Bladder Ultrastructure and Urinary Cytokine Abnormality in Patients with Recurrent Urinary Tract Infection and the Changes after Intravesical Platelet-Rich Plasma Injections

Abstract

This study investigates the bladder from patients with recurrent urinary tract infection (rUTI) at baseline and after intravesical platelet-rich plasma (PRP) injections. Patients with rUTI who underwent repeated intravesical PRP injections provided bladder and urine specimens at baseline and after treatment. Bladder specimens were investigated with electron microscopy and Western blotting. The urine sample was analyzed with commercially available Milliplex immunoassays. A total of 29 patients were enrolled. At baseline, the rUTI bladders exhibited defects of integrity in umbrella cells, a widened tight junction, and lysed organelles. Intracellular bacterial community incubations in the epithelial cells were also noted. Improvement in bladder defects after PRP injection was noted in 25–42% of patients. Bladder UPK3 expression was significantly lower in the patients with rUTI than in controls. Baseline levels of urinary inflammatory cytokine interleukin (IL)-6, IL-8, and brain-derived neurotrophic factor were higher in the patients with rUTI than in the controls, but there were lower levels of vascular endothelial growth factor and nerve growth factor. In the patients with rUTI who recovered from acute infection, the bladders still had immature urothelium, various ultrastructural defects, and elevated urinary inflammatory cytokines. PRP injection has the potential to promote bladder recovery in some of these patients.

Effectiveness of Platelet-Rich Plasma Injections as Prophylaxis for Recurrent Urinary Tract Infection in Women

“…Therefore, urothelial dysfunction and barrier deficits persist after acute UTI episodes, as the bladders still had immature urothelium, various ultrastructural deficits, and elevated urinary inflammation, which may result in rUTI after antibiotic treatment is discontinued [ 8 ]. Intravesical PRP injections have been shown to improve basal cell proliferation in diseased bladders and increase uroplakin expression, which are crucial to restoring the normal bladder mucosal barrier [ 26 ]. In this regard, eliminating chronic inflammation by repeated PRP injections may improve urothelial regeneration and differentiation and rebuild the defense mechanism of the diseased bladder.…”

Safety and efficacy of nightly nitrofurantoin as prophylaxis in dogs with recurrent urinary tract infections: 13 cases (2015‐2021)

“…However, after injury, the bladder urothelium can rapidly reepithelialize, complete by 3 to 9 weeks in dogs (Grotzinger et al 1954, Wishnow et al 1989. Damaged or immature urothelium might be a risk factor for rUTIs (Chuang & Kuo 2013, Jhang et al 2022. In addition, viable bacteria harboured in transitional epithelial cells can re-emerge during cell turnover (Mysorekar & Hultgren 2006).…”

“…Damaged or immature urothelium might be a risk factor for rUTIs (Chuang & Kuo 2013, Jhang et al . 2022). In addition, viable bacteria harboured in transitional epithelial cells can re‐emerge during cell turnover (Mysorekar & Hultgren 2006).…”

Conditions Diagnosed on Bladder Biopsy in Adult Female Patients with Lower Urinary Tract Symptoms (LUTS) Refractory to Medical Treatment

“…For example, urinary incontinence, or involuntary leakage of urine, is one of the most commonly investigated sources of LUTS and reportedly affects between 13%-46% of Australian women 16 . However, urinary incontinence is an umbrella term which encompasses a range of leakage sub-types, such as stress urinary incontinence (SUI, leakage during physical activity), urge urinary incontinence (UUI, leakage associated with urgency) and mixed urinary incontinence [17][18][19] .…”