In July 2016 Catherine West MP (Hornsey & Wood Green) organised a presentation by Professor Malone-Lee at Portcullis House to discuss the diagnosis of Urinary Tract Infections.
Professor Malone-Lee heads the Lower Urinary Tract Symptoms Clinic at the Whittington Hospital in North London. He spoke on the problems surrounding the standard diagnosis of chronic urinary tract infections with particular emphasis on the failures of the standard urine testing.
“Urinary tract infection (cystitis/UTI) affects 150 million people worldwide each year: 33% of women are expected to suffer before they are 24.
Women presenting with symptoms of UTI in primary care will be managed according to a guideline, there are several of these; they are contradictory and most ignore the published science.
The assumption that a UTI will always cause pain is wrong. In fact, pain may be a late manifestation.
The advice to increase fluid intake is not based on evidence. The practice dilutes the urine of natural immune chemicals and antibiotics, if prescribed. The dilution of pathological markers in the urine may falsely imply recovery.
Cranberry juice is not effective.
Many practices will test the urine with dipsticks and, if these prove negative, the patient is informed that there is no infection. This is incorrect advice and confuses ‘no evidence of disease’ with ‘evidence of no disease’. The dipstick test will miss well over 50% of all infections.
If a urine sample is sent to the laboratory for culture, and this is reported as negative, it is probable that this will be assumed to refute the diagnosis of UTI. This is also wrong; the standard MSU culture will also miss well over 50% of all infections, so that a negative test is not evidence of no disease.
If the patient is fortunate enough to be diagnosed with a UTI it is possible that she may be prescribed antibiotics, typically for three days. This may not work: 20% to 30% of patients will fail recommended treatment whether prescribed for three days or 14 days. If she complains that she has not recovered she is likely to be dismissed. She will have been advised to drink plenty, her urine, suitably diluted, will be devoid of pathological signals. Thus it is assumed that she must be better – The test says so.
These facts have been available in the scientific literature for a large number of years. The standard guidelines seem to ignore this evidence placing people at risk of being denied appropriate treatment. We do not know the consequences of untreated UTI persisting over months or years, but it may reap harm. The current anxieties about antibiotic resistance make it harder to bring sober reflection to this problem.
This may be an orphan subject but a cause of immense suffering for many people.”
James Malone-Lee MD FRCP