ACR Updates Imaging Guidance for Recurrent Lower UTIs in Females (2026)

New ACR Appropriateness Criteria: routine imaging not indicated for uncomplicated recurrent UTIs in females. Complicated cases warrant ultrasound screening or CT urography; pregnant patients: ultrasound first, noncontrast MRI selectively.

• Evidence-based guideline update covering three populations: uncomplicated adults, complicated adults, and pregnant patients with recurrent lower UTIs (≥3 infections/12 months).
• CT urography is the preferred comprehensive imaging modality in complicated patients (obstruction, stones, diverticula, fistulas); ultrasound serves as a reasonable first-line screen.
• Limitation: in areas where peer-reviewed evidence is lacking or equivocal, expert opinion serves as the primary evidentiary source, which may reduce recommendation strength.

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