Bladder Washout Research Articles

Pyelonephritic Scarring in 213 Patients with Upper and Lower Urinary Tract Infections: Long-Term Followup

Of 213 patients more than 3 years old with recurrent urinary tract infections new pyelonephritic scars formed only among those with a combination of urinary tract infection and vesicoureteral reflux. Of 61 patients with that combination new renal pyelonephritic scars developed in 7 (11.48 per cent) and severe clubbing in 2. Of 40 patients with vesicoureteral reflux who underwent an antireflux operation new scars formed in 5 and progressive renal damage occurred in 1. Most renal scars (58) were present at initial examination.Neither number of urinary tract infections, number of upper urinary tract infections localized by the bladder washout technique nor attacks of flank pain and fever were seen more often in patients who suffered new scars, and grade of reflux was not a factor. Patients in whom new scars developed during our prospective followup were younger than those who did not have new scars. However, new scars formed after an initial normal excretory urogram in only 1 patient with vesicoureteral reflux and urinary tract infection compared to 4 after an antireflux operation.

Correlation of Symptoms and Results Direct Bacterial Localization Patients with Urinary Tract Infections

During the last 8 years we localized 725 urinary tract infections in 213 patients via the bladder washout test. With this test the infections were located in the upper urinary tract in 11.9 per cent of the patients without vesicoureteral reflux, 27.1 per cent with reflux and 25.3 per cent without reflux after a successful antireflux operation.Of all supravesical and vesical bacteriuric episodes 57.6 and 67.1 per cent, respectively, were asymptomatic. The presence of symptoms differed only slightly among patients with and without reflux, and with and without pyelonephritic scars. Vesical symptoms, such as dysuria and frequency, were seen in 18.8 per cent of the patients with supravesical and 26.2 per cent with vesical infections, while fever and/or loin pain occurred in 23.6 and 6.7 per cent, respectively. However, urinary tract infections with loin pain and/or fever were localized evenly between the bladder and upper urinary tract.We conclude that factors other than the site of infection determine the presence or absence of symptoms.

URINARY LDH IN URINARY TRACT INFECTIDNS

Three published reports show increased activity of the slow moving LDH isoenzymes in the urine of children with upper urinary tract infections. We studied urinary LDH enzyme activity during 88 urinary tract infections in girls in whom the site of infection was localized using the bladder washout test (BWO).These data do not distinguish patients with upper tract from those with lower tract infections. We also compared urinary LDH activity in girls with BWO confirmed clinical cystitis with those with BWO confirmed clinical pyelonephritis.There were no significant differences in LDH activity between these two groups of patients.

Symptomatic urinary tract infections in patients on maintenance hemodialysis.

15 episodes of symptomatic urinary tract infection are described in 11 patients on maintenance hemodialysis. The diagnosis was confirmed by clean-catch or simple voided urine samples where possible, urethral catheterization and bladder washout being used only in anuric patients. Treatment with oral antibiotics proved successful in 13 episodes but 2 patients with polycystic kidneys were admitted to hospital for intravenous therapy. Urinary tract infections are common in dialysis patients including those who are anuric, and patients with polycystic kidneys have an increased risk of serious complications.

Failure of Antibody-coated Bacteria and Bladder Washout Tests to Localize Infection in Spinal Cord Injury Patients

AbstractThe validity of the antibody-coated bacteria test and Fairley washout procedure to determine whether urinary tract infections were of kidney or bladder origin in spinal cord injury patients was assessed by comparing test results with those obtained from culture of ureteral urine specimens. It was concluded that neither the presence of antibody-coated bacteria nor a positive bladder washout test can be considered as definitive evidence that bacteriuria is of renal origin in these patients.

Site of urinary tract infection in elderly women admitted to an acute geriatric assessment unit.

There have so far been no reported studies of localization of urinary tract infection (UTI) in elderly women. The site of infection, renal or bladder, in significant urinary tract infection in 50 elderly women (mean age 80) admitted acutely to a geriatric unit was determined by the Fairley bladder washout method. Of the 31 patients with an unequivocal result, 17 (55%) had renal infection and in only 14 (45%) was the infection confined to the bladder. This study has shown that, contrary to widely-held belief and standard teaching, in over 50% of cases of UTI in elderly hospitalized female patients the infection is renal.

Serum C-reactive protein and the site of urinary tract infections

Elevated surum levels of C-reactive protein have been found regularly in girls with acute clinical pyelonephritis but only infrequently in those with clinical cystitis. Based on these data, the suggestion has been made that elevated serum CRP concentrations may be useful in identifying patients with upper urinary tract infections. In a study in which the bladder washout test was used to localize the site of urinary tract infections, we identified nine girls with renal bacteriuria who did not have clinical findings suggesting acute pyelonephritis; four of these girls had serum CRP concentrations less than 10 micrograms/ml. Twenty-eight girls had bladder washout-proven lower urinary tract infections; three of these had serum CRP values greater than 30 micrograms/ml. These studies show that an elevated serum CRP concentration is not accurate in localizing the site of a urinary tract infection in girls who do not have clinical signs of acute pyelonephritis.

1505 LOCALIZATION OF THE SITE OF URINARY TRACT INFECTIONS USING SERUM C-REACTIVE PROTEIN (CRP)

The CRP test has been used as an indication of the presence or absence of kidney inflammation during urinary tract infections. However, only Jodal's group has reported a study of this application. In our studies the concentration of serum CRP, measured by radial immunodiffusion, are compared with the site of infection determined by bladder washout (BWO) and by clinical criteria. The table shows that 9 of 16 children with upper tract infection by BWO had serum CRP levels >25 μg/ml while only 4 of 28 with lower tract infection had values in this range. Four of 6 children with upper tract infection by BWO and clinical acute pyelonephritis had serum CRP levels >25 μg/ml. However, the CRP levels were <25 μg/ml in 5 of 7 children with upper tract infections by BWO and clinical diagnoses of cystitis or asymptomatic bacteriuria. This suggests that the CRP test may be unreliable for localization of the site of infection in the clinical situation in which this information is most needed.

1494 UTI IN GIRLS: COMPARISON OF BLADDER WASHOUT LOCALIZATION TECHNIQUE WITH URINARY LDH ACTIVITY

Recent reports suggest that elevated urinary LDH isoenzyme 5 activity is a reliable tool to separate upper from lower urinary tract infection. Total urinary LDH enzyme activity and isoenzyme activity were performed in urine from 52 episodes of urinary tract infection studied with the bladder washout technique. The technique for LDH determination includes dialyzing the urine, concentrating it and electrophoresis on cellulose acetate. Thirty-seven infections were localized by bladder washout to the lower tract and 15 to the upper tract. Urines from 33 girls without urinary infection were also analyzed for LDH. There was a significant difference between the total LDH enzyme activity from the “control” group compared with the groups with urinary infection. However, neither total LDH nor % LDH isoenzyme 5 served to distinguish lower from upper tract infection. The marked variations in the total LDH enzyme activity as well as the % of urinary LDH isoenzyme 5 activity are evident in the large standard deviation of the mean values derived from both control and infected subjects. Urinary LDH enzyme activity and percentage LDH isoenzyme 5 do not appear to separate upper from lower urinary tract infections.

Localization of the site of urinary tract infections with the bladder washout test

The data from 100 bladder washout studies on pediatric patients have been analyzed to derive criteria for interpretation of this test and to define the limitations of this procedure in localization of the site of urinary tract infections. Using the bladder washout test, infection of the upper urinary tract is characterized by an abrupt increase in the concentration of bacteria in urinary specimens collected following urinary bladder sterilization. Infection limited to the lower urinary tract is characterized by scant if any bacterial growth in the specimens of urine collected following bladder sterilization. The site of infection may be incorrectly localized to the lower urinary tract or classified as not determined in patients with scant or intermittent renal bacteriuria.

Intravesical Prostaglandin: Release and Effect of Bladder Instillation on some Micturition Parameters

Bladder washout effluent fluid was examined for prostaglandin-like activity following acidic lipid extraction and bioassay using the rat-stomach strips technique. A low basal level of prostaglandin-like material was detected in washouts collected when the bladder was empty in 4 out of 7 dogs. Increased levels were detected following micturition in 5 of these 7 dogs. A significantly high level of prostaglandin-like material was recovered after pelvic nerve stimulation. The prostaglandin-like material was tentatively identified as PGE based on the bioassay with the addition of specific antibody. Intravesically administered PGE2 or PFG2 alpha significantly reduced, in a dose-dependent response, the threshold micturition volume. All of these findings suggested that prostaglandins may play a role in the micturition process.

IDENTIFICATION OF SITE OF URINARY-TRACT INFECTIONS BY ANTIBODY-COATED BACTERIA ASSAY

Accurate identification of the site of urinary-tract infection (UTI) may be clinically and epidemiologically valuable. A review of the literature on the assessment of the antibody-coated bacteria (ACB) assay, a non-invasive technique introduced five years ago, shows that, compared with acceptable standards (bilateral ureteral catheterisation or bladder washout), the overall sensitivity of the ACB assay is 83·1%, the specificity is 76·7%, the predictive value positive is 81·3%, and the predictive value negative is 78·8%. These findings suggest that the ACB assay has at present no role in the management of patients with UTI. Its usefulness as an epidemiological tool remains to be demonstrated.

Comparison of Urinary Lactic Dehydrogenase with Antibody-Coated Bacteria in the Urine Sediment as Means of Localizing the Site of Urinary Tract Infection

Two noninvasive methods of localizing the site of urinary tract infection, urinary lactic dehydrogenase (LDH) isoenzymes and antibody coating of bacteria in the urinary sediment, have been prospectively compared with the bladder washout technique in a series of children with urinary tract infection. Fifteen children had infection localized in the upper tract. Urinary LDH isoenzymes correctly localized the infection in 14 children; however, the infection was correctly localized by the antibody coating of bacteria in only eight patients (P less than .02). Fourteen children had lower tract infection by the bladder washout technique. Urinary LDH isoenzymes localized the infection in all 14 children, whereas the antibody coating correctly localized the infection in ten children (P less than .05). This study shows the urinary LDH isoenzyme pattern to be a more accurate technique than the detection of antibody-coated bacteria for localizing the site of urinary tract infection.

Localization of Urinary Tract Infection

Both the antibody-coating and LDH isoenzyme techniques theoretically fulfill the criteria for an ideal localization test. Both are noninvasive. They are relatively easy to perform and well within the capability of most clinical laboratories. Both can be done rapidly and the results can be in the clinician's hands in a matter of a few hours. The results of the antibody-coating technique do not appear to be valid for children. Since only one controlled study with comparison with other localization techniques has been done in adults, further evaluation needs to be done. The LDH isoenzyme pattern has not been studied in adults but appears to be accurate in children. A prospective comparison of both procedures in adults using either the Fairly bladder washout technique or the Stamey ureteral catheterization method to localize definitively the site of infection would be most helpful. Definitive noninvasive localization techniques could lead to therapy being initiated with the site of infection defined. This would facilitate earlier and more intensive antibiotic therapy in those patients at risk for renal parenchymal damage from upper tract infections.

Influence of mucoidy on antibody coating of Pseudomonas aeruginosa.

Antibody-coated bacteria were found in only two of 34 urine sediments from 19 catheterized patients infected with a single epidemic strain of Pseudomonas aeruginosa, whereas 12 of 19 urine sediments from 16 outpatients contained antibody-coated P. aeruginosa. In urine sediments, individual cells and microcolonies of the epidemic strain of P. aeruginosa were enclosed in ruthenium red (polysaccharide)-positive material. This strain was extremely mucoid when grown in a liquid medium for enhancement of mucoid formation. Renal infections was present in some patients, as determined by the bladder washout test and by titers of antibody in serum, and antibody was present in the urine but not coating P. aeruginosa. We conclude that the mucoid layer interfered with antibody coating of the epidemic strain of P. aeruginosa.

Urinary lactic dehydrogenase isoenzyme IV and V in the differential diagnosis of cystitis and pyelonephritis

To ACCOMPLISH precise localization of the site of urinary tract infection, direct and indirect methods have been developed. The former include culture of kidney biopsy tissue or of ureteral urine, and the bladder washout test1; the latter include assessment of maximal urine concentrating capacity, determination of specific serum antibodies to the infiltrating organism, urinary enzyme assays such as catatase and fl-glucyronidase 2, and calculation of urinary leukocytes, leukocyte casts, or antibodycoated bacteria? The present investigation was undertaken to determine if urinary lactic dehydrogenase isoenzymes could be used to differentiate accurately between pyelonephritis and cystitis?

Localization of Gram Negative Urinary Tract Infection by Immunofluorescence in Infants and Children

Barnett, G. R. and Abbott, G. D. (1978). Aust. Paediatr. J., 14, 143–146. Localization of gram negative urinary tract infection by immunofluorescence in infants and children. Bladder urine samples from 97 gram negative urinary tract infections (U.T.Is) in infants and children were tested for antibody coated bacteria (A.C.B.) by immunofluorescence (I.F.). A.C.B. were detected in 14 of 44 episodes of acute pyelonephritis, one of 20 episodes of probable cystitis and five of 33 episodes of asymptomatic bacteriuria. Bladder washout localization reinforced the conclusion that negative I.F. tests are common in upper U.T.Is in infants and children.An association between A.C.B. and renal scarring was observed. Eight of 17 patients with A.C.B. had reflux nephropathy compared with four of 49 patients without A.C.B. Limitations of the test as a screening procedure for renal scarring were evident, however, after finding nine patients with A.C.B. and no renal scarring as well as four patients with renal scarring and no A.C.B.

The management of indwelling catheters.

Eighteen geriatric patients with indwelling catheters were observed for a total of 393 weekly urine specimens. The effects of a 1 week course of antibiotics/chemotherapeutic agent followed by urinary antiseptics for 6 weeks, and also of regular bladder washouts, were noted. All urine specimens were infected except 24% during antibiotic treatment and 9% during antiseptics and 6% after washouts. Only washouts reduced the extent of catheter blockage. There was little difference in the time in situ between silastic and latex Foley catheters--only 31% of silastic remaining for longer than 4 weeks. Bard-Roberts catheters were the least satisfactory. Catheter leakage was not affected by urinary pH. Further development in long-term catheter management are needed.

Localization of the site of urinary tract infections by means of antibody-coated bacteria in the urinary sediments

A prospective study was conducted in children with urinary tract infections to examine the relationship between the presence of antibody-coated bacteria in the urinary sediments and the presence of pyelonephritis. The site of the urinary tract infection was localized as upper or lower urinary tract by the bladder washout technique. Antibody-coated bacteria in the urinary sediments were identified by an immunofluorescent method. In 4 of 12 children with upper urinary tract infections, less than 1% of the bacteria in the urinary sediments were antibody coated. In 10 of 35 children with lower urinary tract infections more than 50% of the bacteria in the urinary sediments were antibody coated. These studies show no significant correlation between the presence of antibody-coated bacteria in urinary sediments and infection of the upper urinary tract.

The effect of urinary glucose excretion on the plasma glucose clearances and plasma insulin responses to intravenous glucose loads in unanaesthesized dogs.

The effect of urinary glucose excretion on the plasma glucose clearance and insulin response to varying sizes of glucose loads was studied in normal unanaesthesized dogs. Glucose loads ranging from 0.15 to 1.25 g/kg b.w. were infused intravenously in a standard time period of 30 seconds. Plasma glucose and plasma immunoreactive insulin (IRI) concentrations were determined during one-hour after infusion. All urine excreted during the one-hour was collected by a catheterization and bladder wash-out procedure. The urinary glucose excretion was expressed as the percent of the glucose load. The urinary glucose excretion varied directly with the size of the glucose load and ranged from minimal to 12%. This would indicate that urinary losses play a considerable role proportionate to the degree of hyperglycaemia above the renal threshold. Thus, urinary loss of glucose must be recognized as an important factor infuencing the plasma glucose clearance and hence the plasma IRI response. A glucose load of 0.5 g/kg b.w. given in 30 seconds with the k-value calculated between 15-45 min would minimize the influence of urinary loss and provide more accurate plasma clearance values.