Modern science has shown that the widely held beliefs of clinicians about urinary tract infection (UTI) are wrong. A large body of meticulous, rigorous data, from different centres around the world makes this point. How can it be that doctors continue to practise in contradiction of what we now know? A few clinicians are now changing their approach with gratifying results so it is timely to encourage others to do likewise. Clinical guidelines have achieved such influence that most doctors feel compelled to follow them and may face censure if they do not. Regrettably the guidelines are mistaken and contradict the known science. The inertia of bureaucracy and the fear of antimicrobial resistance (AMR) do not help to encourage reflection. However, things are changing and the future should see new and better informed advice. It is a tragedy that these circumstances are leading to widespread suffering amongst many women, some men and children who experience untreated or inadequately treated infection that may plague them for years. This situation has to change. This book sets out the truth about this neglected field and explains the many errors that haunt the topic. The style makes the message accessible to all clinicians. The story is convincing, because the clinical stories that illustrate the text will be so familiar to practising clinicians, who have been baffled by their experiences. Above all, this book will help you and your patients by detailing an accessible, practical approach to resolving this difficult clinical problem in common practice. The scope of the book will cover: the history of the medicine of urinary tract infection (UTI); the urinary microbiome and what the microbes are really up to; the battles between the pathogens and the innate immune system; the truth about the tests and the criteria used to define UTI; antimicrobial resistance and the importance of Darwinian evolution; the science and ground-breaking research on UTIs; the use of antibiotics; successful treatment; supportive and other related treatments; ethics; the future; and, above all, the experiences of the patients.
James Malone-Lee is an Emeritus Professor of Medicine at University College London (UCL). For 37 years as a clinical scientist at UCL he studied lower urinary tract symptoms. His research group made discoveries that challenged numerous strongly held beliefs about lower urinary tract disease, particularly infection. For many years this new knowledge was rejected by many, but in the wake of corroborative evidence from others around the world, this new thinking is becoming more widely accepted.
