TY  - JOUR
VL  - 29
PB  - Springer Verlag
SN  - 0937-3462
IS  - 7
JF  - International Urogynecology Journal
N1  - © 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.
EP  - 1043
KW  - Chronic bladder pain
KW  -  Bladder pain syndrome
KW  -  recalcitrant LUTS
KW  -  Chronic UTI
KW  -  Recurrent UTI
KW  -  Interstitial cystitis.
AV  - public
ID  - discovery10045225
TI  - Recalcitrant chronic bladder pain and recurrent cystitis but negative urinalysis - what should we do?
UR  - https://doi.org/10.1007/s00192-018-3569-7
Y1  - 2018/07//
A1  - Swamy, S
A1  - Barcella, W
A1  - De Iorio, M
A1  - Gill, K
A1  - Khasriya, R
A1  - Kupelian, AS
A1  - Rohn, JL
A1  - Malone Lee, J
N2  - 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.
SP  - 1035
ER  -