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Formaldehyde is the active agent responsible for bacteriostasis and bactericidal activity in the urinary tract [ This mechanism is supported by randomized controlled trials and meta-analyses, which consistently report that methenamine is effective in reducing the incidence of recurrent UTIs, particularly in patients without renal tract abnormalities or neuropathic bladder [ Importantly, the antiseptic effect of methenamine is contingent on maintaining acidic urine, and its efficacy may be reduced in patients with alkaline urine or impaired renal function