Med Hypotheses. 2010 May;74(5):802-6. doi: 10.1016/j.mehy.2009.12.011. Epub 2010 Jan 12.
Many women who suffer from the symptoms of urinary tract infection have a negative urine culture when conventional methods are used. Their condition is described as 'urethral' (or 'dysuria/frequency') syndrome' (US). As they may be indistinguishable clinically from those with positive cultures antibiotics are often prescribed. Their symptoms are usually recurrent and they may receive many courses of treatment. Some women are said to have 'interstitial cystitis' (IC); they have a long history of symptoms and antibacterial treatment. The urine contains white blood cells (pyuria) and biopsy of the bladder wall shows the histological changes of chronic inflammation. Additional culture techniques applied to urine from these two groups of patients consistently yield bacteria, most commonly lactobacilli in those with US. From the urine of women with IC, lactobacilli and some other 'fastidious' bacteria are isolated from catheter specimens and also from bladder wall biopsies. These bacteria are known to be constituents of the mixed commensal flora of the distal one-third of the urethra. It is proposed that these two syndromes are different stages in the natural history of UTI, and that antibacterial agents, by selection of resistant bacteria in the urethral commensal flora, are an important aetiological factor. It is possible that these bacteria may invade the paraurethral glands via their ducts - a situation analogous to invasion of the prostate in men. There is a considerable body of evidence supporting this hypothesis, but as it all emanates from one centre it needs to be confirmed elsewhere. Acceptance would bring great clinical benefit and considerable financial savings. A laboratory protocol which requires only small additional expenditure, and a clinical management regimen are proposed. At present, much antibacterial treatment is prescribed and many patients undergo radiological and invasive investigations such as cystoscopy and urethral dilatation, the latter incurring the risk of post-instrumentation UTI. There is evidence that 'US' responds gradually if antibiotics are withheld. 'IC' is a more difficult problem because bacteria may have invaded the bladder wall. Carefully targeted antibacterial treatment given for at least 10-14 days might be effective, but there are no data on this. Rational management of 'US' might prevent the development of 'IC'. A recent thorough review of published work on this condition states that the aetiology is still unknown. It appears, however, that no attempt has been made in any recent studies to use urine culture techniques capable of detecting bacteria other than the recognised aerobic pathogens.
许多患有尿路感染症状的女性在常规方法下尿液培养呈阴性。她们的病情被描述为“尿道”（或“尿痛/尿频”）综合征（US）。由于她们在临床上可能与培养阳性的患者无法区分，因此经常开抗生素治疗。她们的症状通常反复发作，可能接受过多次治疗。有些女性被称为“间质性膀胱炎”（IC）；她们有很长的症状病史和抗菌治疗史。尿液中含有白细胞（脓尿），膀胱壁活检显示出慢性炎症的组织学变化。将额外的培养技术应用于这两组患者的尿液中，始终可以从 US 患者中分离出细菌，最常见的是乳杆菌。从 IC 女性的尿液中，从导管标本和膀胱壁活检中分离出乳杆菌和其他一些“难养”细菌。这些细菌是尿道远端三分之一混合共生菌群的组成部分。有人提出，这两种综合征是尿路感染自然史的不同阶段，抗菌药物通过选择尿道共生菌群中的耐药菌，是一个重要的病因因素。这些细菌可能通过其导管侵入尿道旁腺——这种情况类似于男性前列腺的感染。有大量证据支持这一假设，但由于它全部来自一个中心，因此需要在其他地方得到证实。如果接受这一假设，将带来巨大的临床益处和可观的经济节省。提出了一种实验室方案，只需额外少量支出，还有一种临床管理方案。目前，大量的抗菌治疗被开处，许多患者接受放射学和有创性检查，如膀胱镜检查和尿道扩张，后者有仪器操作后尿路感染的风险。有证据表明，如果不使用抗生素，US 会逐渐缓解。IC 是一个更困难的问题，因为细菌可能已经侵入了膀胱壁。如果给予至少 10-14 天的靶向抗菌治疗可能有效，但没有这方面的数据。合理管理 US 可能可以预防 IC 的发展。最近对该疾病已发表文献的全面审查指出，病因仍不清楚。然而，似乎在最近的研究中，没有尝试使用能够检测除公认的需氧病原体以外的细菌的尿液培养技术。
