Pathophysiology of UTI Version 3.0
Research type
Research Study
Full title
A prospective observational study of the pathophysiology of urinary tract infection
IRAS ID
295252
Contact name
Rajvinder Khasriya
Contact email
Sponsor organisation
University College London
Duration of Study in the UK
4 years, 3 months, 7 days
Research summary
All contemporary guidelines on UTI advocate diagnosis and management based on urinary dipsticks and/or culture. We now know that cultures cannot differentiate patients from healthy individuals, isolates may not identify cause, so treatments may be misguided. Recalcitrant chronic bladder pain and interstitial cystitis (IC) are rapidly increasing and may result from inadequately treated UTI due to errors promoted in guidelines. The clinical phenotype of UTI, the pathophysiology and diagnostic methods, must be informed by good science. Causation is fundamental and is now revolutionised by Judea Pearl’s work on probability theory providing a mathematically-derived, proven method for validating causation. Next generation sequencing (NGS) of the urinary microbiome is a powerful lens for the polymicrobial urinary microbiome. Artificial intelligence (AI)-assisted robotic microscopy is a versatile tool, that achieves enhanced urinalysis. Integrating these methods with clinical care opens the opportunity to root UTI management in stringent, empirical science. The most pressing concerns are with acute cystitis, pyelonephritis, chronic cystitis and obstetric UTI.
This study will explore UTI through a collaboration between clinicians and scientists using consilience to explain the aetio-pathophysiology, diagnosis and progression of UTI under treatment in key groups: (1) persons experiencing acute UTI including pyelonephritis, (2) those with chronic UTI, (3) UTI in pregnancy, (4) normal controls. It is our intention to establish a reliable diagnostic protocol, attempt to explain the cause and evolve treatment strategies. Our published studies persuade that it will be possible to realise simple, economic, validated methods, sensitive to antimicrobial resistance (AMR), for the management of UTI. It is our purpose to ensure that the methods that are eventually proposed are suitable for primary care so that we may shift the management of UTI out of the hospitals through the timely application of simpler protocols at earlier stages in the disease.REC name
Wales REC 3
REC reference
22/WA/0069
Date of REC Opinion
30 Mar 2022
REC opinion
Further Information Favourable Opinion