PSYCHOLOGICAL PREDICTORS OF SYMPTOMS OF URINARY-TRACT INFECTION AND BACTERIURIA IN PATIENTS TREATED WITH CLEAN INTERMITTENT CATHETERIZATION- A PROSPECTIVE 7-YEAR STUDY

Objective: One of the major clinical problems in relation to clean int ermittent catheterization (CIC) are symptoms of urinary tract infectio n (UTI) and bacteriuria. The aim of the present work was to study to w hat extent measures of psychological well-being, distress and neurotic personality traits in patients performing CIC could predict symptoms of UTI or bacteriuria 7 years later. Patients and Methods: Included in the study were 170 patients with a mean age of 57 years, who had used CIC for 105 months. CIC was practised due to neurogenic bladder dysfu nction in two thirds of the patients, and non-neurogenic dysfunction i n the remaining patients. All patients had been clinically examined 7 years prior to inclusion. Information about subjective symptoms of Un and examination of bacteriuria in urine samples had been assessed. All subjects had also undergone repeated psychometric evaluations of psyc hosocial function, well-being and distress (General Health Questionnai re; GHQ-28; Spielberger State-Trait Anxiety Inventory; STAI X-l) and n euroticism (Eysenck Personality Questionnaire; EPQ-N). The results fro m selected assessments done 7 years earlier were used to predict repor ted UTI and findings of bacteriuria in urine samples in 1995. Results: Clinical UTI symptoms were reported by 35% of the patients. These pat ients had significantly higher GHQ-28 scores in 1988, 1989 and 1995 co mpared to the remaining 65%. Patients without clinical UTI during 1988 /89, but with symptoms suggesting UTI in 1995, had significantly highe r GHQ-28, STAI-X1 and EPQ-N scores in 1988 compared to those who did n ot report symptoms 7 years later. Patients with UTI during 1988/89 who were free of symptoms of UTI in 1995 had scores similar to those who were free of symptoms of UTI both in 1988/89 and in 1995. GHQ-28, STAI X-1 and EPQ-N scores in 1988/89 did not predict current bacteriuria, found in 62% of the urine samples in 1995. Conclusion: Social function , well-being and distress are significant predictors of long-term urin ary tract complaints, but not of bacteriuria. This finding indicates t hat the aetiology of UTI complaints and of actual bacteriuria is diffe rent. Complaints of UTI may often express distress and not symptomatic infection. Physicians' non-recognition of distress may lead to unnece ssary and aggressive interventions for assumed infection such as the p rescription of antibiotics. Identification and treatment of psychologi cal distress and impaired social function should become routine in the clinical follow-up of CIC patients. Such a routine could reduce urina ry tract complaints, lower the unnecessary use of antibiotics and incr ease the tolerability of CIC. Prospective intervention studies are nee ded to verify this hypothesis.