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Recalcitrant chronic bladder pain and recurrent cystitis but negative urinalysis - what should we do?

Swamy, S; Barcella, W; De Iorio, M; Gill, K; Khasriya, R; Kupelian, AS; Rohn, JL; (2018) Recalcitrant chronic bladder pain and recurrent cystitis but negative urinalysis - what should we do? International Urogynecology Journal 10.1007/s00192-018-3569-7. (In press). Green open access

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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 ten 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; sd=18) with chronic LUTS and pyuria. The mean duration of symptoms prior to presentation was 6.5 years. Only 16% of MSU cultures submitted were positive (≥105 cfu ml-1). Mean treatment length was 383 days (SD=347; 95% CI=337-428). Treatment was associated with a reduction in total LUTS (F=98; p=.0001), 24-hour frequency (F=75; p=.0001), urinary 3 urgency (F=90; p=.0001), lower urinary tract pain (F=108; p=.0001), voiding symptoms (F=10; p=.002) and pyuria (F=15.4; p=.0001). Full-dose first-generation urinary antibiotic (such as cefalexin, nitrofurantoin, or trimethoprim) was 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 RCT.

Type: Article
Title: Recalcitrant chronic bladder pain and recurrent cystitis but negative urinalysis - what should we do?
Open access status: An open access version is available from UCL Discovery
DOI: 10.1007/s00192-018-3569-7
Publisher version: https://doi.org/10.1007/s00192-018-3569-7
Language: English
Additional information: © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Keywords: Chronic bladder pain, Bladder pain syndrome, recalcitrant LUTS, Chronic UTI, Recurrent UTI, Interstitial cystitis.
URI: http://discovery.ucl.ac.uk/id/eprint/10045225
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