| Title |
Recalcitrant chronic bladder pain and recurrent cystitis but negative urinalysis: What should we do?
|
|---|---|
| Published in |
International Urogynecology Journal & Pelvic Floor Dysfunction, March 2018
|
| DOI | 10.1007/s00192-018-3569-7 |
| Pubmed ID | |
| Authors |
Sheela Swamy, William Barcella, Maria De Iorio, Kiren Gill, Rajvinder Khasriya, Anthony S. Kupelian, Jennifer L. Rohn, James Malone-Lee |
| Abstract |
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. Over 10 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. We treated 624 women [mean age = 53.4 years; standard deviation (SD) = 18] with chronic LUTS and pyuria. 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% confidence interval (CI) = 337-428]. Treatment was associated with a reduction in total LUTS (F = 98; p = 0.0001), 24-h frequency (F = 75; p = 0.0001), urinary urgency (F = 90; p = 0.0001), lower urinary tract pain (F = 108; p = 0.0001), voiding symptoms (F = 10; p = 0.002), and pyuria (F = 15.4; p = 0.0001). Full-dose first-generation antibiotics for UTI, such as cefalexin, nitrofurantoin, or trimethoprim, were 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. 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 randomized controlled trial (RCT). |
X Demographics
The data shown below were collected from the profiles of 97 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 31 | 32% |
| Australia | 9 | 9% |
| United States | 7 | 7% |
| Sweden | 2 | 2% |
| Spain | 1 | 1% |
| Belgium | 1 | 1% |
| India | 1 | 1% |
| Portugal | 1 | 1% |
| Ireland | 1 | 1% |
| Other | 0 | 0% |
| Unknown | 43 | 44% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 75 | 77% |
| Practitioners (doctors, other healthcare professionals) | 12 | 12% |
| Scientists | 5 | 5% |
| Science communicators (journalists, bloggers, editors) | 2 | 2% |
| Unknown | 3 | 3% |
Mendeley readers
The data shown below were compiled from readership statistics for 71 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 71 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 12 | 17% |
| Student > Master | 9 | 13% |
| Student > Bachelor | 7 | 10% |
| Student > Ph. D. Student | 6 | 8% |
| Other | 6 | 8% |
| Other | 13 | 18% |
| Unknown | 18 | 25% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 24 | 34% |
| Immunology and Microbiology | 5 | 7% |
| Biochemistry, Genetics and Molecular Biology | 4 | 6% |
| Nursing and Health Professions | 4 | 6% |
| Agricultural and Biological Sciences | 4 | 6% |
| Other | 8 | 11% |
| Unknown | 22 | 31% |
Attention Score in Context
This research output has an Altmetric Attention Score of 166. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 12 March 2024.
All research outputs
#250,914
of 25,791,949 outputs
Outputs from International Urogynecology Journal & Pelvic Floor Dysfunction
#6
of 2,916 outputs
Outputs of similar age
#5,736
of 349,237 outputs
Outputs of similar age from International Urogynecology Journal & Pelvic Floor Dysfunction
#1
of 46 outputs
Altmetric has tracked 25,791,949 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 99th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 2,916 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 5.1. This one has done particularly well, scoring higher than 99% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 349,237 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 98% of its contemporaries.
We're also able to compare this research output to 46 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 97% of its contemporaries.