Urinary infections are complex and hard to treat

The work, counselling and campaigning of Ms Kilmartin during the late 60s and 70s should not be underestimated. She bought an orphan subject to the forefront and helped many thousands of sufferers both male and female to alleviate and prevent recurrent infections or manage a terrifying first attack. Her advice is straightforward, no nonsense and works. Indeed it is oft echoed by GPs and Urologists to those patients presenting repeatedly with UTI or those experiencing their first, distressing attack of cystitis.

However in the case of a chronic UTI sufferer, these preventative measures such as bottle washing are now redundant and the issue of effective ongoing treatment, recognition and understanding of the distress and loss of quality of life these sufferers are experiencing is key. Given the recent and ongoing research carried out by the Hultgren Laboratory, University College, London and Loyola University, Chicago amongst many others, into the urinary microbiome, we are now aware of the complex nature of the urinary tract which includes the development of intracellular bladder wall bacterial communities of infection due to fastitudous organisms, complex biofilm structures resulting from bacteria such as e coli and the emerging community of microbes that reside in this tract, once thought sterile.

This microbial community can have an efficacy in warding off infection. What needs to be established is the understanding of a beneficial urinary microbiome and what stresses such as an invading microbe(s) in the urinary system, an antimicrobial treatment related or unrelated to the urinary tract, or some change to the host’s metabolism or immune system place on this. One response to this article called for more research and I can only echo this. This may take many years but we benefit from new scientific techniques not available to Edward Kass when the "Gold Standard” was determined in the 1950s let alone ease of global communication and scientific co-operation. The global burden of this disease is rising, with 16.1% increase in age-standardised incidence between 1990 and 2013 and 58,000 years lost to disability (YLD) in 2003 alone.[i] That alone should mean that ongoing and continued research into urine and the urinary tract should determine to lead to effective, immediate diagnosis and treatment. And yes, I'm sure the GPs and Urologists will continue to mention Ms Kilmartin's advice in the future even as novel, targeted therapies are administered to help those with chronic UTI and prevent the development of such a currently debilitating illness for others.

[i] Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015 Aug 22;386(9995):743-800. doi: 10.1016/S0140-6736(15)60692-4.