The relative incidence of detrusor instability and bacterial cystitis detected on the urodynamic‐test day

Abstract

Objective To determine whether patients with detrusor instability (DI) were more likely to have bacterial cystitis or signi®cant bacteriuria on the urodynamictest day than were women with a stable bladder. Patients and methods A catheter specimen of urine was cultured (overnight in air) from 862 consecutive women at the time of urodynamic testing. The upper urinary tract was imaged, with cystoscopy when indicated, to exclude upper tract lesions or malignancy. The percentage of patients with pure idiopathic DI and those with mixed DI/genuine stress incontinence (GSI), in whom the urine culture was positive, was compared with the percentage who had a stable bladder (pure GSI or urodynamically normal) and a positive urine culture, both for the entire dataset and for women aged > or <65 years. Data were also analysed to detect the converse relationship; in those women found to have bacterial cystitis, the relative risk of being found urodynamically unstable or stable was determined. Results The likelihood of bacterial cystitis occurring in patients with idiopathic DI (5.6%) was signi®cantly greater than that in patients with GSI (1.1%; P = 0.009, Fisher's exact test). The proportion of patients with DI and signi®cant bacteriuria (15.4%) was signi®cantly greater than that in patients with GSI (7.9%; P = 0.02). In patients with combined pure and mixed DI, bacterial cystitis was signi®cantly more likely to occur (6.3%) than in GSI (P <0.001), but bacteriuria was no more likely (12.5%, P = 0.09). Conversely, of those women found to have bacterial cystitis, the relative risk of having an unstable bladder was increased (+1.56), but for those with bacteriuria the relative risk of detrusor instability was not increased. Conclusion There was a signi®cant association between idiopathic DI and bacterial cystitis, and we suggest that in some women with an unstable bladder, urinary infection may enhance detrusor contractility. Nevertheless, large-scale studies are needed of the temporal relationship between the onset of bacterial cystitis and the onset of DI.

Involuntary Detrusor Contraction Is a Frequent Finding in Patients with Recurrent Urinary Tract Infections

“…Although some authors [6,7] have studied the relationship between bacterial cystitis and urodynamically proven IDC, these studies were performed in an era during which the definition of involuntary detrusor (detrusor instability) was not well established or when it was only applicable to cases with high-amplitude detrusor contractions (>15 cm H 2 O); therefore, many cases that would now be diagnosed with detrusor overactivity or OAB were overlooked.…”

“…In the same manner, nonbacterial urinary tract symptoms may be related to the troublesome symptoms that are not due to any endotoxin but are only due to dysfunctional voiding that presents as a cystitis-like syndrome [7]. …”

“…Moore et al [7] previously established the frequency of documented bacterial cystitis in patients with pure idiopathic IDC (5.6%) when submitted to urodynamic catheterisation compared to those without pure idiopathic IDC (1.1%). In the same study, the proportion of patients with detrusor overactivity and significant bacteriuria (15.4%) was significantly greater than that in the patients with stable bladders (7.9%; p = 0.02).…”

“…As stated by Moore et al [7] or by Shekarriz et al [20] in women and girls, respectively, bladders with bacterial growth are not more likely to be unstable, and bacteriuria alone does not appear to induce detrusor instability [6]; however, experimental studies have shown that induction of inflammation or ischemia that is severe enough to disrupt the surface epithelium evokes afferent discharges with rhythmic bladder contractions [21]. …”

The Relaxing Effect of α-Defensin 1 on the Adrenergic Responses of Rat Bladder

“…As we previously mentioned, the effects of α-Defensin 1 on the contractility of vascular smooth muscle are yet unclear, being a subject of debate. There was a significant association between idiopathic instability of the detrusor muscle and bacterial cystitis and also reported that, in some women with an unstable bladder, urinary infection may enhance contractility of the detrusor muscle [16].…”