Urinary tract infection (UTI) is one of the most common infections worldwide (Foxman, Am J Med. 113 Suppl 1A:5S–13S, 2002). Up to half of all women will experience one or more UTIs in their lifetime, and 10–15% will suffer from recurrent infections (Hooton, Int J Antimicrob Agents. 17(4):259–68, 2001). An increasing number of patients seen in a Urogynaecology/Urology clinic will complain of recurrent/chronic UTI (rUTI/cUTI). UTI causes a plethora of symptoms, including pain, urgency, frequency, incontinence, and systemic symptoms, including confusion and falls. Pyelonephritis and septicaemia are life-threatening (Foxman, Am J Med. 113 Suppl 1A:5S–13S, 2002; Hooton, Int J Antimicrob Agents. 17(4):259–68, 2001; England. Excellence in continence care. In: Health. NHS England, 2018). Acute UTI (aUTI) is usually responsive to a short course of oral antibiotics, but 28–37% of patients will not find relief from these limited regimens (Milo et al., Cochrane Database Syst Rev. (2):CD004682, 2005). Unfortunately, current guidelines advise that such women should be treated with MSU culture data. Urine culture has now been discredited beyond redemption, so it would seem that a large number of women who fail standard regimens for aUTI end up with untreated persisting infection. Here we outline the patient history, investigations, and management of UTI, particularly cUTI and rUTI, which are ill-served by current guidelines. The published science shows that the diagnosis and management should hinge only on the symptoms and signs 90% of the time (Khasriya et al., Int Urogynecol J. 29(7):1019–28, 2018).