As we are a unique clinic and treat patients from all over the country, the waiting list is very long. We will do our best to send an appointment as soon as we can.
Accessing the service
Why do I need to come to the Clinic for urinalysis?
How do I collect prescriptions?
How can I get in touch with the service?
How do I access Whittington Hospital?
Tell us a little about your approach. What is your treatment protocol?
What is the average duration of treatment?
The average duration of treatment in our patient group is 383 days and we try not to change the treatment regime which requires a determined persistence from our patients. We have, in the past changed our regime too quickly in response to a flare, with regret. It is expected that patients will have symptom exacerbations along the way. A smaller proportion of our patients require one of our second line regimes involving a more broad spectrum antibiotic and an even smaller proportion are on a combination of antibiotics. We aim is to achieve a situation where the symptoms are stable on methenamine alone and then to eventually withdraw the methenamine also.
Why do I need a blood test?
Why you do not consider broth cultures and rigorous culturing in general of importance when you are treating patients?
One of the problems that troubles us the most is knowing what microbes are causing the symptoms. It is very important to understand that just because you detect the presence of an organism through culture of the urine; be it in a routine NHS laboratory, a broth culture or a culture of the urinary sediment, it does not mean that the bacteria isolated is the cause of the infection. It might be that it is just easy to grow and that it exists without harm in the bladder. This is becoming all too evident from our current laboratory work. There appears to be no reliable method for implicating an isolate as the ‘cause’ of the symptoms. The normal bladder is not sterile and has a polymicrobial microbiome of well over 450 different species. We can still see presumed pathogenic species in the urine of patients who have recovered and in our healthy volunteers. For years it has been widely assumed that if you detect a microbe in the urine, obtained from someone with lower urinary tract symptoms, then it must be the cause of the symptoms. It is difficult to accept this given modern evidence. This is why we put so much emphasis on the symptoms and the plots of the urinary urothelial cell counts and pyuria. We see patients who have sent urine to the USA and elsewhere, seeking special cultures. All too often, the data obtained do not help matters but do encourage people to focus on specific bugs without necessarily knowing whether they are relevant.
Is there any way to cure embedded infection, or is it a case of managing symptoms? Can you give us an idea of your success rate?
How do you see the future in terms of treating embedded infection? Will there ever be a time when long-term antibiotics are superseded by something better? What might that be?
This is our hope. If we can move away from oral antibiotics we would be delighted. We are working on a trial of a treatment that would be local in the bladder, however, such treatments require a long time to develop and test. We will keep you all posted on this.
What does it mean to participate in a research study?
We are an active research centre and part of the Chronic Cystitis Research Group (CCRG). You may be asked to participate in our ongoing research studies investigating the cause and treatment of chronic urinary symptoms. It will not affect your treatment. We hope that you will consent to take part in the studies and you will be provided with detailed information should you wish to participate. Taking part in the research studies is entirely voluntary.
List of References
- Barcella, W., et al., A Bayesian Nonparametric Model for White Blood Cells in Patients with Lower Urinary Tract Symptoms. Electronic Journal of Statistics, 2016. 10(2): p. 3287-3309.
- Khasriya, R., et al., Lower urinary tract symptoms that predict microscopic pyuria. Int Urogynecol J, 2017.
- Horsley, H., et al., Enterococcus faecalis subverts and invades the host urothelium in patients with chronic urinary tract infection. Plos One, 2013. 8(12).
- Khasriya, R., et al., The Inadequacy of Urinary Dipstick and Microscopy as Surrogate Markers of Urinary Tract Infection in Urological Outpatients With Lower Urinary Tract Symptoms Without Acute Frequency and Dysuria.
- J.Urol., 2010. 183(5): p. 1843-1847.
- Horsley, H., et al., A urine-dependent human urothelial organoid offers a potential alternative to rodent models of infection. Sci Rep, 2018. 8(1): p. 1238.
- Swamy, S., et al., Recalcitrant chronic bladder pain and recurrent cystitis but negative urinalysis: What should we do? Int Urogynecol J, 2018.
- Swamy, S., et al., Cross-over data supporting long-term antibiotic treatment in patients with painful lower urinary tract symptoms, pyuria and negative urinalysis. Int Urogynecol J, 2018.
- Kupelian, A.S., et al., Discrediting microscopic pyuria and leucocyte esterase as diagnostic surrogates for infection in patients with lower urinary tract symptoms: results from a clinical and laboratory evaluation. BJU Int, 2013. 112(2): p. 231-8.
- Khasriya, R., et al., Spectrum of bacterial colonization associated with urothelial cells from patients with chronic lower urinary tract symptoms. J Clin Microbiol, 2013. 51(7): p. 2054-62.
- McGinley, M., et al., Comparison of various methods for the enumeration of blood cells in urine. J.Clin.Lab Anal., 1992. 6(6): p. 359-361.
- Tenke, P., et al., Update on biofilm infections in the urinary tract. World J.Urol., 2011.
- Anderson, G.G., et al., Intracellular bacterial communities of uropathogenic Escherichia coli in urinary tract pathogenesis. Trends Microbiol., 2004. 12(9): p. 424-430.
- Mysorekar, I.U. and S.J. Hultgren, Mechanisms of uropathogenic Escherichia coli persistence and eradication from the urinary tract. Proc Natl Acad Sci U S A, 2006. 103(38): p. 14170-5.
- Hilt, E.E., et al., Urine is not sterile: use of enhanced urine culture techniques to detect resident bacterial flora in the adult female bladder. J Clin Microbiol, 2014. 52(3): p. 871-6.
- Sathiananthamoorthy, S., et al., Reassessment of Routine Midstream Culture in Diagnosis of Urinary Tract Infection. J Clin Microbiol, 2018.
- Mariappan, P. and C.W. Loong, Midstream urine culture and sensitivity test is a poor predictor of infected urine proximal to the obstructing ureteral stone or infected stones: a prospective clinical study. J Urol., 2004. 171(6 Pt 1): p. 2142-2145.