Pathophysiology and potential treatment modalities in women with recurrent urinary tract infection

Abstract

Urinary tract infection (UTI) of the urinary bladder is a common bacterial infection that predominantly affects women, with many experiencing recurrent episodes. Recurrent UTIs (rUTIs) are associated with significant physical, psychological, and social difficulties. Further, they are closely related to lower urinary tract dysfunction (LUTD). LUTD affects bladder function and structure, thereby contributing to urinary urgency, frequency, and incontinence, which, in turn, increases the risk of recurrent infections due to impaired urothelial defense mechanisms. The current study explored the pathophysiology of LUTD in women with rUTIs. Potential treatments for rUTIs include long-term prophylactic antibiotics, probiotics, D-mannose, vaccines, small molecule inhibitors, and stem cell therapy. Moreover, it evaluated the use of platelet-rich plasma (PRP) therapy as a treatment modality for LUTD. PRP has regenerative and anti-inflammatory properties. Hence, it can be a promising option for enhancing urothelial barrier integrity and reducing infection recurrence. Repeated intravesical PRP injections are effective in improving bladder symptoms and decreasing UTI recurrences by enhancing the proliferative ability of the urothelium in patients with rUTIs. Further, this review examined the potential predictors of successful PRP treatment outcomes such as cytokine and urothelial biomarker levels, which provided insights into patient selection and individualized treatment strategies. Identifying the predictive biomarkers of treatment responsiveness is essential for optimizing PRP therapy. Hence, to improve the clinical outcomes and quality of life of patients with rUTIs, future research should focus on refining the use of PRP, exploring combination therapies, and validating biomarkers.

Keywords: Biomarkers; Lower urinary tract dysfunction; Platelet-rich plasma; Recurrent urinary tract infection; Women.

Figure 1

Platelet-rich plasma (PRP) treatments enhance Ki-67 expression in patients with recurrent urinary tract infections (rUTIs). Immunohistochemistry demonstrated elevated Ki-67 protein expression (brown staining) in the urothelial nuclei of patient with rUTIs after PRP treatments. The nuclei were counterstained with hematoxylin

Figure 2

Induction of E-cadherin expression in patient with recurrent urinary tract infection (rUTI) after platelet-rich plasma (PRP) treatments. Immunofluorescence staining revealed an increase in E-cadherin protein expression (green fluorescence) in the urothelium following PRP treatments in patient with rUTIs. The nuclei were counterstained with DAPI: 4’,6-diamidino-2-phenylindole. PRP: Platelet-rich plasma