Urinary disorders affect 20% of the population as a whole. By the age of 50, one in three people will have a urinary disorder. One in every five people has this problem called overactive bladder (OAB) which, for some, means not being able to hold in urine, needing to go to the toilet often, or waking in the night to empty their bladder. Some wear sanitary towels or disposable underwear, while others worry that even with absorbent underwear, they’ll smell of urine, so they choose instead to stay at home. Diagnosing an overactive bladder – when a patient needs to urinate very often, and sometimes wets their pants – is, at best, a cumbersome process. Clinicians need to first rule out a wide range of possible diseases and conditions with the same symptoms, including some cancers, Type 2 diabetes, cystitis, and a urinary tract infection. One of these tests is invasive and painful and costs £1,000 per person. The treatments for each possible disease varies greatly. Some of the tests aren’t accurate at giving a clear result, prolonging clinicians’ search for a diagnosis. The conditions can be so complex to diagnose, that patients’ health has often worsened by the time the results are finally in. Thanks to a new research, however, millions of people might eventually be spared the embarrassment and extreme isolation caused by wetting themselves.
Scientists at the University of Portsmouth have identified chemicals in urine that are specific to overactive bladder. Mucosal biopsies were taken by flexible cystoscopy from patients with storage symptoms referred to Urology Departments of collaborating hospitals. Immunohistochemistry (n = 12) and Western blot analysis (n = 28) were used to establish the qualitative and quantitative expression profile of a receptor called P2Y6 in human mucosa. This cellular surface protein is activated by some nucleotides, DNA bases with phoshate groups, and is involved in several physiological processes. INdeed, the team has identified nucleotides ATP and ADP in urine. Participants from the general population provided a mid-stream urine sample. Bioluminescent assays were used to quantify adenosine triphosphate (ATP; n = 66) and adenosine diphosphate (ADP; n = 60) concentrations. P2Y6 immunoreactivity, more prominent in the urothelium (colocalized with the uroepithelial marker pan-cytokeratin), was more greatly expressed in OAB compared to age- and sex-matched controls (benign prostatic hyperplasia) without OAB symptoms. Mucosal P2Y6 was positively correlated only with incontinence (P = .009). Both urinary ATP and its hydrolysis product, ADP, an agonist to P2Y6, were positively correlated with total OAB symptom score.
The next step is to develop a gadget similar to a pregnancy test, to see if these chemical markers are present. Such a device is 12-24 months from clinical trials, but the early signs are encouraging. Dr. John Young from the School of Pharmacy and Biomedical Sciences at Portsmouth, published the research in Nature’s Scientific Reports. He commented: “The first step has been to identify chemicals in urine that are specific to overactive bladder. The next step is to develop a gadget for use in GPs, pharmacies and nursing or care homes which is simple to use, accurate and doesn’t need to be sent to a laboratory for processing. If successful, it would save millions of patients from painful procedures and long waits for a diagnosis. This is the first step in transforming the lives of millions of people who suffer in silence, too embarrassed to go out or even to speak about their condition. It would also save healthcare providers, including the National Health Service, millions of pounds. Finally, if clinical trials bear out the development, it would allow treatment for the condition to begin much earlier. The dipstick test Dr. Young and colleagues are proposing would cost about £10 and take a few minutes to give an accurate result. Treatment could start immediately, long before the sometimes debilitating symptoms have forced a patient to wear sanitary products or to stop going out from home.
Dr. Young concluded: “It’d be as simple as a pregnancy test. Effective treatment is early treatment. When left untreated, the bladder can change. Additional nerves, blood vessels and cells grow, leaving it smaller than before. It isn’t good enough that so many millions of people feel forced to isolate themselves in their homes, avoiding all social interaction, with a condition which if caught early, has treatments which can help”.
- edited by Dr. GIanfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.
Firouzmand S et al., Young JS. Neurourol Urodyn. 2020 Feb 12.
Polat S et al. Int Braz J Urol. 2019 Nov-Dec; 45(6):1186-1195.
Abdul-Razzak KK et al. Neurourol Urodyn. 2019 Apr; 38(4):1160.
Dott. Gianfrancesco Cormaci
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