PMID- 29556674
OWN - NLM
STAT- MEDLINE
DCOM- 20181105
LR  - 20181114
IS  - 1433-3023 (Electronic)
IS  - 0937-3462 (Print)
IS  - 0937-3462 (Linking)
VI  - 29
IP  - 7
DP  - 2018 Jul
TI  - Recalcitrant chronic bladder pain and recurrent cystitis but negative urinalysis: 
      What should we do?
PG  - 1035-1043
LID - 10.1007/s00192-018-3569-7 [doi]
AB  - PURPOSE: Lower urinary tract symptoms (LUTS) may be associated with chronic 
      urinary tract infection (UTI) undetected by routine diagnostic tests. 
      Antimicrobial therapy might confer benefit for these patients. MATERIALS AND 
      METHODS: Over 10 years, we treated patients with chronic LUTS. Pyuria was adopted 
      as the principal biomarker of infection. Urinary leucocyte counts were recorded 
      from microscopy of fresh midstream urine (MSU) samples. Antibiotics were 
      prescribed and the prescription adjusted to achieve a measurable clinical 
      response and a reduction in pyuria. RESULTS: We treated 624 women [mean 
      age = 53.4 years; standard deviation (SD) = 18] with chronic LUTS and pyuria. 
      Mean duration of symptoms prior to presentation was 6.5 years. Only 16% of MSU 
      cultures submitted were positive (>/=10(5) cfu ml(-1)). Mean treatment length was 
      383 days [SD = 347; 95% confidence interval (CI) = 337-428]. Treatment was 
      associated with a reduction in total LUTS (F = 98; p = 0.0001), 24-h frequency 
      (F = 75; p = 0.0001), urinary urgency (F = 90; p = 0.0001), lower urinary tract 
      pain (F = 108; p = 0.0001), voiding symptoms (F = 10; p = 0.002), and pyuria 
      (F = 15.4; p = 0.0001). Full-dose first-generation antibiotics for UTI, such as 
      cefalexin, nitrofurantoin, or trimethoprim, were combined with methenamine 
      hippurate. We recorded 475 adverse events (AEs) during 273,762 treatment days. 
      There was only one serious adverse event (SAE). We observed no increase in the 
      proportion of resistant bacterial isolates. CONCLUSION: This large case series 
      demonstrates that patients with chronic LUTS and pyuria experience symptom 
      regression and a reduction in urinary tract inflammation associated with 
      antimicrobial therapy. Disease regression was achieved with a low frequency of 
      AEs. These results provide preliminary data to inform a future randomized 
      controlled trial (RCT).
FAU - Swamy, Sheela
AU  - Swamy S
AUID- ORCID: 0000-0001-9039-1073
AD  - Centre for Nephrology, Division of Medicine, UCL, London, UK. sheswa@yahoo.com.
FAU - Barcella, William
AU  - Barcella W
AD  - Department of Statistical Science, Faculty of Mathematics and Science, UCL, 
      London, UK.
FAU - De Iorio, Maria
AU  - De Iorio M
AD  - Department of Statistical Science, Faculty of Mathematics and Science, UCL, 
      London, UK.
FAU - Gill, Kiren
AU  - Gill K
AD  - Hillingdon Hospitals NHS Trust, London, UK.
FAU - Khasriya, Rajvinder
AU  - Khasriya R
AD  - University College London Hospitals NHS Trust, London, UK.
FAU - Kupelian, Anthony S
AU  - Kupelian AS
AD  - University College London Hospitals NHS Trust, London, UK.
FAU - Rohn, Jennifer L
AU  - Rohn JL
AD  - Centre for Nephrology, Division of Medicine, UCL, London, UK.
FAU - Malone-Lee, James
AU  - Malone-Lee J
AD  - Centre for Nephrology, Division of Medicine, UCL, London, UK.
LA  - eng
PT  - Journal Article
DEP - 20180320
PL  - England
TA  - Int Urogynecol J
JT  - International urogynecology journal
JID - 101567041
RN  - 0 (Anti-Infective Agents, Urinary)
SB  - IM
MH  - Anti-Infective Agents, Urinary/*therapeutic use
MH  - Cystitis/*drug therapy/urine
MH  - Female
MH  - Humans
MH  - Lower Urinary Tract Symptoms/*drug therapy/microbiology
MH  - Middle Aged
MH  - New York
MH  - Pain
MH  - Pyuria/*physiopathology/urine
MH  - Urinalysis
MH  - Urinary Tract Infections/*drug therapy/urine
PMC - PMC6004281
OTO - NOTNLM
OT  - Bladder pain syndrome
OT  - Chronic UTI
OT  - Chronic bladder pain
OT  - Interstitial cystitis
OT  - Recalcitrant LUTS
OT  - Recurrent UTI
COIS- No author has a conflict of interest, except Dr. Jennifer Rohn, who is paid 
      1.5 days a week by AtoCap Ltd. (a startup Biotech company developing novel 
      therapies for chronic UTI)
EDAT- 2018/03/21 06:00
MHDA- 2018/11/06 06:00
PMCR- 2018/03/20
CRDT- 2018/03/21 06:00
PHST- 2017/10/28 00:00 [received]
PHST- 2018/01/17 00:00 [accepted]
PHST- 2018/03/21 06:00 [pubmed]
PHST- 2018/11/06 06:00 [medline]
PHST- 2018/03/21 06:00 [entrez]
PHST- 2018/03/20 00:00 [pmc-release]
AID - 10.1007/s00192-018-3569-7 [pii]
AID - 3569 [pii]
AID - 10.1007/s00192-018-3569-7 [doi]
PST - ppublish
SO  - Int Urogynecol J. 2018 Jul;29(7):1035-1043. doi: 10.1007/s00192-018-3569-7. Epub 
      2018 Mar 20.