Chronic Cystitis

WHAT IS A CHRONIC UTI AND HOW DOES IT OCCUR?

The inner lining of the bladder is known as the urothelium. It is comprised of urothelial cells. A Chronic UTI occurs when pathogenic bacteria in the urine penetrate these cells in the bladder lining, activating the immune system which sets up an inflammatory response.

The commentary below gives a detailed account of how this occurs

00 Chronic urinary infection Picture Commentary August 2018 (1).pdf (1.13 MB)

 Testing for UTIs

Standard NHS tests are insensitive and miss many acute and chronic infections. Several studies have discredited dipstick urine tests and routine urine culture which is based on a criteria devised in the 1950s and has never been up-dated in the light of more recent research. You cannot rely on an NHS culture to diagnose an infection!

However, Bladder Health has recommended sufferers to use private testing. We understand that not everyone is able to afford a private test but it can make a significant difference to your treatment options if you do decide to opt for this.

Below are some of the clinics we have worked with.

Systems Biology Labs

SBL was founded in 2004 as a not-for-profit, independently funded and highly focused research laboratory.

SBL harvests DNA directly from a urine sample with no need for culture or PCR testing. They analyse over 100,000 long-string microbe DNA sequences per sample using state-of-the-art Nanopore sequencing and match them to their database of pver 4,000 bacteria that have their full DNA code already established. They also look for matches to commonly occurring yeasts and over 10,000 DNA viruses.

The process tells them with a high degree of certainty which microbes were present and at what level, normally within 48 hours of the sample arriving at the lab.

The method has many other benefits. Often they recover enough DNA sequences to be able to recreate the entire DNA code of the bacterial species in the sample, cataloguing all its unique variations to give a fingerprint of the exact strain present.

Turnaround of urine analysis can take up to two weeks.

Test kits can be ordered at the following link www.digital-microbiology.com

Focus Labs Online (Focus Medical Clinic)

Focus Labs Online offer Extended Quantitative Urine Culture. They also offer liquid broth extraction for bugs which do not culture well on agar.

You can order a test direct at the following link https://focuslabs.online/ but please be aware, that Focus are not able to issue a prescription based on the results. This will need to be obtained from your clinician.

Alternatively, you can opt for a signed GP referral. This option includes an explanation of your results and suggested medication together and duration of treatment. Both you and your GP should receive a copy.

You can request a GP referral form at the following link https://focuslabs.online/referrals/ which you should take to your GP requesting it is completed and returned to Focus.

MicroGen DX

This US-based lab does offer options for testing to international patients as well as those based in the U.S.A.

Microgen uses molecular diagnostics (PCR and NGS testing) to identify microbes by looking for bacterial DNA within the urine sample. The data obtained is compared to a database of 21 common pathogens.

Microgen are also able to detect antibiotic resistance genes and make recommendations on which antibiotic should be used. However no antibiotic sensitivities can be provided without the signature of a clinician.

No GP or consultant referral is required to request a test kit and you can request the kit at the following link

https://microgendx.com/product/uti-urinalysis-test-service-dm-intl/

PRACTITIONERS

There are only a limited number of practitioners in the UK who are willing to test and treat Chronic UTI. The following are the main practitioners at present. For a full list of practitioners, join BHUK to receive a copy of our Chronic Infection Pack.

   Dr Catriona Anderson MB ChB BSc(Hons), MRCGP, DFSRH

Dr Anderson is a private GP based at Focus Medical Clinic in Staffordshire. She has a specialist interest in microbiology and womens bladder health.             

Dr Anderson is currently not taking new patients but should the position change, we will up-date this page.

        Dr Rajvinder Khasriya

Dr Khasriya is a Uro-Gynaecologist at the Lower Urinary Tract Symptoms (LUTS) Clinic at the NHS Whittington Hospital, London. She will treat patients via the NHS following a tertiary referral from a consultant.

Also avaiable for private consultation.

The Portland Hospital, London 

 Contact Details

The Portland Hospital

London

Email: uti.portland@hcahealthcare.co.uk

Dr Kiren Gill:

Dr Kiren Gill PhD MRCOG is a Consultant Urogynaecologist at the Tertiary Lower Urinary Tract Symptoms (LUTS) Clinic at the NHS Whittington Hospital, London. She is able to treat patients via the NHS following a secondary care referral from a consultant. She has a clinical and academic interest in the field of UTI

Also avaiable for private consultation.

The Portland Hospital, London 

Dr Kiren Gill PhD MRCOG and Dr Rajvinder Khasriya PhD MRCOG, who have both trained under the late Professor James Malone-Lee, have a clinic at the Portland Hospital in London. Dr Gill and Dr Khasriya are urogynaecologists and able to treat gynae and pelvic floor issues as well as those relating to chronic UTI.

Contact Details

The Portland Hospital

London

Email: uti.portland@hcahealthcare.co.uk

                MR SACHIN MALDE (Private)

Mr Malde is a Urologist based at Guys & St Thomas’s Hospital, London. He is treating patients with chronic UTI privately following a GP referral.

Appointments can be made by calling 020 3488 2636 or emailing info@londonurologist.net

10 HARLEY STREET, LONDON (Private)

A team of clinicians practice at a clinic based at 10 Harley Street, London. All clinicians have been trained by the late Professor James Malone-Lee and treat according to his protocol of long-term, high-dose antibiotics. They will see patients following a referral from a GP.

BHUK used to have a link here to Professor James Malone-Lee who sadley passed away February 19th 2022

I have added the message sent out by Jane Meijlink , the Chair of the International Painful Bladder Foundation because it sums up so well the character and prescence of this man.

Thank you to Jane for such a fitting comment about this unique person.

Dear all,

In the advocacy meetings there has been much discussion about the controversies surrounding embedded infection with mention of the work of Professor James Malone-Lee from London. Some of you may not yet know that James Malone-Lee sadly passed away from terminal cancer a week ago. He will be greatly missed, not only because he was a dashing eccentric, always friendly, kind and helpful, but also because he drew unprecedented attention to urinary tract infections and particularly UTIs not getting diagnosed due to outdated, inadequate methods. Hopefully his work – often highly controversial! – will have encouraged urologists and urogynaecologists to focus more attention on this neglected field in the coming years. We will all miss this colourful figure who initiated so much ground-breaking research for the sake of patients.

 kind regards,

Jane

Jane Meijlink, BA Hons, MCIJ

Chairman

International Painful Bladder Foundation

https://www.painful-bladder.org/

info@painful-bladder.org

Registered Charity: 24382693

Charity Fiscal Number: 8168.41.597

Diagnosis and Treatment of Chronic UTI

Diagnosis and treatment for Chronic UTI varies between specialists.

Dr Anderson favours rigorous testing and culture of samples. Following a positive result, she will prescribe long-term or short-term antibiotics as appropriate. Also, on occasion, she will use Uromune, the UTI vaccine and Hiprex. She will also advocate natural products such as D-Mannose where appropriate.

Dr Khasriya and the Harley Street team do not culture but examine a fresh urine sample under a microscope for the presence of bacteria. They rely on a detailed history from their patients to gain an understanding of their condition. They prescribe long-term antibiotics, together with Hiprex.

For further information on Chronic UTI become a member of Bladder Health UK to receive our Chronic Infection Pack.