Detrusor overactivity (DO) is a chronic debilitating disorder, where in patients experience urinary urgency and frequency, with or without urge incontinence. The primary treatment is with antimuscarinic agents but 35% of all DO sufferers are refractory to this therapy. The cause of refractory DO is not known although our work has shown infection/inflammation is a major contributing factor to the refractory state.
We have shown that approximately 50% of patients with refractory DO have an underlying infection. We know that in the bladder the response to infection is to secrete cytokines which recruit neutrophils and macrophages to destroy the infection. To control the extent of damage and limit the inflammatory response, anti-inflammatory cytokines (such as IL-10) are secreted to protect the bladder. Therefore a careful balance between anti- and pro-inflammatory cytokines is important in the bladder response to infection.
The aim of this project is to determine whether a cytokines imbalance contributes to the aetiology of refractory DO. We will compare urinary cytokine levels and their relationship with clinical symptoms in patients with refractory DO versus control patients with no bladder urgency. We hypothesise that chronic low grade bacterial cystitis is a key etiological factor for the refractory state in at least 50% of women with DO and that cytokines are an important mediator of clinical symptoms and the pathophysiology of the refractory state.
Illawarra Health and Medical Research Institute
Collaborative Research Project
University of Wollongong / South Coast Urology