Infections in the Culture of Catheter Urine Specimens and Bladder Biopsies in Women Undergoing Cystoscopy.

Introduction and hypothesis: Urinary tract infections (UTIs) are one of the most common reasons for seeking medical review worldwide. Women are disproportionately affected, with a life-time incidence of 50%. Women presenting with clinical symptoms of UTI such as dysuria and urinary frequency can often have negative urine culture results, especially if they have been taking multiple courses of antibiotics. This can make the diagnosis and management of recurrent or chronic UTI challenging. In this study we compared the culture results of urine and bladder tissue in women undergoing rigid cystoscopy presenting with lower urinary tract symptoms. We hypothesise that a biopsy of the bladder wall might be more likely to reveal a causative uropathogen on culture than urine.

Methods: Women had clean-catheter urine samples sent for urine culture and then bladder biopsies taken at cystoscopy cultured for uropathogens. Culture results from urine and bladder tissue were analysed and compared.

Results: We found that under 10% of urine cultures were positive (n = 30), whereas 51% of bladder tissues cultures grew a uropathogen (n = 155). Analysis showed that the culture results of urine and bladder tissue did have a statistically significant relationship (p = 0.008). Culture of bladder tissue revealed a wider variety of uropathogens.

Conclusions: This study proposes that cystoscopy with a bladder biopsy for culture might be a useful adjunctive tool in selected women with refractory symptoms of urine infection.