Overactive bladder in women: Does low‐count bacteriuria matter? A review

Walsh, Colin; Moore, Kate H.

doi:10.1002/nau.20927

“…This diagnostic threshold is important given the association between low-CFU bacteriuria count (<1,000 CFU per ml), urinary incontinence 50 and refractory LUTS. In those with a history of recurrent UTIs, requesting the results of the previous microscopy, culture and antibiotic sensitivity analyses can assist in confirming the diagnosis, determining the correct treatment based on sensitivities and determining whether the UTIs are recurrent or persistent 1 .…”

Section: Diagnosis Screening and Preventionmentioning

confidence: 99%

Urinary incontinence in women

Aoki

¹

,

Brown

²

,

Brubaker

³

et al. 2017

Nat Rev Dis Primers

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Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence.

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“…Several studies have suggested that this s-QBC cut-off may be inappropriate for some clinical conditions, and modified lower and higher cut-off values ranging from 10 3 to ≥10 6 CFU/ml have been proposed [30-33]. In addition, many laboratories continue to disregard s-QBC of <10 5 CFU/ml for Gram-positive bacterial uropathogens, and there remains debate regarding the prognostic value of s-QBC of <10 4 CFU/ml for diagnosis of UTI due to different organisms [34]. …”

Section: Introductionmentioning

confidence: 99%

Prognostic value of semi-quantitative bacteruria counts in the diagnosis of group B streptococcus urinary tract infection: a 4-year retrospective study in adult patients

Tan

¹

,

Ulett

²

,

Steele

³

et al. 2012

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BackgroundSemi-quantitative bacteruria counts (s-QBC) are important in the diagnosis of urinary tract infection (UTI) due to most uropathogens. The prognostic value of s-QBC for diagnosis of UTI due to group B streptococcus (GBS) is unknown. In this study, we assessed the value of s-QBC for differentiating acute GBS UTI from asymptomatic bacteruria (ABU), independent of other potential prognostic indicators.MethodsMedical record review and urinalysis (UA) values for 1593 patients who had urinary GBS isolated (103 to ≥105 CFU/ml) during a four-year period were analyzed using binary logistic regression to determine the predictive values of s-QBC, age, and gender for infection category (acute UTI, ABU) based on the clinical diagnosis.Resultss-QBC alone had a strong predictive value for infection category but only for ABU. Multivariate logistic regression showed similar predictive power of s-QBC for infection category using age as a co-predictor, which was also independently associated with infection category. Typical s-QBC cut-off values that are commonly used in diagnostic settings had no significant power in predicting infection category. Among other UA measures, proteinuria and hematuria were significantly associated with acute infection.ConclusionsTogether, these data show that s-QBC is not useful in the differential diagnosis of GBS UTI. Among the patients in this study, age was an equally effective prognostic indicator compared to s-QBC for identifying high- and low-risk patients for acute GBS UTI. Collectively, these findings indicate that age-based associations may be equally as useful as s-QBC for predicting infection category in the setting of adult patients with GBS-positive urine cultures.

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“…Sequencing of urine samples collected using specific techniques to avoid vaginal contaminants, from patients and healthy volunteers, has revealed a wide range of colonizing organisms that might be implicated in lower urinary tract dysfunction 48 . Evidence of exacerbation of lower urinary tract symptoms (LUTS) in association with both planktonic bacteria in the urine and urothelial colonization by bacteria has been reported [49][50][51] , but it remains unclear which species of bacteria may be responsible.…”

Section: Urgency Urinary Incontinencementioning

confidence: 99%

“…This diagnostic threshold is important given the association between low-CFU bacteriuria count (<1,000 CFU per ml), urinary incontinence 50 and refractory LUTS. In those with a history of recurrent UTIs, requesting the results of the previous microscopy, culture and antibiotic sensitivity analyses can assist in confirming the diagnosis, determining the correct treatment based on sensitivities and determining whether the UTIs are recurrent or persistent 1 .…”

Section: Urological Testsmentioning

confidence: 99%

Urinary incontinence in women

Ss

¹

,

Rm²

2017

Nat Rev Dis Primers

15

0

1

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Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence.Correspondence to R.C. Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London W2 1PG, UK. r.cartwright@imperial.ac.uk. Author contributions Competing interestsThe authors declare no competing interests. Publisher's noteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. HHS Public AccessAuthor manuscript Nat Rev Dis Primers. Author manuscript; available in PMC 2018 April 01. Published in final edited form as:Nat Rev Dis Primers. ; 3: 17042. doi:10.1038/nrdp.2017.42. Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptUrinary incontinence is the complaint of involuntary loss (leakage) of urine 1 . The condition occurs in both sexes, but is much more frequent in women. Although some overlap in pathophysiology is evident between sexes, incontinence in men is often a consequence of prostatic enlargement or from damage to continence mechanisms during surgery or radiotherapy for prostate cancer. By contrast, incontinence in women is typically related to dysfunction of the bladder or pelvic floor muscles, with such dysfunction often arising during pregnancy or childbirth, or at the time of menopause. This Primer focuses on female urinary incontinence because of its higher prevalence and unique pathophysiology.There are two main subtypes of urinary incontinence: stress incontinence and urgency incontinence. According to the International Urogynecological Association (IUGA) and the International Continence Society (ICS) standard definition, stress incontinence is the complaint of urine leakage in association with coughing, sneezing or physical exertion, whereas urgency incontinence is the comp...

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Overactive bladder in women: Does low‐count bacteriuria matter? A review

Cited by 27 publications

References 40 publications

Urinary incontinence in women

Urinary incontinence in women

Prognostic value of semi-quantitative bacteruria counts in the diagnosis of group B streptococcus urinary tract infection: a 4-year retrospective study in adult patients

Urinary incontinence in women

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