The diagnosis of urinary tract infections should be based on the patient's symptoms, such as dysuria, frequency, and urgency with the absence of vaginal discharge. The urine culture is only recommended in cases with atypical symptoms, pregnant women, or those who do not respond to empirical antimicrobial treatment. Therefore, treatment should be prescribed according to symptoms. Questionnaires help get an accurate diagnosis. The acute cystitis symptoms score (ACSS) developed by the European Association of Urology (EAU) Section of Infections in Urology (ESIU) is useful for the diagnosis of acute cystitis. It is also developed for differential diagnoses such as vaginosis and acute pyelonephritis.

The questionnaire includes the assessment of typical symptoms, differential symptoms and the effect on the quality of life. The questionnaire is validated in several languages, such as Russian, English, German, and Italian. The article reported the validation of the questionnaire to Spanish, including patients from Spain and America. The study showed that the ACSS questionnaire is a reliable, valid, and easy-to-use questionnaire that can evaluate patients' symptoms and clinical outcomes with acute cystitis. It can be used as a patient's self-diagnosis and help to rule out other pathologies in patients with the voiding syndrome.

Urinary pH has several implications for patients with urinary tract infections. Urinary pH influences the potential growth of bacteria, and low pH may protect against urinary tract infections. Moreover, not all antibiotics will have the same effects at different pH. Therefore, pH modifiers such as L-methionine (Metiofitina®) have reduced the incidence of urinary tract infections. The basis for urine acidification with L-methionine is intended for acidophilic antibiotics. It works synergistically by increasing antibiotic urine concentration, promoting its bioactive chemical state, and making uropathogens more sensitive to iron chelation, an essential nutrient they need to survive and proliferate.

The study reviews the evidence for both in vitro and in vivo studies. The pH of urine influences the ionization state of antibiotics. Fluoroquinolones, aminoglycosides, and trimethoprim have a better profile in alkaline pH. Acid urine pH is associated with a higher resistance rate to fluoroquinolones. On the other hand, fosfomycin, tetracycline, nitrofurantoin and some Beta-lactams are better recommended in acid pH.

The study of the microbiome is currently a topic of interest. Alterations in the urine and intestinal are associated with several disorders, such as recurrent urinary infections, overactive bladder, and pelvic pain. Patients with recurrent urinary tract infections frequently receive antibiotics that lead to significant changes in the intestinal microbiota and cause the possibility of urinary tract infection recurrence.

Antibiotic selection is also important as all antibiotics' influence on microbiota differs. It seems that phenoxymethylpenicillin, nitrofurantoin, and amoxicillin had the slightest effect. Prebiotics and probiotics have been proposed as a tool to correct microbiota disorders. Currently, a clear recommendation is not available and large-scale, high-quality research is required to determine the importance of probiotics in UTI prevention and treatment.

Finally, diet is another point that may be useful in restoring intestinal microbiota. The study concludes that maintaining a healthy intestinal microbiota and correcting dysbiosis may be a promising method for the treatment and prevention of urinary tract infections.