How Chronic UTI is Diagnosed & Treated - Chronic UTI Australia
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How Chronic UTI is Diagnosed & Treated

Currently there is no simple, suitable test to diagnose Chronic UTI. At a specialist London clinic treating complex urinary infections, treatment for Chronic UTI involves a clinical diagnosis of carefully taking the patient’s full UTI history, listening closely to the patient’s symptoms (this includes a non-invasive physical examination) and the microscopic analysis of an immediately fresh, unspun urine sample to look for white blood cells (pus cells sent to the bladder to fight the infection), epithelial cells (shed from the bladder wall in an attempt to rid infected cells) and any other relevant signs of infection. On average, patients treated at the London clinic have been suffering from Chronic UTI for six and a half years before being properly diagnosed and treated.

Australia has no such specialist clinic diagnosing and treating chronic UTI, or the clinicians with specialist knowledge or training in this type of complex infection. The usual route for someone in Australia with Chronic UTI symptoms is a referral to an urologist, who then will perform a series of invasive and non-invasive tests to exclude possible causes for the ongoing LUTS experienced. This involves urodynamic testing such as ultrasounds, CT and MRI scans, a cystoscopy with or without bladder hydrodistension (stretching), urethral stretching and/or a bladder biopsy.   Once obvious causes are excluded, the patient will usually be labelled with an incurable ‘urinary syndrome’ that describes their symptoms, such as interstitial cystitis (IC), painful bladder syndrome (PBS), overactive bladder (OAB), chronic pelvic pain disorder/syndrome, urogenital syndrome and chronic bladder pain syndrome.


On average, it takes three to seven years and three to five different practitioners before an IC diagnosis is made. It is hard to ascertain how many Australians suffer from a ‘urinary syndrome’. Some estimates quote there are 65,000 people in Australia with IC/PBS, with 90 percent being female. Others estimate three to six percent of Australian women have IC/PBS, so that is between 300,000 and 600,000 women alone. There is a stark difference between those figures, which proves how inconsistent and confusing this diagnosis is. It is important to understand that being labelled with an incurable ‘urinary syndrome’ does not diagnose the cause of the symptoms—it merely acknowledges you have them.

How are ‘urinary syndromes’ like IC/PBS/OAB treated?

Various accepted pharmacological and surgical treatments are offered with the aim of attempting to manage symptoms. Most of these treatments have unpleasant side effects and low success rates. Many patients report these treatments worsen their symptoms. In Australia, the mainstream treatments offered could include: hydro-distension to stretch the bladder, anti-histamines to reduce inflammation, amitriptyline/nortriptyline for pain, Elmiron designed to restore the bladder lining, also known as the glycosaminoglycan (GAG) layer, Gabapentin to modify pain, DMSO (a chemical solvent), heparin, steroid bladder instils, hyaluronic acid and chondroitin sulphate instils (iAluRil) and Chlorpactin bladder rinses.   Surgical treatments are offered for worst case scenarios and include: sacral neuromodulation to block nerves, urinary diversion and/or bladder removal (cystectomy) with a bag to collect urine outside the body, or bladder reconstruction using part of the bowel to form a larger bladder for those with reduced capacity and extreme frequency.


None of the accepted mainstream treatments for those with a diagnosed ‘urinary syndrome’ are targeted at addressing the cause of the symptoms. They are mostly invasive, expensive, on-going, highly questionable and the side-effects are often extreme, intolerable and/or life-changing. This is far from being an acceptable situation for those with LUTS, who could in fact have an undiagnosed and treatable Chronic UTI.


Some important notes on ‘urinary syndromes’:

  • Professor James Malone-Lee, Head of the Community LUTS Clinic in London successfully treats patients previously diagnosed with IC/PBS/OAB/recurrent UTI with their Chronic UTI antibiotic treatment protocol.


  • World renowned Western Australian, Professor Barry Marshall, 2005 Nobel Prize winner for discovering the bacterial cause for stomach ulcers, has vowed to get to the bottom of the IC/PBS diagnosis. On his website he states about IC/PBS:
    “There are no conclusive diagnostic tests or reliable therapies, pharmacological or surgical. Therefore, by default, IC-BPS is often blamed on “psychosomatic factors”, “stress”, or hypothetical abnormalities of the mucosa. IC-BPS does not respond well to surgical treatment. Therefore it does not excite urological surgeons who are trained to deal with other life-and-death issues on a daily basis. In this environment, I doubted that 21st Century technology had been used to investigate this disorder thoroughly.”


  • Professor Scott Hultgren is the head of the Center for Women’s Infectious Disease Research (cWIDR) at Washington University School of Medicine, USA, where IC/PBS is named as a topic of study under their infectious disease listing.


  • Professor Alan Wolfe, Loyola Urinary Education and Research Collaborative (LUERC) at Loyola University, Chicago, USA, was behind the 2012 ground breaking discovery of the female urinary microbiome (FUM). Since this important discovery, the team has launched into numerous studies exploring bacterial explanations for previously unexplained LUTS. This includes a study for the American Urogynecologic Society (AUGS) on the Female Urinary Microbiome in IC/PBS, to be completed in July 2017.
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