Decreased intravesical adenosine triphosphate in patients with refractory detrusor overactivity and bacteriuria
Purpose Although several studies have examined the relationship between ATP release from the urothelium and bladder sensations including painful filling and urgency, the association between bacteriuria and urothelial ATP release is not well studied. Our aim was to evaluate women with “refractory” detrusor overactivity (DO), who were experiencing an acute exacerbation of their DO symptoms, including frequency, urgency, nocturia (and/or urge incontinence); we wished to measure changes in intravesical ATP levels in these women with and without bacteriuria.
Methods A prospective cohort study of women with “refractory” DO, were invited to attend our unit during acute symptomatic exacerbation. On presentation, a catheter urine specimen (CSU) was collected and 50ml normal saline was instilled into the bladder to evoke gentle stretch and removed after 5 minutes; ATP concentrations were determined on fresh washings using a bioluminescence assay.
Results The incidence of bacteriuria ≥103 CFU/ml was 27% (15/56 specimens) over the 16-month study period. ATP concentrations were lower during bacteriuric episodes in both the overall cohort (p=0.0013) and paired samples from individual patients (p=0.031), compared to episodes of sterile urine.
Conclusions For the first time, we have demonstrated a striking difference between ATP levels measured in the presence of, and absence of, bacteriuria in this patient group.