Document Overview

Document Title

Recurrent Lower Urinary Tract Infections in Females

Authoring Society

American College of Radiology

Document Publication Date

Apr 13, 2026

Page Last Reviewed/Updated

May 6, 2026

Document Type

Appropriate Use Criteria

Country of Publication

United States

Full Text Freely Available

Yes

Full Text Guideline

www.jacr.org/article/S1546-1440(26)00158-4/fulltext

Source Citation

Expert Panel on Urological Imaging; Ward RD, Allen BC, Turkbey B, Ariyibi O, Cameron AP, Costa DN, Gerena M, Harmath C, Lalani T, Lew SQ, Whitworth P 3rd, Khatri G. ACR Appropriateness Criteria® Recurrent Lower Urinary Tract Infections in Females: Update 2026. J Am Coll Radiol. 2026 Apr 7:S1546-1440(26)00158-4. doi: 10.1016/j.jacr.2026.03.006. Epub ahead of print. PMID: 41973892.

Document Scope, Criteria, and Use Cases

Document Objectives

Urinary tract infections (UTIs) are common in females and usually originate in the lower urinary tract. Recurrent UTIs, defined as three infections within 12 months, may be uncomplicated, occurring without underlying abnormalities, or complicated, when structural, functional, or systemic factors increase susceptibility. Complicated and recurrent UTIs, including those during pregnancy, require careful evaluation because pregnancy and comorbidities increase the risk of recurrence and serious maternal and fetal complications. This review outlines initial imaging strategies for uncomplicated adults, complicated adults, and pregnant patients. In uncomplicated patients without risk factors, routine imaging is generally not indicated due to low diagnostic yield. In complicated patients, imaging is appropriate to evaluate for obstruction, stones, diverticula, fistulas, or other structural causes; ultrasound is a reasonable screening tool, whereas CT urography is typically preferred for comprehensive evaluation. In pregnant patients, imaging is reserved for suspected complications, with ultrasound preferred and noncontrast MRI used selectively. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Scope

Assessment and Screening

Diseases/Conditions (MeSH)

D014552 - Urinary Tract Infections

Keywords

Lower Urinary Tract Infection, Recurrent Lower Urinary Tract Infections, Urinary tract infections (UTIs), appropriate use criteria

Inclusion Criteria

Female, Adult, Older Adult

Health Care Settings

Ambulatory, Radiology Services

Intended Users

Nurse, Nurse Practitioner, Physician, Physician Assistant, Radiology Technologist