bladder with a thin flexible scope threaded through the urethra. He diagnosed her with recurrent UTIs and identified a bladder infection, known as trigonitis, as the immediate problem. He also discovered Eileen’s narrowing urethra was making it difficult for her body to flush out urine, which encouraged the return of bladder infections. Since Eileen did not want to rely on daily antibiotics for the rest of her life – especially as many of them came with their own side effects – he recommended electrofulguration, which would also allow him to dilate the urethra during the process.

Eileen agreed and checked into William P. Clements Jr. University Hospital at UT Southwestern in August 2023.

“My surgery experience at UTSW was a very positive one,” she said. “Everyone I came in contact with was so kind and compassionate, especially Dr. Zimmern, who was very reassuring and comforted me before the procedure."

Two years later, she says the difference is “remarkable.” She can now enjoy activities she previously had to struggle through: Riding horses with her husband, doting on her five grandchildren, and traveling to far-flung places without fear of crippling pain.

“My 20 years of suffering was difficult, but I would like to give it purpose by making other women aware of this amazing treatment available,” she said. “To this day, I still find myself in almost disbelief over the level of good health I’m enjoying in my life now, and I’m so grateful to Dr. Zimmern and his commitment to the research in this field.”

Trailblazing research on chronic UTIs

Electrofulguration is primarily used to remove polyps and cancerous lesions. It is not considered a standard treatment for recurrent or chronic UTIs. Most urologists do not offer it – many are not even aware of it. But Dr. Zimmern, who has co-authored more than 430 peer-reviewed papers in his field and contributed to multiple urology textbooks, wants to change that.

He led a study published in The Journal of Urology in 2023 that became the first in the U.S. to demonstrate the long-term efficacy of the technique. He and other researchers reviewed the medical records of 96 women who underwent electrofulguration for recurrent UTIs between 2006 and 2012 at UT Southwestern. They found that 72% of patients were clinically cured with no more than one infection annually while 22% had fewer than three infections annually.

He is also working to launch a randomized trial that compares outcomes of patients who receive electrofulguration with those who receive a daily low-dose antibiotic for months, which is the current standard of care.

Going the extra mile – or 2,000 miles – for urology care

UTSW, consistently recognized by U.S. News & World Report as one of the top 25 urology departments in the country, is already emerging as a leading institution for patients far and wide.

Ana, who lives in the Pacific Northwest, was an avid hiker and traveler when, in 2022, she developed a chronic UTI that trapped her in what she described as “a daily and endless cycle of pain.”

She tried a slew of medications and pain management techniques over three years, but she and a revolving cast of specialists were stumped. They could not pinpoint the source of her affliction. Confoundingly, almost all of her urine lab cultures returned a false negative for UTI-causing bacteria – which can happen depending on the testing method and the pathogen.

She was eventually diagnosed with interstitial cystitis, a non-infectious inflammatory bladder disorder that has no known cause and no definitive cure.

“Being told at age 25 that you’re going to be in pain every day for the rest of your life and there was nothing to be done about it was incredibly hard,” Ana said. “I truly questioned whether I could ever live a good life again, if I was trapped in this body that experienced constant pain.”

Dr. Zimmern explained that interstitial cystitis is a diagnosis of exclusion, meaning it’s the answer physicians typically arrive at after eliminating all other explanations.

“But for patients like Ana, if you treat them for something they do not have, needless to say, they will not get better,” he said.

In 2024 another physician told Ana about a specialist at UT Southwestern offering a little-known procedure to help women like her. Ana decided the cost of a flight to Dallas was a small price to pay for the chance to live pain-free. In December, she booked a flight for an appointment with Dr. Zimmern, who had just helped launch the Cain Center for Bladder Health earlier that year. He was the 13th urologist she saw.

“He instantly proved to be the best doctor I’ve ever had. He listened to my story and was very patient. Within five minutes of our first appointment, he got the right diagnosis,” Ana said. “He said I probably had a chronic UTI that’s caused by embedded bacteria stuck in the wall of my bladder. And then he told me he had a potential solution – which no other doctor could tell me before. It was a pivotal moment in my life, to finally learn there was a pathway to resolving my pain. I was very emotional during that first appointment, and so grateful I had flown to Dallas.”

A few days later, Dr. Zimmern performed a cystoscopy to confirm his diagnosis. He found Ana had pockets of embedded bacteria in her bladder wall, along with trigonitis, a type of infection located at the base of the bladder, from which UTIs may recur.

“During the cystoscopy, I could see the sites of infection on Dr Zimmern’s screen with my own eyes. It was incredibly validating to finally see the source of all my pain, after years of suffering with no real answers,” Ana recalled.

Dr. Zimmern performed the procedure for Ana in January 2025. In May, Ana returned to Dallas for a follow-up cystoscopy, which showed that her bladder had completely healed. She is currently managing other health issues, but she is looking forward to experiencing more of what was once impossible: going on long hikes, staying engaged at work, or simply enjoying an entire day without pain. She said the days without pain are the best she’s ever had in her life and mean so much to her, after everything she’s been through.

“The quality of care that I received from Dr. Zimmern and the nurses was so supportive and helpful,” Ana said. “I really appreciated the way he spoke to me to manage my expectations because it’s not a quick fix. I had to allow the healthy tissue in my bladder wall to regrow, so I knew I had an uphill battle. But it’s completely worth it.”

Related reading: Stopping the cycle of recurrent urinary tract infections in women

Tips on UTI risk and prevention

There is still much to learn about recurrent UTIs. Dr. Zimmern and other experts in North Texas are making strides in raising awareness and setting the standard for evidence-based practices.

• Ask your doctor about other supplements or probiotics: Some antibacterial medications may help ward off infection. Dr. Zimmern is launching a randomized trial that studies the effectiveness of d-mannose, a simple sugar found in foods such as cranberries, as a preventive therapy against UTIs.
• Avoid sugary foods and drinks: Too much sugar is bad for your health for multiple reasons, and excessive sugar levels in your urine encourage the growth of bacteria, which thrives on sugar. Drinking about 6 to 8 glasses of water or other fluids each day and moderating the amount of sugar in your diet will help.
• Check for urinary dysfunction: Recurrent UTIs might be the result of an underlying issue, such as bladder prolapse or retention issues, which can make it harder for your body to clear away infections. Detecting these conditions and addressing them could help prevent future infections.

Living with UTI pain might be a common experience, but it should not be accepted as the norm. Dr. Zimmern said he continues to raise funding and awareness for a topic that’s often overlooked in medicine due to stigma and lack of research.

“Our mission right now is to let people know there's a center here dedicated to the care of women with this condition so they can find a place to be helped,” Dr. Zimmern said. “When you come to UT Southwestern, you will find a team committed to evaluating your condition and treating it with the hope of healing.”