Do you initiate vaginal estrogen for recurrent UTI prevention without a urology referral in a postmenopausal woman with no anatomic or structural risk factors?

Clinical practice data suggest fewer than 1 in 7 eligible patients receive any UTI prophylaxis in primary care, and most PCPs defer vaginal estrogen and other preventive measures to subspecialty evaluation despite AAFP guidance supporting PCP-initiated management of uncomplicated recurrent UTI.