Antibody-coated bacteria in urine of patients with ileal conduit urinary diversion.

The antibody-coated bacteria (ACB) test is a helpful adjunct for differentiating pyelonephritis from cystitis in the intact urinary tract, particularly in female patients. This test was used in patients with ileal conduits and infected urine in an attempt to determine whether bacilluria was of renal or conduit origin. Every patient with infected conduit urine had a positive ACB test even though no patient had clinical stigmas of acute pyelonephritis. In patients with ileal conduits, the ACB test cannot be used alone as an indicator that bacilluria is a cause of symptoms or renal damage.     

对女性膀胱炎几种疗法的研究

目的：如何合理治疗膀胱炎,尿沉渣中抗体包裹细菌（ＡＣＢ试验）在指导尿感治疗中的意义。方法：分组治疗急性膀胱炎２２３例;氟嗪酸０．６单剂顿服,０．２每日 ２次共３ ｄ、０．２每日 ２次共７ ｄ;复方新诺明 ５片单剂顿服,２片每日２次共３ｄ。治疗停止后跟踪监测４周,治疗前送检ＡＣＢ试验。结果：上述各组停药后４周治愈率分别为６８％、８６％、９１．７％、６３％和８４％。３ｄ疗法结果表明：①比单剂治愈率高（Ｐ＜０．０５）;②较之单剂治疗其复发车少（Ｐ＜０．０５）;③治愈率与 ７ ｄ疗法无明显差异（Ｐ＞０．０５）。 ＡＣＢ试验与治疗是否成功无关（Ｐ＜０,０５）,亦与治疗失败或复发无关（Ｐ＜０．０５,故ＡＣＢ不能作为尿感定位的根据。结论：推荐使用３ｄ疗法。ＡＣＢ试验对尿感的治疗无指导意义。     

Clinical significance of the antibody-coated bacteria test in patients with candiduria

The clinical significance of the antibody-coated bacteria (ACB) test was evaluated with urine from 20 patients with candiduria. The relationship between the in vitro antibody-coating test for Candida albicans, urinary immunoglobulin (Ig) levels and serum antibody titres was evaluated in 40 patients without candiduria, 23 of whom had bacterial urinary tract infection (UTI). Urine specimens from 19 of the 20 patients with candiduria gave a positive result regardless of clinical symptoms; 12/23 specimens of urine from patients with bacterial UTI were positive for antibody-coated C. albicans cells, but there were no positive samples in the patients without UTI. All of the coating-positive patients had serum antibody titres greater than or equal to 1:160, the class of antibody being dependent on the urinary Ig levels. The ACB test for candiduria is of little clinical value in indicating invasive Candida UTI as the Candida cells appear to adhere to antibodies in urine contaminated with circulating fluids.     

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

OBJECTIVE: To determine whether patients with detrusor instability (DI) were more likely to have bacterial cystitis or significant bacteriuria on the urodynamic-test 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 significantly greater than that in patients with GSI (1.1%; P = 0.009, Fisher's exact test). The proportion of patients with DI and significant bacteriuria (15. 4%) was significantly greater than that in patients with GSI (7.9%; P = 0.02). In patients with combined pure and mixed DI, bacterial cystitis was significantly 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 significant 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.     

In vitro-produced antibody-coated bacteria

A new in vitro method was developed which enabled isolation and identification of ACB-positive bacteria in polymicrobial renal bacteriuria. This approach was used in 16 patients with permanent nephrostomies and asymptomatic bacteriuria who had shown positive ACB test by the method of Thomas et al. A total of 48 urinary isolates were obtained from these patients in which 21 (43.8%) were revealed as being positive by the present method. In 13 of the 16 patients, there was only one positive species among several species of bacteria. The species with a colony count of more than 10(5)/ml was found to be most commonly ACB positive (71.5%). Of the 13 patients who had creatinine clearance tests available, 11 (84.6%) showed a considerable decrease in renal function after the intervals since nephrostomy. The immunologically different characteristics observed among multiple bacterial species in polymicrobial renal bacteriuria suggest a possible aggressive role for the ACB-positive species and therefore a need for eradicating them.     

Granulomatous cystitis: a reversible lesion in children

27 children with granulomatous cystitis associated with schistosomiasis and urinary tract infection were studied by urine culture and the direct immunofluorescence technique to detect the presence of antibody-coated bacteria (ACB). All patients had urinary schistosomiasis (100%); urine cultures of more than 10,000 bacteria/ml were present in 18 (66%) patients, and ACB-positive tests in 23 (85%) patients. Depending upon an ACB-positive test, children received full courses of antimicrobial and antibilharzial therapy. Follow-up after 3 months showed that granulomatous lesions subsided in 20 out of 23 (87%) children.     

The Intravesical Potassium Sensitivity Test and Urodynamics: Implications in a Large Cohort of Patients with Lower Urinary Tract Symptoms

PURPOSE: Bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH) is the most common diagnosis in older men with lower urinary tract symptoms. However, these symptoms also can occur with interstitial cystitis. We determine whether the potassium sensitivity test is useful for distinguishing BPH from possible intersitial cystitis in patients with lower urinary tract symptoms. We also test the hypothesis that patients with these symptoms who have a positive test will have urodynamic findings consistent with the diagnosis of interstitial cystitis. MATERIALS AND METHODS: The potassium sensitivity test was performed in 526 (95%) males and 25 (5%) females with lower urinary tract symptoms undergoing urodynamic testing. Urodynamic parameters in the positive and negative potassium sensitivity test groups were compared. %Results: Of the patients 16% (89 of 551) had a positive potassium sensitivity test. Compared with patients who had a negative test, those who had a positive test were younger (61 versus 64 years, p = 0.03), had urgency at significantly lower volumes (108 versus 182 cc, p <0.0001), lower bladder capacity (343 versus 436 cc, p <0.0001) and lower post-void residual (49 versus 95 cc, respectively, p <0.001). Urodynamic parameters in the 24% (6 of 25) of women who had a positive potassium sensitivity test were similar to those in men who also had a positive test. CONCLUSIONS: Urodynamic findings in patients with lower urinary tract symptoms who have a positive potassium sensitivity test are significantly different from those in patients who have a negative test, and are similar to those findings characteristic of interstitial cystitis. Interstitial cystitis should be considered in patients with lower urinary tract symptoms who have a positive test. The potassium sensitivity and urodynamic tests may be a useful combination for screening men with lower urinary tract symptoms to identify those symptoms that may be due to interstitial cystitis versus BPH.     

Do antibody-coated bacteria reflect local immune response in the urinary tract?

We examined whether antibody-coated bacteria (ACB) reflect local immune response or passive adsorption of immune globulins (Ig). For this purpose, bacterial subcultures from infected urines and third-party bacteria were incubated with Ig preparations. These were obtained from infected urine either by removal of Ig from ACB (dissociation in alpha-methylmannoside, 0.1 M glycine-HCl, or 3 M NaSCN) or by staphylococcal protein A affinity chromatography from the supernatant of infected urine. Coincubation of either Ig preparation with bacterial substrains of the original urine and with third-party strains (Pseudomonas aeruginosa, Proteus mirabilis, several Escherichia coli strains, enterococci, Serratia marcescens, Klebsiella pneumoniae, Staphylococcus aureus) caused coating of the bacterial surface with Ig. Coating was not measurably influenced by coincubation with various carbohydrates or by preincubation of bacteria with glucosidases. Adsorption of Ig was observed after heat denaturation and formalin treatment of bacteria and was independent of bacterial growth phase. Coating was observed both with intact IgG and with F(ab)2 fragments. We further examined the proportion of bacteria coated with IgA, IgG, and IgM in urines of 200 bacteriuric women with symptomatic urinary tract infection. The frequency histogram plot showed a continuous nonlinear unimodal distribution. Consequently, any selection of a 'normal range' is arbitrary. It is concluded that coating of the bacterial surface with Ig may not necessarily reflect local immune response. A major problem of the ACB test is definition of the normal range.     

Intravesical potassium sensitivity in patients with prostatitis

PURPOSE: Prostatitis and interstitial cystitis encompass similar symptoms and may be manifestations of a single pathophysiological process in the lower urinary tract. Most patients with interstitial cystitis have urinary epithelial dysfunction, as indicated by a positive intravesical potassium sensitivity test. We used the potassium sensitivity test for the presence of epithelial dysfunction in men with diagnosed prostatitis. MATERIALS AND METHODS: We administered the potassium sensitivity test in men who presented with the signs and symptoms of prostatitis (urgency/frequency and/or pelvic pain) after being diagnosed with prostatitis and receiving at least 1 course of antibiotic treatment administered by a urologist other than one of us. We also surveyed the patients for urinary symptoms and pain locations using 2 self-evaluation questionnaires. RESULTS: A total of 44 patients with prostatitis completed the questionnaires and underwent the potassium sensitivity test. Of the 44 men 37 (84%) had positive potassium sensitivity test results, 89% reported urinary urgency/frequency and 82% reported pain. Pain locations included the perineum, lower abdomen, lower back, penis, testes, scrotum and rectum as well as dysuria and post-void pain. Pain with sexual intercourse was reported by 75% of the patients with prostatitis. CONCLUSIONS: The rate of positive potassium sensitivity test results in patients with prostatitis is almost identical to that reported in those with interstitial cystitis (84% and 79%, respectively), suggesting that prostatitis and interstitial cystitis may be a continuum of lower urinary epithelial dysfunction. Similar to patients with interstitial cystitis, most patients with prostatitis experience pain during sexual intercourse and perceive pain at locations throughout the pelvis. We suggest reclassifying the prostatitis-interstitial cystitis disease process as lower urinary dysfunctional epithelium.     

Renal concentrating capacity in female outpatients with symptomatic urinary tract infection

OBJECTIVE: Renal concentrating capacity (RCC) has been used as a tool in the diagnosis of the site of urinary tract infection (UTI). In this study, RCC was measured in women with symptoms of UTI in relation to the clinical picture and the bacterial species isolated. MATERIAL AND METHODS: In 633 outpatients aged > or =18 years with symptoms of UTI, a renal concentration test with desmopressin was performed at baseline. The test was repeated after antibiotic treatment in a subset of patients with osmolality values below the reference levels at entry. The bacterial species were identified and patients were classified as having either pyelonephritis or cystitis. RESULTS: RCC was reduced in patients infected with Escherichia coli or Staphylococcus saprophyticus compared to those who had negative urine cultures and increased after antibiotic treatment. Patients with symptoms of both pyelonephritis and cystitis had reduced RCC: 44/68 (65%) and 205/457 (45%), respectively. CONCLUSIONS: These findings demonstrate a considerable overlap in RCC between patients with pyelonephritis and cystitis, making the osmolality test unreliable for the purpose of diagnosis of the site of UTI.     

上尿路梗阻与伴发慢性膀胱炎的相关性临床研究

目的：探讨上尿路梗阻与伴发慢性膀胱炎之间的相关性.方法：通过尿液细菌培养、膀胱镜和输尿管镜检查,对350例上尿路梗阻患者进行前瞻性研究.结果：350例上尿路梗阻中,75例（21.43%）伴发慢性膀胱炎;254例肾盂、输尿管结石性上尿路梗阻中,伴有慢性膀胱炎51例（20.08%）;96例其他原因上尿路梗阻中,伴有慢性膀胱炎24例（25.00%）（P＞0.05）.在75例慢性膀胱炎中,非细菌性膀胱炎58例（58/350,16.57%）,其中腺性膀胱炎38例（10.86%）,膀胱白斑病11例（3.14%）,增生性膀胱炎9例（2.57%）.58例上尿路梗阻伴发慢性非细菌性膀胱炎中,6例（10.34%）尿液细菌培养阳性;275例不伴有膀胱炎中,27例（9.82%）尿液细菌培养阳性（P＞O.05）.16例上尿路梗阻伴有慢性非细菌性膀胱炎患者获术后随访,其中10例膀胱病灶区炎症消失.但其他6例炎症仍较严重而需进一步治疗.结论：上尿路梗阻与伴发慢性膀胱炎之间具有相关性,长期上尿路梗阻可诱发慢性非细菌性膀胱炎的发生,其发病机制需进一步深入研究.     

Antibody coated bacteria in ejaculatein bacterial prostatitis

In patients with bacteriologically proved prostatitis (Stamey test) ejaculate was examinedfor antibody-coated bacteria (ACB). Forty-four of the 68 patients (65%) with bacteriologically proved prostatitis had ACB in the ejaculate, but only 7 of 89 patients (8%) with prostatodynia. Concomitantly, coeruloplasmin and complement (C3) concentrations in the ejaculate were examined by radial immunodiffusion (RID). The ACB test had much higher specificity (92%) than RID, and the sensitivity of ACB was 65 per cent.     

DETECTION OF EUBACTERIA IN INTERSTITIAL CYSTITIS BY 16S rDNA AMPLIFICATION

Objective

To determine what role non-culturable microorganisms play in the etiology of interstitial cystitis (IC).

Materials and Methods

Thirty patients fulfilling NIH criteria for the diagnosis of interstitial cystitis and sixteen control patients with culture negative urine gave written informed consent and underwent bladder biopsy. Polymerase chain reaction (PCR) using two sets of universal primers for bacterial 16S rDNA was performed on urine from the cystoscope and on a cold cup bladder biopsy specimen. Of the PCR positive bladder biopsies, three patients with interstitial cystitis and three controls were randomly selected and cloned. Ten clones from each were sequenced and putative taxonomic assignments made.

Results

12/26 (46%) IC and 5/12 (42%) control urine specimens and 16/30 (53%) and 9/15 (60%) bladder biopsies were PCR positive, respectively. The bacterial populations in the two patient groups tested appeared to be different based upon analysis of the 16S rRNA sequences.

Conclusions

Both IC and control patients had non-culturable bacteria in their bladders. A random sampling of the two populations revealed that the bacterial populations are different, suggesting a possible link between one or more bacterial species and IC.     

Characteristics of mast cells in normal bladder, bacterial cystitis and interstitial cystitis.

An analysis was made of the numbers and characteristics of mast cells in lateral bladder wall biopsies from 22 patients with interstitial cystitis, 6 with bacterial cystitis and 8 normal controls, using toluidine blue stains and computerised video image analysis techniques. A significantly greater number of mast cells were found within the detrusor muscle in interstitial cystitis than in bacterial cystitis or normal controls. Within the urothelium and submucosa, mast cell numbers were significantly greater than in normal controls in both interstitial and bacterial cystitis. In interstitial cystitis mast cells were significantly larger within the detrusor than in the urothelium/submucosa and they appeared to degranulate predominantly within the superficial layers. Differential staining techniques, using long and short toluidine blue stains, failed to reveal statistically significant evidence of mast cell heterogeneity within the bladder wall in interstitial cystitis.     

Further studies on specificity of red cell adherence test: nonmalignant bladder lesions

Specific red cell adherence test for blood group antigens was utilized in 32 nonmalignant bladder lesions, none of which was associated with bladder cancer, to determine the specificity of this test. All of the 14 lesions of cystitis cystica, cystitis glandularis, and chronic cystitis retained their antigens. Of the 18 lesions of squamous metaplasia, 13 (72%) were antigen positive. Testing for blood group antigens showed an overall 84 per cent specific rate in 27 of the 32 nonmalignant bladder lesions.     

The potassium sensitivity test: a predictor of treatment response in interstitial cystitis

OBJECTIVE: To determine whether the potassium sensitivity test (PST) can be used to predict the response to treatment with intravesical sodium hyaluronate in patients with interstitial cystitis. PATIENTS AND METHODS: Thirty-eight patients diagnosed with interstitial cystitis were recruited; each had a PST, carried out in a double-blind fashion, followed by six weekly doses of intravesical sodium hyaluronate. The patients were assessed before and after treatment using a self-administered interstitial cystitis symptom index (CSI) and problem index (PI). The clinical response was defined as none (<25% improvement in clinical symptoms), mild (>25%), moderate (50-75%) and excellent (>75%). RESULTS: The PST was positive in 23 and negative or indeterminate in 13 patients; two patients withdrew from the study. Overall 20 of 36 (55%) patients reported an improvement after six doses of intravesical sodium hyaluronate, but 17 (74%) with a positive PST improved, compared to only five (22%) with a negative test (P = 0.03). There was an improvement in the CSI after treatment in both groups, but a significant improvement in the PI only in patients with a positive PST (P = 0.01). The magnitude of change for the CSI and PI was significantly greater in the positive than in the negative group (CSI, P = 0.043; PI, P < 0.001). There were no major complications. Three patients complained of pain after the test, and two with a positive and one with a negative PST developed a urinary tract infection. CONCLUSIONS: Although the role of the PST in the diagnosis of interstitial cystitis requires further clarification, the test helps to predict the response to treatment with glycosaminoglycan-substitution therapy.     

Saireito-induced cystitis in children: Two new cases and a review of the literature

We describe 2 children with sterile cystitis caused by Saireito, a traditional Chinese herbal medicine. A diagnosis of cystitis was made for 1 child at 8 months and for the other at 11 months after Saireito treatment for renal disease was initiated. Clinical symptoms were resolved 1 and 6 weeks after Saireito treatment was withdrawn. We also reviewed the first report written in the English language on 8 additional patients with Saireito-induced cystitis. We found that Saireito-induced cystitis occurred mainly in children and developed 6 months or more after Saireito treatment was initiated. The incidence is not uncommon, and the cause may be an allergic reaction, because eosinophilic cell infiltration was noted on histopathologic examination, and the challenge test was positive. We recommend that, when sterile cystitis develops during treatment with Saireito, Saireito should be immediately withdrawn.     

Cystitis in 8 patients treated with tranilast

We encountered 8 cases of cystitis probably caused by Tranilast. Bladder biopsy performed on 6 of the 8 cases revealed eosinophilic cystitis in 3 cases. In the lymphocyte stimulation test using Tranilast as an antigen, a positive and false positive reaction was seen in one case each. This disease seemed to occur as a result of allergy of the bladder specific to Tranilast.     

Localization of catheter-induced urinary tract infections: interpretation of bladder washout and antibody-coated bacteria tests

Accurate differentiation of upper from lower urinary tract infection (UTI) has been reported based on the presence or absence of antibody-coated bacteria (ACB) in the urinary sediment. The specificity of ACB localization in adults has been reported to be high based on a strong correlation with localization results obtained with the bladder washout technique. The present study examines the efficacy of ACB testing with respect to accurate anatomic localization of UTI in 20 studies in 14 patients exhibiting bacteriuria as a result of chronic urethral catheterization. 17 studies (85%) demonstrated significant ACB. Localization of UTI was assessed in each study by the bladder washout technique. Following instillation of a washout solution, a normal decrease in colony counts was observed in only 3 studies (15%), a frequency significantly lower than the value of 90% previously reported in noncatheterized bacteriuric patients (p less than 0.001). Each of these 3 patients was ACB-positive, yet anatomic localization indicated lower tract UTI. The observed characteristics of the 14 patients included the absence of upper tract signs and symptoms, and spontaneous clearing of ACB and bacteriuria following catheter removal. These findings suggest that in chronically catheterized patients, both (1) the observed abnormal resistance of bacteria to bladder washout and (2) the high frequency of positive ACB tests are indices of severe chronic tissue invasion and intense antibody production in the lower urinary tract in this condition and thus not of value in localizing infection to the upper tract. Neither ACB nor washout testing with current techniques can reliably localize UTI in chronically catheterized patients.     

Does the potassium stimulation test predict cystometric,cystoscopic outcome in interstitial cystitis?

PURPOSE: We establish the relationship among symptom duration, cystometric and cystoscopic findings and potassium stimulation test in patients with interstitial cystitis. MATERIALS AND METHODS: A retrospective chart review was performed of 189 patients treated at an ambulatory clinic between 1992 and 1998. Urodynamic parameters, potassium stimulation test results and subjective response to treatment were evaluated. Fisher's exact test was used for statistical analysis. RESULTS: Of the 189 patients diagnosed with interstitial cystitis 173 (92%) were female and 16 (8%) were male. The potassium stimulation test was positive in 105 (83%) patients, negative in 16 (13%) and equivocal in 6 (4%). A cystometrogram and potassium stimulation test were done in 118 patients. Bladder capacity averaged 259 ml. in patients with tests potassium positive and negative, while average bladder volume at first sensation to void was 85 ml. and 148 ml. in those with negative and positive tests, respectively. Among the 102 patients with a positive potassium stimulation test 52 had normal cystoscopic findings. CONCLUSIONS: The potassium stimulation test is not correlated with either bladder capacity or cystoscopic findings.