This blog is for you if you (or a friend) struggle with a persistent health issue for which there seems to be no universal solution.

In my case the problem is UTIs (urinary tract infections) which apparently affect mostly women. For some there are simple solutions such as drinking cranberry juice or even improving “hygiene”. But for others (like me) it’s not that easy: Cranberry juice has no effect and hygiene is impeccable. The best I can do is hold it to two or three episodes a year, even with careful hygiene, a daily estrogen pill, plenty of water daily, and antibiotics for the flare-ups.

I suspect I am not alone in my search for a better way to address this problem and/or others. So I created this forum for us to share credible solutions and observations about our problems: I invite you to describe and submit your problems for others to read.  Maybe together we can find and share ways to treat situations that plague us, and possibly alert our health care professionals

I  also welcome articles, information and comments from those professionals. I look to having them work with us and maybe even enlist our help.

Thank you to fellow sufferers and professionals for visiting. I look forward to hearing from you and posting your thoughts in one of these ways . . .

  1. Add a comment (at the bottom) of this post or another one, or
  2. Open a personal page by selecting Contact in the menu at the top right of this site.


Good News: Possible Prevention

I recently saw a urologist who specializes in UTIs. After studying my history, analyzing a sample, and asking many questions, she concluded that I might reduce the frequency or  even eliminate them. On average I have 2 annually, with no complicating conditions. I take an estrogen tablet daily and drink plenty of liquids. Five days of antibiotics eliminate the infection.

Dr. Cameron recommended a very condensed cranberry extract supplement which has had good results in clinical trials. Her summary follows:

“Ellura is a prescription strength cranberry supplement that is highly purified, having the oxalate and acid almost essentially removed from the tablet. There is 36 milligrams of cranberry concentrate in each tablet, the dosage is one tablet per day, and this has a much higher effective dose than other over‐the‐counter cranberry supplements that typically have between 5 and 6 milligrams of the active ingredient. This particular preparation of the cranberry tablet was that used in trials that did show reduction in urinary tract infections in women and neurogenic bladder patients.”

Ellura is not available in retail stores. And a referring physician’s name must be provided in order to make a purchase. It can be ordered online from www.myellura.com and amazon.com. I visited both and found  myellura.com to be less expensive and more “user friendly”. It also provides  phone support for usage and offers discounts for regular purchases.

My first order will arrive soon, and I will report here on the results. Since I have infections only about twice a year it will take at least a year to know if it is effective. But I can report on any side effects and my experiences with the company and the ordering process.

Until the, wish me luck!  Your blogger, Mary

Links to UTI Info from the National Institutes of Health

Cranberry capsules more effective in lowering UTI risk than juice

A urinary tract infection (UTI) can be an unwelcome visitor—leaving you with the urge to sprint for the bathroom every few minutes. You may have heard that drinking a large glass of cranberry juice can effectively ‘treat’ a bladder infection, but is this remedy more fact or fiction?

A UTI is an infection in any part of the urinary system, kidneys, bladder or urethra. They are more common in women and affect more than 3 million Americans per year. Many in the population will turn to sipping on a cranberry juice cocktail to alleviate their symptoms, but, according to a Texas A&M Health Science Center urologist, drinking cranberry juice to treat a UTI is little more than an old wives’ tale.

“Cranberry juice, especially the juice concentrates you find at the grocery store, will not treat a UTI or bladder infection,” said Timothy Boone, M.D., Ph.D., vice dean of the Texas A&M Health Science Center College of Medicine Houston campus and chairman of the department of urology for Houston Methodist Hospital. “It can offer more hydration and possibly wash bacteria from your body more effectively, but the active ingredient in cranberry is long-gone by the time it reaches your bladder.”

With that said, the active ingredient in cranberry (A-type proanthocyanidins or PACs) can block the adhesion of bacteria to the wall of the bladder. “For a UTI to occur, bacteria must adhere to and invade the lining of the bladder,” Boone said. “PACs interfere with the bacteria’s ability to bind to the wall of the bladder and create an infection.”

Unfortunately, PACs aren’t present in cranberry juice at all—only in cranberry capsules. “It takes an extremely large concentration of cranberry to prevent bacterial adhesion,” Boone added. “This amount of concentration is not found in the juices we drink. There’s a possibility it was stronger back in our grandparents’ day, but definitely not in modern times.”

A study published in the American Journal of Obstetrics and Gynecology did conclude that taking cranberry capsules lowered the risk of UTIs by 50 percent in women who had a catheter in place while undergoing gynecological surgery. “In this study, they took the cranberry itself and put it in a capsule—the equivalence of drinking 28 ounces of cranberry juice. As you can see, it takes a large amount of pure cranberry to prevent an infection,” Boone said.

Symptoms of a UTI include increased urge to urinate, pain with urination, pelvic pain or blood in the urine. While they can be self-diagnosed and are often short-lasting, UTIs usually need to be treated with antibiotics. “Sometimes it easy to confuse a UTI with overactive bladder, so it’s always best to consult your physician about any adverse symptoms you’re having,” Boone said. “UTIs may also progress into kidney infections which are much worse.”

Treatment of UTIs can be complicated because of the high rates of reoccurrence, and approximately 20 to 30 percent of women will develop multiple UTIs. Another troublesome barrier to treatment is the increasing resistance of bacteria to commonly used antibiotics—enter probiotics.

“In these instances, probiotics were shown to be safe alternative to antibiotics in the treatment of UTIs,” Boone said. “There are many benefits of probiotics, although more research still need to be done.”

Source:  Article URL   Published on February 10, 2016 at 1:15 PM
Texas A&M Health Science Center

Urinary Tract Infections: How new Findings Create New Research Questions

Urinary Tract Infections: How New Findings Create New Research Questions

Matty L. Terpstra; Suzanne E. Geerlings
Curr Opin Infect Dis. 2016;29(1):70-72.

 Urinary tract infections (UTIs) remain an important and interesting topic: important as it is still one of the most common bacterial infections and causes of sepsis (urosepsis), and interesting as it is a great example of how new techniques contribute to our understanding of the pathogenesis of infectious diseases in general.

Even though clinical urine specimens have always been considered to be sterile when they do not yield uropathogens using standard operating procedures, this is now being questioned in several studies applying new sensitive methods such as DNA sequencing techniques.[1,2] Bacteria that are not routinely cultivated have been identified by new techniques in voided urine, urine collected by transurethral catheter and by suprapubic aspirate, regardless of whether the patients had urinary symptoms.[1] Thus, a urine specimen that was previously assumed to be sterile appeared to obtain bacterial products. These findings have opened the discussion considering the accuracy of our current culture techniques, the presence of (uncultivated) bacteria in urine, the microbiome of the urogenital tract and the importance of the microorganism–host interaction.

These new insights, combined with the already known aspects of UTIs, are discussed in four reviews that are considered in this issue of Current Opinion of Infectious Diseases. As each review is focussing on a different patient population susceptible for UTIs, this issue provides a clear overview on where we stand at this moment concerning the epidemiology, pathophysiology, risk factors, consequences and treatment of UTIs.

The epidemiology of UTIs shows a great variety depending on the geographic location and patient population. An important aspect in this is the onset location, as the bacterial spectrum and resistance rates appear to greatly vary between community-associated UTIs and healthcare-associated UTIs. Tondogdu and Wagenlehner (pp. 73–79) describes the global epidemiology of UTIs, the dependence on geographic location and the influence of changes in our healthcare system. The shorter duration of hospital stay has led to an increase in admissions, which are shorter than the bacterial incubation time, resulting in the diagnosis of infection after hospital discharge. These infections are considered to be community onset healthcare-associated UTIs, a category that is not clearly defined yet. In addition to this, an increasing amount of patients are receiving healthcare (e.g. urinary catheter exchange) at home or are living in nursing homes. It is unclear whether the pathogens causing infections in these patients are comparable to the pathogens of the community or healthcare-associated UTIs, as many epidemiology studies have not taken this category into account. Research on this developing category is necessary to determine how we should categorize these patients to offer them an optimal treatment.

For UTI, different kinds or presentations exist. Schneeberger et al. (pp. 80–85) give an overview about febrile UTI and describe the most important conclusions of recent studies published considering the interaction between causative microorganism and the host. Eschericia coli remains the most common organism causing pyelonephritis and urosepsis. Less-virulent strains can cause infection in immunocompromised patients whereas more virulence factors are needed to infect the immune-competent host. Known risk factors are obstructive uropathy, diabetes and being older, although interestingly, neutropaenia was not a risk factor for lower UTI or urosepsis. This might be explained by the hypothesis that neutropenia as a result of chemotherapy does not affect immunoglobulin A-mediated genitourinary mucosal immunity. Another relevant reported finding was the isolation of E. coli isolates from hospitalized patients with pyelonephritis compared with outpatients with cystitis. The isolates from admitted patients with pyelonephritis showed higher bacterial gene diversity and more virulence factors. Further exploration on this field is necessary to determine whether these findings could contribute to the development of new therapeutic options.

A common presentation of UTI in men is bacterial prostatitis; nearly one in six men report a history of prostatitis.[3] Furthermore, it is an inconvenient disease that also carries potential for serious morbidity from sepsis, abscess or fistula. In this issue of Current Opinion of Infectious Diseases, Gill and Shoskes (pp. 86–91) provide an overview and discussion of bacterial prostatitis, its categorization by type and a summary of recent findings.

The results of a large epidemiological study could not identify clear clinical risk factors for chronic prostatitis, but recurrence rates were high, suggesting incomplete eradiation. A possible explanation is found in the demonstration of the presence of bacteria that are able to produce a biofilm; the presence of these bacteria showed a positive association with symptom severity and a negative correlation with improvement after treatment. In another study, typical chronic prostatitis organisms were cultured in aspirated seminal vesicle fluid that suggests that the seminal vesicles may sequester bacteria causing recurrent prostatic infections. These new findings contribute to the understanding of the pathogenesis behind the recurrence of prostatic infections.

For patients with chronic prostatitis/pelvic pain syndrome and asymptomatic inflammatory prostatitis, to date no data support the role of ‘hidden infection’ or atypical organisms. Despite the strong belief of many patients that a true infection exists, there is currently no role for antibiotic treatment in these patients and there is often no explanation for their complaints [Gill and Shoskes (pp. 86–91)]. An important question in this matter is whether our current diagnostic tools are accurate. New sensitive techniques such as DNA sequencing might change our perspective on these patient categories.

In a certain way, the same counts for women with persistent urinary symptoms despite negative urine cultures. This issue is addressed in the review by Lakeman and Roovers (pp. 92–97). Interestingly, they discuss that in women with overactive bladder symptoms (OABs), low-count bacteriuria [at least 102 colony-forming unit (CFU)/ml] is more prevalent and the hypothesis is that intracellular bacterial communities in the bladder wall are present. Furthermore, several studies have reported relevant differences in the microbioma in women with OAB compared with healthy controls. These women are reporting symptoms and with the current diagnostic tools in most cases, no causative factor is found. Especially in these patients, the accuracy of our current diagnostic tools is being questioned, because the current screening methods are mostly using a detecting threshold of at least 105 CFU/ml, are mainly targeted at detecting uropathogenic E. coli and are failing to detect intracellular bacterial communities.

This detection threshold of at least 105 CFU/ml is based on studies performed by Kass[4] in the 1940s and 1950s. However, after the publication of the results by Hooton et al.[5] in 2013, which showed that in women with symptoms of cystitis, the sensitivity increased from 81 to 91% and the negative predictive value from 78 to 94% by using a threshold of at least 102 CFU/ml, the European Urology guidelines have been adapted [Lakeman and Roovers (pp. 92–97), Grabe et al.]. Nevertheless, in clinical practice, the most common used threshold is still a bacterial count of at least 105 CFU/ml. Whether low-count bacteriuria is the cause of OAB and should be treated with antibiotic therapy remains unclear. Studies evaluating the effect of antibiotic treatment for women with low-count bacteriuria are scarce and future research on this topic is required to determine which patients potentially benefit from antibiotic therapy.

In the recent years, the composition and diversity of particular microbiomes can be assessed far more accurately by molecular tools such as the quantitative PCR of 16S rRNA genes. Next to the identification of pathogens causing disease, these techniques have also led to new insights in the diversity of the bacterial communities that colonize the human body in the physiologic situation. The sequence analysis of 16S rRNA has now been used to determine the microbiota composition in numerous tissues in the healthy human body. The Human Microbiome Projects (http://commonfund.nih.gov/hmp/) have begun to catalogue the core microbial composition of the healthy human body to determine whether changes in this microbial community affect health.[1]

These new insights into the characteristics of bacterial communities residing within our body are, however, also pointing out our rather limited capacity to cultivate microorganisms.

After reading this issue of Current Opinion of Infectious Diseases, it is evident that our perspective on UTIs is changing. The sequencing of bacterial DNA is providing us an increasing amount of information on bacteria and species residing within the urinary tract and their interaction with the host. Our current screening methods to detect UTIs might not be sufficient. However, there is little known about the effectiveness of treatment of patients with low-count bacteriuria and OAB symptoms. Future research is necessary to determine whether undetected bacteria are contributing to currently poorly understood symptoms and complaints of the urinary tract.

We would like to thank all authors for their contributions. After reading their interesting findings, it is clear that a lot of research questions remain, especially considering the human urinary microbiome, bacterial characteristics in UTIs and the microorganism–host interaction.