Apropos of pathogenesis of recurrent lower urinary tract infections

Many young women and also postmenopausal women have to deal with recurrent lower urinary tract infection (RLUTI), which is defined as 3 or more episodes of infection in 1 year or 2 or more episodes during 6 months. Approximately 20-30% of women develop recurrence after first event of acute cystitis. Treatment of female patients with RLUTI is a complicated issue. Despite the recommendations to the optimization of behavior, usage of the non-antimicrobial and antibacterial substances, the recurrence rate stays commonly high. This warrants the revision of pathogenesis of RLUTI, using the modern data from immunology, molecular biology and genetics area. It was shown, that 68% of recurrence cases are associated with E. coli, which is identic to the original strain, and these recurrences with detection of the same strain could occur up to 1 year after the initial event. Although the superficial epithelial cells of the bladder with their layer of glycosaminoglycans represent a reliable barrier for bacterial colonization, in certain circumstances uropathogenic E. coli (UPEC) could fasten onto the surface of epitheliocytes and then invade into these, forming the intracellular bacterial inclusions - the zones of bacterial persistence and starting point for RLUTI. In this review we describe the mechanisms of UPEC persistence in urothelial cells, host reactions on the invasion of infectious agent and although possible modifications of these interactions using certain strains of UPEC. The question of the predisposition to the development of urinary tract infection is also thoroughly discussed.