Urinary Tract Infection in Overactive Bladder: An Update on Pathophysiological Mechanisms

Abstract

Overactive bladder (OAB) is a clinical syndrome defined by urinary urgency, increased daytime urinary frequency and/or nocturia, with or without urinary incontinence, that affects approximately 11% of the western population. OAB is accepted as an idiopathic disorder, and is charactersied clinically in the absence of other organic diseases, including urinary tract infection. Despite this, a growing body of research provides evidence that a significant proportion of OAB patients have active bladder infection. This review discusses the key findings of recent laboratory and clinical studies, providing insight into the relationship between urinary tract infection, bladder inflammation, and the pathophysiology of OAB. We summarise an array of clinical studies that find OAB patients are significantly more likely than control patients to have pathogenic bacteria in their urine and increased bladder inflammation. This review reveals the complex nature of OAB, and highlights key laboratory studies that have begun to unravel how urinary tract infection and bladder inflammation can induce urinary urgency and urinary frequency. The evidence presented in this review supports the concept that urinary tract infection may be an underappreciated contributor to the pathophysiology of some OAB patients.

Phytotherapy (BNO 1045) of Acute Lower Uncomplicated Urinary Tract Infection in Women Normalizes Local Host Responses

“…Both, urine IL-6 and IL-8 levels increase dramatically within hours of infection during uUTIs [22,23] and IL-6 is a biomarker that can differentiate UTI severity [14]. Both cytokines promote inflammation, which in turn leads to sensitization of sensory neurons and thereby contributes to symptoms such as dysuria, pollakisuria, and urgency [24]. In the present study, urinary IL-6 and IL-8 were analyzed on day 1 (visit 1; before treatment) and on day 8 (visit 3; end of treatment) in a subgroup of patients who fulfilled the same inclusion/exclusion criteria (e.g., ACSS sum score ≥6 for the three main uUTI symptoms dysuria, pollakisuria, and urgency) as the entire study population to elucidate the previously reported clinical efficacy of BNO 1045.…”

Pathophysiology of Overactive Bladder and Pharmacologic Treatments Including β3-Adrenoceptor Agonists -Basic Research Perspectives-

“…In one study, in which antibiotics were administered to OAB patients who tested negative for the conventional culture technique, symptoms improved in half of the patients [133]. In addition, using a new culture technology, approximately 39% of refractory OAB patients who had not been able to diagnose UTIs with existing culture technology had bacterial infections [134]. In UUI patients, bacterial DNA and higher bacterial load were found more frequently, and the diversity of the urinary microbiome was reduced [135][136][137].…”