2008 Annual Meeting Abstracts
Chronic UTI In Children Is Not Associated With Bladder Wall Bacterial Pods
Craig A Peters, Owen Hendley*, Theresa A. Schlager*
University of Virginia, Charlottesville, VA
Introduction:
Recurrent UTI in various patient populations is a major clinical challenge whose pathophysiology remains incompletely defined. Recent evidence demonstrating the presence of bacterial pods in the mucosa of the bladder in animals would explain some recurrence and suggest alternative therapeutic approaches. A new method of tissue fixation (Carnoy’s fixative) that preserves the mucosa and mucus layer should demonstrate bacteria in children with recurrent UTIs.
Methods:
13 patients with neuropathic bladder(9), reflux (3), or dysfunctional voiding (1) had open or endoscopic biopsies at the time of open bladder surgery, or at cystoscopy for recurrent UTI refractory to extended antibiotic regimens. Tissue was studied using Carnoy’s fixative and the presence of bacteria assessed by FISH (fluorescent in situ hybridization) to a universal bacterial antigen. 10 patients had a history of recurrent UTI and 5 had active infection at the time of biopsy. Human tonsil specimens were used as the positive control for mucus layers and bacteria.
Results:
No bacteria were detected in any of the bladder specimens. Cystitis cystica was present grossly in 4 patients with histologic evidence of lymphoid infiltrate. Hypervascularity and submucosal inflammatory infiltrates were noted in most patients.
Conclusions:
Despite experimental evidence of bacterial pods in bladder biofilms, we could not identify any comparable pattern in humans with recurrent UTIs even in the presence of active UTI and cystitis cystica. The clinical significance of this finding remains to be defined. Alternative theories for recurrent UTIs need to be developed.
