Biennial Report of the Director

Research in Diseases, Disorders, and Health Conditions
Chronic Diseases and Organ Systems
Urologic Diseases and Conditions

Diseases and conditions affecting the bladder and associated structures of the lower urinary tract affect people of all ages, result in significant health care expenditures, and may lead to substantial disability and impaired quality of life. Women are disproportionately affected by many urologic diseases and conditions, such as urinary incontinence, urinary tract infections (UTIs), and interstitial cystitis/painful bladder syndrome (IC/PBS) (see “Chronic Pelvic Pain”). A conservative estimate is that approximately 13 million Americans, most of them women, suffer from urinary incontinence. 183 UTIs are among the most common infectious diseases acquired by humans; in fact, only respiratory infections occur more often. UTIs caused by the bacterium Escherichia coli (E. coli, which is normally found in the colon) accounted for over 8 million doctor visits, nearly 7 million by women, in 2000, and many women suffer from frequent infections.184 In men, non-cancerous growth of the prostate, or benign prostatic hyperplasia (BPH), is a common cause of bothersome lower urinary tract symptoms, such as weak or intermittent urine stream, an inability to empty the bladder completely, and having to urinate frequently, especially at night. The prevalence of BPH increases from 40 to 50 percent in men ages 51 to 60 to greater than 80 percent in men older than 80.185 Congenital malformations or obstructions of the urinary tract can lead to a variety of urologic problems in children, including reflux of urine back toward the kidneys (vesicoureteral reflux) and UTIs. Urologic diseases and disorders can also contribute to or be the primary cause of sexual dysfunction. As people age, many non-cancerous urologic conditions become more prevalent. Thus, addressing the burden of urologic diseases and conditions is an important challenge to meet as the American population ages overall.

Spearheaded by NIDDK, NIH supports basic and clinical research on the normal and abnormal development, structure, function, and injury repair of the genitourinary tract. Areas of particular interest include the causes of and treatments for major adult urological diseases and disorders, such as BPH, urinary incontinence and UTIs. (Other disorders of the genitourinary tract, such as IC/PBS and chronic prostatitis/chronic pelvic pain syndrome, are discussed under “Chronic Pelvic Pain.”) Additional areas of interest include research on treatments for kidney stones (hard masses developed from crystals that separate from the urine within the urinary tract), such as shock-wave and laser lithotripsy to break up stones, and therapeutic approaches to inhibit their formation and growth.

NIH efforts include the GenitoUrinary Development Molecular Anatomy Project, an NIDDK-funded consortium of laboratories working to provide the scientific and medical community with tools to facilitate research on the genitourinary tract.186 With co-funding from ORWH, NIDDK also supports the Urinary Incontinence Treatment Network thatinvestigates surgical, behavioral, and medical treatments for stress and urge urinary incontinence.187 One study in this network has revealed that two common operations for stress urinary incontinence (SUI) help women achieve similar levels of dryness. The Trial of Mid-Urethral Slings compared the outcomes of two minimally invasive surgical procedures involving use of synthetic mesh slings that are FDA-approved to treat this condition in women. Importantly, the trial also captured the risks and side effects of each type of surgery, which differed. Having this information will better equip women with SUI and their doctors to weigh the benefits and risks of available treatment options.188

The NIDDK-supported multicenter, randomized, double-blind, placebo-controlled Randomized Intervention for Vesicoureteral Reflux trial is designed to determine whether daily antimicrobial prophylaxis is superior to placebo in preventing recurrence of UTI in children with vesicoureteral reflux.189

NIDDK and other ICs support basic and clinical research on UTIs to elucidate the cause(s) and illuminate potential treatment approaches for acute and recurrent UTIs. For example, scientists at a Specialized Center of Research co-supported by NIDDK and ORWH have made tremendous progress in understanding factors in both the host organism (e.g., human or mouse) and the infecting bacteria that contribute to the onset and recurrence of UTIs.

An NIDDK-supported effort, Urologic Diseases in America (UDA) incorporates current and retrospective data on all aspects of the epidemiology, practice patterns, costs, and impact of urologic diseases in the United States. The UDA compendium delineates the changes in these areas over a ten-year period. In addition to updating the original 2007 compendium, the second phase of the UDA has focused less on descriptive analyses and more on analytical outcomes analyses, and attempted to increase involvement of the urologic community in analytical activities. The UDA is intended for use by public officials, nongovernment organizations, the media, academic researchers, health professionals, and the public.190

Results from the Complementary and Alternative Medicine for Urological Symptoms multi-center clinical trial, co-funded by NIDDK, NCCAM, and ODS, has found that the commonly used herbal dietary supplement saw palmetto does not improve BPH-related symptoms even at high doses—information that men with these symptoms and their health care providers can use in discussing and making choices about conventional and alternative therapies for symptom relief.191

Possessing a specific chemical coat called a K1 capsule appears to be a requirement for infectious bacteria to grow and form large masses called intracellular bacterial communities (IBCs) within the urinary tract of mice. Prior studies in rodent models indicated that formation of these IBCs helps promote sustained infection and may help explain at least some recurrent UTIs. By identifying the bacterial capsule as a factor that contributes to IBC formation, researchers have now illuminated targets for potential novel therapeutic interventions to prevent or treat UTIs. As IBCs have been observed in human bladder infections, these results likely have direct clinical implications.192

Kidney stones are among the most painful and most common urologic disorders. Scientists have uncovered new insights into how one particular type of kidney stone forms and grows, including a possible strategy to disrupt this growth. This information may lead to better treatments for a condition that accounts for approximately 3 million visits to health care providers each year.193
Priority research areas identified by NIH include:

183 Urological Diseases in America. NIDDK, NIH Publication Number 07-5512. Available at https://kidney.niddk.nih.gov/statistics/uda/Urologic_Diseases_in_America.pdf
184 Urological Diseases in America. NIDDK, NIH Publication Number 07-5512. Available at https://kidney.niddk.nih.gov/statistics/uda/Urologic_Diseases_in_America.pdf.
185 For more information, see https://kidney.niddk.nih.gov/KUDiseases/pubs/kustats/index.aspx#16.
186 For more information see: http://www.gudmap.org/ Exit Disclaimer
187 For more information see: http://www.uitn.net/ Exit Disclaimer
188 Richter HE, et al. N Engl J Med. 2010;362(2): 2066–76. PMID: 20479459,
189 For more information see: https://www.cscc.unc.edu/rivur/ Exit Disclaimer
190 For more information see: https://kidney.niddk.nih.gov/statistics/uda/
191 Barry MJ, et al. JAMA. 2011;306(12):1344-51. PMID: 21954478.
192 Anderson GG, et al. Infect Immun. 2010;78(3):963–75. PMID: 20086090.
193 Rimer JD, et al. Science. 2010; 330(6002):2066–-76. PMID: 20947757.