The role of bacterial infection and inflammation in the generation of overactive bladder symptoms

There is substantial evidence of considerable insensitivity affecting the current tests used to screen for urinary infection. The studies within this thesis provide original work in examining the performance of recommended diagnostic tests for urinary tract infection, and explore the bacterial ecology of urinary infection and its associated urothelial inflammatory response in patients with symptoms of overactive bladder. The association between lower urinary tract inflammation, bacterial colonisation and the generation of overactive bladder symptoms was explored. An enhanced bacterial culture method was used and quantitative thresholds discredited. Comparative data from patients and controls demonstrated that bacterial urinary infection was evident in ninety percent of patients. Quantitative and qualitative differences in the bacterial ecology were found amongst patients and controls. These were associated with increased urothelial inflammation amongst patients. Adenosine-5'-triphosphate (ATP) is a neurotransmitter and inflammatory cytokine implicated in the pathophysiology of lower urinary tract disease. ATP additionally reflects microbial biomass, thus may function as a surrogate marker of urinary tract infection (UTI). The potential of urinary ATP in the assessment of lower urinary tract symptoms, infection and inflammation was tested. Sampling techniques suitable for clinical practice were validated. Urinary ATP was reviewed as a marker of infection in patients with lower urinary tract symptoms. Though it may have a role as a research tool, it was unconvincing as a surrogate, clinical diagnostic marker. Several urinary cytokines were explored and urinary IL6 and Lactoferrin varied in relation to surrogate markers of infection in patients with overactive bladder symptoms