Overactive bladder (OAB) is characterised by frequency, urgency and urge incontinence in the absence of infection. We have identified previously unrecognised pyuria in patients diagnosed as having OAB; associated with more severe symptoms.1 Antibiotic treatment of these patients is successful if maintained for long periods. Others have shown that bacteria can thrive in urothelium, resisting host immunity and antibiotics. It is also documented that inflammation, when caused by infection, is associated with increased ATP release from cells, and extracellular ATP signalling is involved in bladder sensation.We hypothesise that in OAB, with pyuria, there is enhanced ATP release from urothelium caused by intracellular bacteria, which ultimately results in increased sensory nerve excitation and heightened symptoms of OAB. Here we begin to investigate our hypothesis.Human bladder urothelium biopsies were obtained using cystoscopy. ATP release from urothelium was measured using a luciferin luciferase assay.Basal and stretch‐evoked (using a hypotonic solution) ATP release was significantly greater from the urothelium of pyuric OAB patients than from non‐pyuric OAB or asymptomatic patients.In summary, this data supports our hypothesis.1. Malone‐Lee et al, Urinary white cells and symptoms of the Overactive bladder. Urodyn. Supplement for International Continence Society (Rotterdam, 2007) Abstract 42.

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