Urinary tract infection (UTI or “bladder infection”) is the most common bacterial infection seen in the outpatient setting and the most common healthcare-associated infection, making it a major worldwide public health problem. UTIs cause significant pain and discomfort, and lead to time lost from work and school. Neuropathic bladder (when a person lacks bladder control due to a problem in the central nervous system), often due to spinal cord or brain injury and diseases, puts people at high risk for recurrent UTIs.
People with neuropathic bladder are often disabled due to their spinal cord or brain injury or disease, resulting in multiple chronic diseases. Frequent visits to multiple healthcare providers are needed to manage the chronic diseases; however, people face numerous barriers (such as transportation challenges, financial constraints, and inaccessible buildings or offices) in attaining this health care.
When the study team surveyed people with neuropathic bladder due to spinal cord injury and spina bifida, we found that UTI is a problem for more than 80 percent of people. Focus group participants with neuropathic bladder explained that UTI is such a problem that they frequently self-manage with a variety of supplements or even antibiotics. There was a strong consensus among our consumer partners that research to investigate the benefits of a patient-initiated self-management protocol would be extremely helpful and well-received by the community with neuropathic bladder.
For these reasons, we propose a prospective study in which we will develop and assess a patient-initiated Self-Management Protocol using Probiotics (SMP-UTI) instilled directly into the bladder for UTI symptom relief, early UTI management, and urinary health. To do this, we will work with local consumers with neuropathic bladder and United Spinal Association to engage more than 600 consumers across the nation to develop a Urinary Symptom Questionnaire and then the patient-initiated self-management protocol. We will then conduct a 15-month prospective assessment of the SMP-UTI with 100 local and regional participants. To assess the biology of how probiotics influence UTI, we will use traditional urinalysis and urine culture alongside novel metagenomic analyses in a subset of 50 people. Through this study with our consumer partners, we aim to develop and assess a protocol that will have high patient satisfaction and be easily translatable to all populations with neuropathic bladder who are at disproportionally high risk for UTI.
Tractenberg RE, Garver A, Ljungberg IH, et al., Maintaining primacy of the patient perspective in the development of patient-centered patient reported outcomes, Public Library of Science (March 2017).