A prospective observational study of urinary cytokines and inflammatory response in patients with Overactive Bladder Syndrome

Kiren Gill,Harry Horsley,Rajvinder Khasriya,James Malone-Lee,Sheela Swamy

doi:10.1186/s12894-021-00809-4

Abstract

BackgroundContemporary studies have discredited the methods used to exclude urinary tract infection (UTI) when treating overactive bladder (OAB). Thus we must revisit the OAB phenotype to check that UTI has not been overlooked.AimsTo examine the differences in urinary cytokines IL6 and lactoferrin in OAB patients compared to controls, with references to microscopy of urine and enhanced quantitative urine culture.MethodsA blinded, prospective cohort study with normal controls using six repeated measures, achieved two-monthly, over 12 months.ResultsThe differences between patients and controls in urine IL6 (F = 49.0, p < .001) and lactoferrin (F = 228.5, p < .001) were significant and of a magnitude to have clinical implications. These differences were for lactoferrin correlated to symptoms (9.3, p = .003); for both to pyuria (IL6 F = 66.2, p < .001, Lactoferrin F = 73.9, p < .001); and for IL6 microbial abundance (F = 5.1, p = .024). The pathological markers had been missed by urinary dipsticks and routine MSU culture.ConclusionThe OAB phenotype may encompass patients with UTI that is being overlooked because of the failure of standard screening methods.

Highlights

Contemporary studies have discredited the methods used to exclude urinary tract infection (UTI) when treating overactive bladder (OAB)
The diagnosis is contingent on exclusion of urinary tract infection (UTI), usually achieved by bedside urinary dipstick testing and/or midstream culture analyses using Kass criterion for exclusion of infection [2]
Like others [4, 7], we found that the dipsticks and routine culture failed to discriminate between the OAB patients and normal controls

Summary

Introduction

Contemporary studies have discredited the methods used to exclude urinary tract infection (UTI) when treating overactive bladder (OAB). The diagnosis is contingent on exclusion of urinary tract infection (UTI), usually achieved by bedside urinary dipstick testing and/or midstream culture analyses using Kass criterion for exclusion of infection [2]. We reported significant differences in the urinary white cell and urothelial cell counts and in the results of spun sediment culture between OAB patients and normal controls, over a period of 12-months. Other surrogate markers of infection and inflammation: Spun sediment cultures, microscopic pyuria (WBC), and urinary uroepithelial cell (EPC) counts, revealed significant between group differences [5]. These data suggest that standard screening for UTI in

Methods

Results

Conclusion