During much of my medical career, my understanding of the human bladder was that it was a reservoir for the body’s metabolic waste and that it simply stores #urine until it signals a sense of fullness to motivate volitional voiding. As filling increases tissue distension, intensity of desire to void increases accordingly. Throughout most of the day, the bladder just passively fills. How reassuringly simple! I also understood that bladders, and mostly of females, are very vu

Historically, #cystitis generally was a problem for women, who otherwise were well. They suffered in silence, drank water like fish, and, perhaps, also guzzled K+ citrate and/or cranberry juice, for what they thought they were worth. Antibiotics’ arrival brought simple and convenient “pill-popping,” treatment with most getting symptom relief, while the others continued suffering quietly, so cystitis garnered little medico-scientific interest. Today, cystitis presents very d

Colleagues Some good news: I had a meeting with the #UKHSA this week to present my root cause analysis on #AMR. I was met by insightful...

Colleagues I’ve been wading through the UK #governments second 5-year anti-AMR action plan, “Confronting #AntimicrobialResistance 2024-20...

The case for widening the #intravesical approach to #bladder diseases and disorders In the European Association of #Urology 2024 conference, intravesical chemotherapy “took centre stage:” https://www.linkedin.com/pulse/eau24-expert-commentary-professor-fufu-zheng-nmibc-postoperative-i6xre?trk=organization_guest_main-feed-card_feed-article-content The case for their use in uro-oncology was made over 60 years ago with the introduction of Mitiomycin C. The value in delivering d

I offer this “case report” and cautionary note to dedicated doctors with inventive minds. For many years in UK medicine, the most...

Botanical compounds, that we call cPACs exist in nature and having been patented by UroPharma for #urinarytract use, are being investigated by the company. They are for incorporation into a #lubricant urethral gel for safer urinary catheterisation, because the first line of defence against CAUTI is to prevent the bacteria getting into the bladder in the first place! #Urinary #catheters are such essential clinical tools that over a billion units are used annually with numbers

UroPharma produced #intravesical drug-delivery technology to bring, under licence, better cystitis (lower #UTI) treatments. For decades,...

Unconscious bias is a systematic cognitive error in decision-making, about which the decision-maker is unaware. Unconscious bias against #bladders is common, especially infected ones. Compared to other organs, progress in #cystitis management has barely changed for ~ ¾ of a century, despite incidences increasing, recurrences abounding, and AMR becoming more pervasive, because of antiquated, flawed and haphazard treatments. We challenge “haphazard” through #antibioticsteward

For some reason, we long assumed that #bacteria in the extra-systemic, #urinary cavity are subject to the same conditions as in other tissue infections, but they aren’t. #Antibiotics get to other tissue infections via blood whereas #cystitis #pathogens encounter antibiotics in #urine. That’s a big difference, first of all, blood pH range is narrow, so an antibiotic’s MIC (minimum inhibitory concentration) is predictable there. The urinary pH range is very wide. Antibiotic MIC

#Epithelia line tissue surfaces that the outside world can directly access, such as skin, sclera, mouth, gut, vagina, #bladder and...

When we find a solution to a problem, naturally we look to the same approach for the next similar challenge. #Antibiotics changed the...

Recurrent #cystitis reportedly occurs in about 25% of women within months after a first episode, which far exceeds recurrences from other infections. Cystitis investigations reveal a worryingly high rate of associated #antimicrobial resistance (#AMR) compared with other common infections, suggesting bacteria survive our treatments, adapt and reinfect. Dead bacteria don’t do either, so despite clinical recovery, evidently many cystitis treatments, even uncomplicated ones, fail

“We know almost nothing about managing UTI.” This assertion went unchallenged at the British Society of #Antimicrobial Chemotherapy multidisciplinary conference of experts last year. Increasingly, we struggle because following #cystitis #treatments, #infection recurrences and #antimicrobial #resistance too often occur, compromising patients’ health and efficient service provision. PubMed UK searches reveal over 81,000 articles are available on “UTI” and more than 16,000 on

By Prof. Scott Glickman If a drug treatment for #cystitis is approved by a patient safety regulatory agency, without evidence that it can produce cure, who, if anyone, actually is, or should be responsible for an infection recurrence with it? I ask because I see no convincing evidence that any approved oral #antibiotic treatment has ever come with evidence that it reliably cures cystitis (i.e. produces pathogen annihilation). Of course, I see symptom recovery, but notwithst

Homeostatic mechanisms optimise our cellular chemistry. #antibiotics treatments are developed specifically to work in our narrow-band homeostatic chemical milieu to be delivered through blood to #infection sites for intimate combat with #bacterial invaders. With #cystitis, the bacteria are planktonic in urine and attached to urothelial cell membranes, so are too far away to be influenced by that approach. For #antibiotic tablets to have any chance to be effective against cy

I ask you to start the new year with a fresh look at cystitis and its management. While all the following are true: • The bladder is a soluble waste storage “bin.” • Urine is liquid metabolic waste dross. • Cystitis is a scourge. • Antibiotic stewardship must protect against over-use and • Symptom relief and clinical recovery are treatment goals. These facts haven’t helped us address cystitis recurrences, urosepsis or reduce AMR, so consider these facts, too: • Cystitis trea

From our Chief Medical Director, Professor Scott Glickman: With people working on AMR from cystitis treatments, I would be grateful to discuss the following conundrum. My analysis indicates that the oral/systemic route of administration is critically flawed by rate-limited initial drug filtration and ureteric drip-feed of antibiotic into urinary pools of sufficient volumes to delay it reaching MIC, and with its fluctuant pH likely dynamically altering MIC in-vivo as well, thu