title: Detection of intracellular bacteria in exfoliated urothelial cells from women with urge incontinence.
abstract: The role of subclinical infection in patients with urge incontinence has been largely ignored. The aim of this study was to test for the presence of intracellular bacteria in exfoliated urothelial cells obtained from the urine of patients with detrusor overactivity or mixed incontinence +/- a history of UTI, and compare this to a control group of patients with stress incontinence and no history of infection. Bacterial cystitis was assessed by routine microbiology and compared to microscopic analysis of urine by Wright staining. Subsequent analysis of urothelial cells by confocal microscopy was performed to determine the existence of intracellular bacteria. Bacterial cystitis was seen in 13% of patients based on routine microbiology. Wright staining of concentrated urothelial cells demonstrated the presence of bacteria in 72% of samples. Filamentous bacterial cells were observed in 51% of patients and were significantly more common in patients with detrusor overactivity. Intracellular Escherichia coli were observed by confocal microscopy. This study supports the possibility that a subset of patients with urge incontinence may have unrecognised chronic bacterial colonisation, maintained via an intracellular reservoir. In patients with negative routine microbiology, application of the techniques used in this study revealed evidence of infection, providing further insights into the aetiology of urge incontinence.
authors.affiliation: Departments of Urogynaecology, University of New South Wales, Kogarah NSW 2217, Australia.
authors.forename: Ying
authors.initials: Y
authors.lastname: Cheng
authors.affiliation: Departments of Urogynaecology, University of New South Wales, Kogarah NSW 2217, Australia.
authors.forename: Zhuoran
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Australian Infectious Disease Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane QLD 4072, Australia.
authors.forename: Jayde A
authors.initials: JA
authors.lastname: Gawthorne
authors.affiliation: Microbiology, St George Hospital, University of New South Wales, Kogarah NSW 2217, Sydney, Australia.
authors.forename: Chinmoy
authors.initials: C
authors.lastname: Mukerjee
authors.affiliation: Microbiology, St George Hospital, University of New South Wales, Kogarah NSW 2217, Sydney, Australia.
authors.forename: Kerry
authors.initials: K
authors.lastname: Varettas
authors.affiliation: School of Medicine, University of Wollongong, Wollongong NSW 2522, Australia kylie@uow.edu.au.
authors.forename: Kylie J
authors.initials: KJ
authors.lastname: Mansfield
authors.affiliation: Australian Infectious Disease Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane QLD 4072, Australia.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schembri
authors.affiliation: Departments of Urogynaecology, University of New South Wales, Kogarah NSW 2217, Australia.
authors.forename: Kate H
authors.initials: KH
authors.lastname: Moore
mesh_terms: D000328:Adult; D000368:Aged; D001419:Bacteria; D016022:Case-Control Studies; D003556:Cystitis / Q000150:complications* / Q000382:microbiology*; D004847:Epithelial Cells / Q000382:microbiology* / Q000473:pathology; D004926:Escherichia coli; D005260:Female; D006801:Humans; D018613:Microscopy, Confocal; D008875:Middle Aged; D053202:Urinary Incontinence, Urge / Q000209:etiology*; D019459:Urothelium / Q000382:microbiology*
keywords: bacterial cystitis; intracellular bacteria; recurrent urinary tract infection; urge incontinence; urothelium