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.
