“It’s another water infection — and there was blood again. The hospital says I’m fine, but I’m not.”

Recurrent UTI (two or more in six months, or three or more in twelve) needs a search for modifiable causes once structural disease has been excluded — and the commonest are found in the history, not the scan: post-coital timing, genitourinary syndrome of menopause, douching or spermicides, low fluid intake, incontinence and incomplete emptying. In women with recurrent UTI, send urine for culture rather than relying on dipstick. Visible haematuria during a proven infection, with a normal cystoscopy and CT urogram three weeks earlier, is very likely inflammatory, but repeat urinalysis after treatment closes the loop. NICE NG112 (updated 2024) sets out the prevention ladder: behavioural and personal-hygiene advice; vaginal oestrogen for postmenopausal women; single-dose antibiotic prophylaxis after exposure to a trigger, or daily prophylaxis; and methenamine hippurate as an alternative to daily antibiotics. Here the complication is an aromatase inhibitor: NICE NG23 advises non-hormonal treatments first and, for women on aromatase inhibitors, agreeing options for persistent genitourinary symptoms with the breast cancer specialist. Talking about sex plainly and positively — especially with an older woman in a new relationship — is part of good clinical care.