Why Bladder Problems Keep Coming Back in MS

You have been told your bladder problems are just “nerve damage.” But if nerve damage is permanent, why do some people with MS see their bladder function improve within days of changing their diet?

Up to 80 percent of people with MS develop bladder dysfunction at some point. Urgency. Nighttime trips. Leaking. A weak stream. Difficulty emptying. Repeated “UTIs.” Bladder and kidney stones. These are not small symptoms. They shape what you can do, where you can go, and how you sleep.

UTIs are also the single most common reason people with MS end up in the hospital. Yet almost nobody is asking a simple, obvious question.

If this is only nerve damage, why does it keep flaring, easing, and sometimes improving so quickly when you change what you eat or how you treat infections?

Why has no one ever explained what is causing this?

 

Doctors usually talk about three types of bladder dysfunction in MS.

• Overactive bladder: the bladder squeezes when it should not, causing urgency, leaking, and needing to go often, including many times at night.
• Underactive bladder: the bladder does not squeeze hard enough, so urine is left behind after you think you are done. That leftover urine feeds infections.
• Combined dysfunction: a mix of both. The bladder squeezes at the wrong time and still does not fully empty.

But that list does not capture what you live with every day.

You may feel anxious about leaving the house, always checking where the closest bathroom is. You may plan every outing around bathroom access. You may not make it in time, and then feel shame and embarrassment. You may wake up five or six times a night, so you are exhausted before the day even starts.

When urine keeps backing up or is not fully emptied, it puts pressure on the kidneys. Over time, chronic retention and chronic infection raise the risk of bladder and kidney stones, kidney damage, and even chronic kidney disease.

These are not small issues. They affect sleep, confidence, and independence.

 

What You Have Been Told About the Cause

The standard explanation from neurologists goes like this:

MS lesions damage the nerve pathways between the brain, spinal cord, and bladder. The protective coating on the nerves, called myelin, is lost. That disrupts the signals that tell the bladder when to squeeze and when to relax.

From this view, the damage is seen as permanent and progressive. The focus is on managing symptoms. So patients are offered:

• Medications to calm the bladder
• Self-catheterization to empty it
• Botox injections into the bladder muscle if medicines do not work
• Sometimes surgery

All of these aim to control symptoms, not to fix the cause.

This explanation is not completely wrong. Demyelination does affect nerve signals. But it is not the whole story.

There is a key fact this view cannot explain:

If the only problem is permanent nerve damage, why does a low carbohydrate diet often improve bladder control within one to two weeks?

This is what many students in the Live Disease Free program report. One student said:

“I am tripping less. My bladder issues are getting so much better. I used to be up at least 5 to 6 times a night. Now I might be in the bathroom 1 to 2 times per night.”

Another student shared:

“I have been following the Live Disease Free diet and have started to treat parasites. My bladder is better. I no longer have a sense of urgency. For the first time in my life, I am having a bowel movement every day. I am sleeping seven hours a night. My spasticity is improved.”

If the bladder problems were only from dead nerves, diet changes should not make this much difference. Yet they do, over and over.

So there must be more going on.

 

A Clear Example: Chagas Disease Shows How Parasites Can Damage Organ Control

Before looking at MS directly, it helps to study a disease where everyone already agrees that a parasite can damage how organs are controlled without destroying the organs themselves.

Chagas disease is caused by a tiny parasite called Trypanosoma cruzi. It is best known for damaging the heart and gut. But it also affects the bladder.

A clinical study of 137 people with chronic Chagas disease found that 63 percent had lower urinary tract dysfunction. Many had an overactive bladder, incontinence, or a stiff bladder that could not relax normally. Urodynamic testing, which measures how the bladder fills and empties, showed detrusor overactivity in 69 percent of the patients tested. Almost half had moderate or severe kidney impairment.

Animal research supports this. In infected mice, the bladder became enlarged and deformed, with inflammation of the nerve ganglia and fibrosis. The bladder muscle became overactive and less flexible.

Here is the key point. In Chagas disease, the nerves that control the bladder are injured by the parasite. The control system is damaged by infection.

This is worldwide accepted science. It is not controversial.

It gives a clear model. When looking at bladder problems in MS, it is not enough to think about damaged organs. Chronic infections that disrupt the control systems also have to be considered.

 

The Diet Clue and the Gut–Kidney–Stone Connection

Many parasites and microbes love sugar. A low carbohydrate diet removes their favorite fuel source. When you cut sugar and refined starches, you reduce microbial activity, reduce inflammation, and often improve nerve signaling.

Long before antibiotics, ketogenic diets were used as a treatment for urinary infections. In the early twentieth century, doctors reported success using a fat based, very low carbohydrate diet in people with chronic urinary tract infections.

There is also a specific gut–kidney connection that matters for stones and chronic infection. A gut bacterium called Oxalobacter formigenes breaks down oxalate in the intestine. When this bacterium is missing, more oxalate passes into the urine, and the risk of calcium oxalate kidney stones rises.

Studies have found that people colonized with O. formigenes have a much lower risk of recurrent calcium oxalate stones. One review suggests the risk may be reduced by about 70 percent. Repeated courses of antibiotics, which are common in people treated for frequent UTIs, can wipe out O. formigenes from the gut.

This sets up a vicious cycle:

1. Antibiotics given for UTIs damage the gut flora and remove O. formigenes.
2. Urinary oxalate levels go up.
3. More calcium oxalate stones form.
4. Stones harbor bacteria and act as a hiding place for infection.
5. UTIs keep coming back.

The Live Disease Free low carbohydrate plan focuses on restoring a healthier gut ecosystem, lowering oxalate, and reducing stone risk. If bladder problems were only from permanent nerve damage, these changes in diet and gut health would not consistently improve symptoms. But they do.

 

Organisms Already Linked to MS Type Problems in the Bladder and Kidneys

Now, look at what the research says about specific infections and how they affect the bladder and kidneys. This is not theory. These are findings in peer reviewed papers.

Lyme Disease (Borrelia burgdorferi)

Lyme disease is caused by the spiral shaped bacterium Borrelia burgdorferi. Its effects on the nervous system can look a lot like MS.

A controlled study found that 35 percent of people with Lyme disease had symptoms of bladder detrusor dysfunction, compared to none of the healthy controls. That means more than one in three Lyme patients had bladder problems similar to those seen in MS.

A classic paper in the Journal of Urology described seven patients with Lyme related nervous system infection who developed serious bladder symptoms. Testing showed that five had an overactive bladder muscle, and two had a bladder that would not contract at all. In one of these patients, a biopsy showed Lyme bacteria actually inside the bladder wall.

Other case reports describe people whose first clear symptom of Lyme infection was sudden urinary retention, stiff and weak legs, and walking difficulty that looked exactly like an MS relapse.

This shows that a known infection can cause both MS like presentation and serious bladder dysfunction, including direct infection of the bladder itself.

Filarial Worms

Filarial worms are thread like parasites that live in the lymphatic system. They are best known for causing massive swelling of limbs, called elephantiasis.

They can also damage the kidneys. Biopsy studies have found microfilaria directly inside kidney tissue. These parasites can cause many different forms of glomerular injury, including nephrotic syndrome, severe protein loss in the urine, rapidly progressive kidney failure, and membranous nephropathy.

Doctors who study this now describe microfilaria in the kidney as a cause of “diverse and aggressive” glomerular injury that is still under recognized. Filarial infections can also block lymph drainage into the urinary tract, causing milky urine and other urinary problems.

Pathologist Dr. Alan MacDonald found many filarial worms in the spinal fluid of every MS subject tested.

Again, a parasite is shown to damage how the kidneys and urinary system work by inflaming and scarring these vital structures.

Toxoplasma gondii

Toxoplasma gondii is a single celled parasite that can live silently in human tissue for years. Many adults carry it without knowing.

Several studies have linked T. gondii infection with abnormal kidney function. A large analysis of United States NHANES data found that people with positive Toxoplasma IgG antibodies had higher odds of chronic kidney disease, even after adjusting for age, sex, race, and body mass index. Another registry study reported that about two thirds of people with chronic kidney disease tested positive for Toxoplasma IgG, compared with around 15 percent of healthy controls, and that active infection was more than three times as common in the kidney disease group.

A review in a tropical medicine journal described a “close relationship” between toxoplasmosis and kidney dysfunction, including both acute and chronic effects.

So toxoplasma is another example of a parasite that can silently damage kidney function in the background.

Schistosoma haematobium (Blood Fluke of the Urinary Tract)

Schistosoma haematobium is a blood fluke that specializes in the bladder and urinary system. Adult worms live in the veins around the bladder. The female lays thousands of eggs that must pass through the bladder wall to leave the body in urine.

Many eggs get stuck in the bladder wall and the lower ureter instead of escaping. The immune system reacts by forming granulomas around them, which over time turn into scar tissue and then calcify.

This process causes:

• Thickening and stiffening of the bladder wall
• Narrowing and blockage where urine should flow out
• Back pressure toward the kidneys
• Hydronephrosis, which is swelling of the kidneys from backed up urine
• Higher risk of stones in the urinary system

Bladder wall calcification from S. haematobium is described as the most common cause of bladder wall calcification worldwide. Reviews of urinary schistosomiasis clearly state that egg deposition leads to granulomas, fibrosis, calcification, strictures, and stones in the urinary tract. Long term infection with this parasite is a proven cause of bladder cancer.

A detailed case report described a man with bladder stones inside a diverticulum. When surgeons removed the stones and examined the tissue, they found chronic granulomatous inflammation and many Schistosoma eggs in the diverticular wall. After removing the stones and treating with praziquantel, his symptoms resolved.

Eggs can also lodge higher up in the urinary tract, in the ureters and near the kidneys, contributing to scarring, obstruction, and stone formation there.

This is a very clear example of how a parasite can lay eggs in the bladder wall, trigger inflammation and calcification, and set off a chain of events that leads to chronic bladder problems, stones, and kidney damage.

Trichomonas vaginalis

Trichomonas vaginalis is a very common sexually transmitted parasite. The World Health Organization estimates there are around 156 million new infections each year worldwide.

This parasite infects the lower genital tract and can also inflame the urethra and bladder. It causes burning when passing urine, urgency, and frequent urination, symptoms that are usually labeled as “another UTI.”

The problem is that routine UTI testing does not look for T. vaginalis. Standard urine cultures only test for bacteria, such as E. coli. They completely miss trichomonas unless the clinician specifically orders a trichomonas test.

A pilot study of women with recurrent UTIs found that 16.9 percent were actually positive for T. vaginalis. The authors recommended that testing for trichomonas be considered in anyone with recurrent UTIs. Another study showed that when doctors relied only on symptoms and basic microscopy, they missed almost half of trichomonas infections that were detected by more sensitive molecular tests.

The Centers for Disease Control and Prevention note that untreated trichomonas can last for months or years, and that symptoms may come and go.

So it is not hard to imagine this happening in MS. A person has urgency and burning. They are told it is another UTI. They are given antibiotics for bacteria. The bacteria may briefly improve, but the parasite remains. Symptoms return, sometimes over and over, and nobody ever orders a proper test for T. vaginalis.

 

Bacteria and Fungi Hiding Inside Stones and Biofilms

Parasites are one part of the story. Bacteria and fungi also play a major role in chronic bladder problems, especially when stones and catheters are involved.

Recent research has shown that bacteria are not only on the surface of many kidney stones, but actually built into the stone structure itself. A 2026 study found that bacteria embedded deep inside calcium based stones are common, which means antibiotics reaching the urine do not always reach the bacteria protected within the stone. Reviews of stone disease highlight this close relationship between urinary stones and infection.

Some bacteria, such as Proteus species, make an enzyme called urease. This enzyme breaks down urea and makes the urine more alkaline. That change in urine chemistry encourages formation of infection related stones called struvite stones. These stones act like a scaffold that supports ongoing infection and can be associated with severe kidney infections and future kidney damage if not removed.

Fungi add another layer. In people who have catheters, take immune suppressing drugs, or have diabetes, Candida yeast can grow in the urinary tract and form clumps or “fungal balls” in the kidney drainage system or bladder. These masses can block urine flow and worsen kidney function if they are not recognized and treated.

Diabetes makes Candida infections more likely by raising glucose in the urine, which feeds the yeast. Repeated antibiotics kill friendly bacteria that normally keep yeast in check, which also encourages overgrowth.

All of this matters in MS, where many patients:

• Have bladder dysfunction that leads to retention
• Use catheters
• Take immune suppressing medications
• Receive repeated courses of antibiotics for recurrent UTIs

These conditions create the perfect environment for chronic bacterial and fungal infections of the urinary tract and kidneys.

 

How Standard MS Treatment Can Make the Problem Worse

There is a difficult truth here. The usual way MS bladder problems are treated can actually strengthen the very infections that may be driving the symptoms.

• Repeated antibiotics disturb the gut microbiome and remove Oxalobacter formigenes, which increases urinary oxalate and raises stone risk.
• Catheter use provides a surface where bacteria and fungi can form biofilms, which are slimy, protective communities that are hard to remove.
• Immune suppressing drugs weaken the body’s ability to control parasites, bacteria, and fungi.
• Bladder dysfunction itself causes urine to sit still instead of flushing out, which encourages both infection and stone formation.

So the person is told, “You just have nerve damage. This is your new normal.” Yet no one looks carefully for the chronic infections, parasites, disrupted gut flora, and stone related biofilms that the science already describes.

 

This Pattern Exists in Other Autoimmune Diseases Too

MS is not the only condition where infection links have been found.

• Rheumatoid arthritis is treated with hydroxychloroquine, a drug first used against malaria.
• Hashimoto’s thyroiditis has been linked to Helicobacter pylori infection in some studies.
• Guillain–Barré syndrome is strongly associated with Campylobacter infection.
• Type 1 diabetes and metabolic disease have been linked to worm infections and helminth derived molecules that alter immune responses.

If the immune system can react to infections in all of those conditions, it is reasonable to ask why MS is treated so differently, as if infections could not possibly be involved.

 

Why You Have Not Heard This Before

Parasite testing in stool and urine only detects a small fraction of what is truly present in the body. Many experts estimate that standard tests pick up only about 10 percent of infections. Most people with MS are never tested for parasites or chronic urinary infections beyond basic bacterial cultures.

There is also a financial reality. There is no patent on generic antiparasitic drugs or on a low carbohydrate diet. No company can own and profit from the idea that treating infections and changing one’s diet could improve MS symptoms. Large trials are expensive. Few are eager to fund this kind of research.

That does not mean the connections are not real. It simply means they are not profitable to investigate at scale.

The studies quoted here come from peer reviewed journals, major medical centers, and accepted tropical medicine texts. They are real. They are just not being brought to the attention of people who live with these symptoms.

 

Hope: Recovery Is Possible When the Cause Is Addressed

When the real drivers of bladder dysfunction are treated, many people find that their health improves.

This does not mean every person with MS will have a perfect bladder. It does mean that urgency can calm down, nighttime trips can drop, UTIs can stop recurring, and stones can be prevented or reduced in many cases.

Across hundreds of students in the Live Disease Free program, the same pattern appears. When infections are addressed and the diet removes the main fuel for parasites and harmful microbes, bladder control, sleep, energy, and quality of life improve.

This is not random. It is a pattern.

You do not have to accept “you just have nerve damage” as the full story. It is reasonable to ask about chronic infections, parasites, gut dysbiosis, and stone related biofilms. It is reasonable to ask whether anyone has looked for these factors in your case.

Bladder dysfunction and kidney damage linked to infections are often treatable when the actual cause is identified. You deserve more than symptom control. You deserve to know what may be causing your symptoms.

 

There are real solutions to recover from parasites today!

To restore health, we must focus on treating the cause of inflammation, which are parasites. First, identify the enemy (parasites), then support the body and treat the parasites while following a holistic approach. When parasitic infections are treated effectively, we can overcome inflammation or disease.

If you’re frustrated with the fact that our standard of care STILL doesn’t offer a real solution for treating MS and other diseases, then click on the link below to watch Pam Bartha’s free masterclass training and discover REAL solutions that have allowed Pam and many others to live free from MS and other diseases.

CLICK Here to watch Pam’s masterclass training

 

References:

MS bladder dysfunction and recurrent UTIs

National Multiple Sclerosis Society. Bladder Dysfunction in Multiple Sclerosis.
Key findings: States that bladder dysfunction occurs in at least 80% of people with MS and lists urgency, frequency, retention, and incontinence as common MS bladder symptoms.
https://www.nationalmssociety.org/understanding-ms/what-is-ms/ms-symptoms/bladder-problems

Multiple Sclerosis Association of America. Bladder dysfunction. 2015.
Key findings: Explains how MS lesions disrupt neural control of the detrusor and sphincter, causing frequency, urgency, retention, and leakage, and outlines standard management options.
https://mymsaa.org/ms-information/symptoms/bladder-dysfunction/

de Sèze M, Ruffion A, Denys P, Joseph PA, Perrouin-Verbe B; GENULF. The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines. Mult Scler. 2007;13(7):915‑928.
Key findings: Reviews prevalence and mechanisms of neurogenic bladder in MS and proposes management guidelines (antimuscarinics, intermittent catheterization, monitoring of upper tracts), representing the classic “nerve damage” model.
https://pubmed.ncbi.nlm.nih.gov/17881401/

Mahadeva A, Tanasescu R, Gran B. Urinary tract infections in multiple sclerosis: under-diagnosed and under-treated? A clinical audit at a large University Hospital. Am J Clin Exp Immunol. 2014;3(1):57‑67.
Key findings: Clinical audit showing that bladder dysfunction, bacteriuria, and UTIs are frequent in MS; UTIs often worsen neurological symptoms, and the authors conclude that UTIs in MS are commonly under‑diagnosed and under‑treated.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3960762/

Pietropaolo M, Bernetti A, Bargellini A, et al. Urinary tract infection in patients with multiple sclerosis: an overview. Mult Scler Relat Disord. 2020;46:102560.
Key findings: Summarizes high UTI prevalence in MS, key risk factors (neurogenic bladder, catheters, immunosuppression), and the role of UTIs in triggering pseudo‑relapses and contributing to hospitalizations and morbidity.
https://pubmed.ncbi.nlm.nih.gov/32890816/

 

Infection‑driven neurogenic bladder (Chagas, Lyme)

Bey E, Paucara Condori MB, Gaget O, Solano P, Revollo S, Saussine C, Brenière SF. Lower urinary tract dysfunction in chronic Chagas disease: clinical and urodynamic presentation. World J Urol. 2018;37(7):1395‑1402.
Key findings: In adults with chronic Chagas disease, 63% had urinary symptoms; urodynamics frequently showed overactive bladder and incontinence, especially in those with megacolon, demonstrating that chronic protozoal infection can cause neurogenic bladder.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6620250/

Puri BK, Shah M, Julu PO, Kingston MC, Monro JA. Urinary bladder detrusor dysfunction symptoms in Lyme disease. Int Neurourol J. 2013;17(4):180‑184.
Key findings: Controlled study where 35% of patients with late Lyme disease had detrusor symptoms (urgency, frequency, incomplete emptying) versus 0% of controls, indicating a specific association between Lyme infection and bladder dysfunction.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3797892/

 

Schistosomiasis – common parasitic cause of bladder and kidney damage

Barsoum RS. Schistosomiasis and the kidney. Semin Nephrol. 2003;23(1):34‑41. doi:10.1053/snep.2003.50003a.
Key findings: Reviews schistosomiasis (around 200 million infected) and shows that Schistosoma haematobium eggs trapped in the lower urinary tract cause fibrosis, calcification, obstruction, reflux, infection, stone formation, interstitial nephritis, and progression to end‑stage renal disease.
URL: https://pubmed.ncbi.nlm.nih.gov/12563599/ 

Barsoum RS. Urinary schistosomiasis: review. J Adv Res. 2012;4(5):453‑459. doi:10.1016/j.jare.2012.08.004.
Key findings: Summarizes how S. haematobium egg–induced granulomas in the bladder and ureter heal with fibrosis and calcification, leading to strictures, urodynamic abnormalities, obstruction, reflux, infection, stone formation, and increased risk of bladder cancer.
URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC4293885/

Lee HJ, Sung WS. Calcification of the urinary bladder and ureter in schistosomiasis. Kidney Res Clin Pract. 2018;37(3):304‑305. doi:10.23876/j.krcp.2018.37.3.304.
Key findings: Brief case report describing marked calcification of the urinary bladder and distal ureter on CT in a patient with Schistosoma
haematobium infection; the authors note that the extent of calcification corresponds to the number of dead eggs and is characteristic of chronic urinary schistosomiasis, with potential for obstruction and renal impairment.
URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC6147189/

Mohammad A Alkhamees. Bladder stones in a closed diverticulum caused by Schistosoma mansoni: a case report. World J Clin Cases. 2020;8(19):4513‑4520. doi:10.12998/wjcc.v8.i19.4513.
Key findings: Patient with bladder stones in a diverticulum whose wall contained numerous S. mansoni eggs and granulomas; symptoms resolved after stone removal and praziquantel, directly implicating schistosome eggs as contributors to bladder stone disease.
URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC7559665/

 

Filarial worms and other helminths – renal / urinary damage

Langhammer J, Birk HW, Zahner H. Renal disease in lymphatic filariasis: evidence for tubular and glomerular disorders at various stages of the infection. Trop Med Int Health. 1997;2(9):875‑884. doi:10.1046/j.1365-3156.1997.d01-404.x.
Key findings: In Brugia malayi–infected patients from an endemic area, proteinuria was significantly higher than in endemic normals and European controls. Detailed urine protein analysis showed predominantly tubular but also glomerular involvement across asymptomatic infection, filarial fever, and chronic obstructive disease, demonstrating that lymphatic filariasis commonly causes both tubular and glomerular renal damage. URL: https://pubmed.ncbi.nlm.nih.gov/9315046/

Prasad N, Gupta A, Yadav B, et al. Caught by surprise – microfilaria in renal biopsies. Indian J Nephrol. 2024;34(3):257‑260. doi:10.4103/ijn.ijn_382_22.
Key findings: Series of five native‑kidney biopsies from patients in a filariasis‑endemic region where microfilariae were unexpectedly found in glomerular capillaries and interstitium; clinical presentations included hematuria, proteinuria, nephrotic syndrome, and rapidly progressive glomerulonephritis, establishing microfilaria as a direct cause of diverse renal injuries.
URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC11302504/

Centers for Disease Control and Prevention. Clinical overview of lymphatic filariasis. Atlanta, GA: US Department of Health and Human Services, CDC; 2024.
Key findings: Clinical summary explaining that adult filarial worms damage lymphatic vessels and that complications include chyluria from lymphatic–urinary fistulas, as well as microscopic hematuria and proteinuria, directly linking lymphatic filariasis to abnormal urine and urinary tract involvement.
URL: https://www.cdc.gov/filarial-worms/hcp/clinical-overview/index.html

Palhano SB, Falcão MC, Ramalho LN, Souza RM. Dioctophymiasis: a rare case report. J Clin Diagn Res. 2016;10(3):PD03‑PD04. doi:10.7860/JCDR/2016/17148.7432.
Key findings: Case report of human infection with the giant kidney worm Dioctophyme renale causing destruction of renal parenchyma, hematuria, hydronephrosis, and the need for nephrectomy, illustrating severe helminth‑mediated kidney damage.
URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC4800531/

MacDonald AB. Nematode filarial worms in cerebrospinal fluid of a multiple sclerosis patient at autopsy. F1000Research. 2016;5:79 (poster). doi:10.7490/f1000research.1111264.1.
Key findings: Autopsy case of a patient with a clinical and pathological diagnosis of MS in whom histologic examination of cerebrospinal fluid and meningeal tissue revealed nematode filarial worms. The author presents this as the first reported association between parasitic filarial infestation of human CSF and concurrent multiple sclerosis, suggesting a possible parasitic contribution to demyelination.
URL: https://f1000research.com/posters/5-79 

 

Microbes, stones, and recurrent UTIs

Ripa F, Pietropaolo A, Montanari E, Hameed BMZ, Gauhar V, Somani BK. Association of kidney stones and recurrent UTIs: the chicken and egg situation. A systematic review of literature. Curr Urol Rep. 2022;23(9):165‑174. doi:10.1007/s11934-022-01103-y.
Key findings: Systematic review of 17 studies examining kidney stone disease (KSD) and recurrent urinary tract infections (rUTIs). The authors report a strong association between KSD and rUTIs, with many series showing that surgical clearance of stones often results in resolution of recurrent UTIs. They conclude that KSD and rUTIs are mutually coexisting and reciprocally causal, and recommend proactive stone removal and stone culture in patients with recurrent infections, regardless of stone composition.
URL: https://pubmed.ncbi.nlm.nih.gov/35877059/

Agarwal DK, Krambeck AE, Sharma V, Maldonado FJ, Westerman ME, Knoedler JJ, Rivera ME. Treatment of non-obstructive, non-struvite urolithiasis is effective in treatment of recurrent urinary tract infections. World J Urol. 2020;38(8):2029‑2033. doi:10.1007/s00345-019-02977-3.
Key findings: Retrospective multicenter series of 46 patients (mostly women) with non‑obstructive, non‑struvite upper tract stones and ≥3 culture‑proven UTIs in 12 months. After ureteroscopy or PCNL with a median follow‑up of 2.9 years, only 5 patients (10.9%) had recurrent UTIs, giving an 89.1% success rate for eliminating further recurrences. Residual stone fragments were the only independent risk factor for persistent UTIs, indicating that even non‑infection stones can act as infectious foci and that complete stone clearance is crucial.
URL: https://pubmed.ncbi.nlm.nih.gov/31646382/

Sobel JD, Fisher JF, Kauffman CA, Newman CA. Candida urinary tract infections—epidemiology. Clin Infect Dis. 2011;52(Suppl 6):S433‑S436. doi:10.1093/cid/cir109.
Key findings: Reviews the epidemiology of Candida urinary tract infections in humans, emphasizing that candiduria is uncommon in healthy individuals but common in hospitalized and high‑risk patients—especially those with indwelling catheters, diabetes, recent antibiotic exposure, or critical illness. Notes that in neonates and severely ill adults, candiduria may reflect invasive candidiasis and can be associated with fungus balls in the urinary tract.
URL: https://pubmed.ncbi.nlm.nih.gov/21498836/

Kauffman CA, Fisher JF, Sobel JD, Newman CA. Candida urinary tract infections—diagnosis. Clin Infect Dis. 2011;52(Suppl 6):S452‑S456. doi:10.1093/cid/cir111.
Key findings: Reviews diagnostic issues in Candida urinary tract infections, emphasizing that candiduria is often colonization and that pyuria, colony counts, and positive urine cultures alone cannot distinguish colonization from true infection. Stresses that clinical context (symptoms, host factors, systemic signs) must guide interpretation and that imaging—particularly renal and bladder ultrasonography, with CT used when upper tract involvement or abscess is suspected—is essential in symptomatic or critically ill patients to identify obstruction, fungus balls, or pyelonephritis.
URL: https://pubmed.ncbi.nlm.nih.gov/21498838/

Fisher JF, Sobel JD, Kauffman CA, Newman CA. Candida urinary tract infections—treatment. Clin Infect Dis. 2011;52(Suppl 6):S457‑S466. doi:10.1093/cid/cir112.
Key findings: Reviews management of Candida urinary tract infections, including when antifungal therapy is indicated for asymptomatic candiduria and recommended agents for cystitis and pyelonephritis (with fluconazole as the preferred drug due to high urinary concentrations). Emphasizes that fungus balls and casts can obstruct the collecting system and require combined systemic antifungal therapy and surgical or interventional removal (such as nephrostomy irrigation or endoscopic extraction) to prevent or reverse acute and chronic renal dysfunction.
URL: https://academic.oup.com/cid/article/52/suppl_6/S457/285164

 

Protozoa missed on standard UTI workup (Trichomonas)

PChang PC, Hsu YC, Hsieh ML, Huang ST, Huang HC, Chen Y. A pilot study on Trichomonas vaginalis in women with recurrent urinary tract infections. Biomed J. 2016;39(4):289‑294. doi:10.1016/j.bj.2015.11.005.
Key findings: In women labeled as having recurrent urinary tract infections in a urology clinic, Trichomonas vaginalis was detected in 16.9% (11/65) using an immunochromhttp://j.bjatographic test on urine samples. The authors highlight this relatively high prevalence and suggest that testing for T. vaginalis should be considered in women with recurrent UTIs because it would not be identified by routine urine culture alone.
URL: https://pubmed.ncbi.nlm.nih.gov/27793272/

Centers for Disease Control and Prevention. About trichomoniasis. Atlanta, GA: US Department of Health and Human Services, CDC; 2026.
Key findings: Fact sheet describing Trichomonas vaginalis as a very common, curable sexually transmitted infection that often causes no symptoms but can lead to burning, itching, irritation, abnormal discharge, and discomfort with urination or sex when symptomatic. It emphasizes that many infections are asymptomatic or unrecognized and that trichomoniasis cannot be diagnosed based on symptoms alone, so laboratory testing—particularly highly sensitive nucleic acid amplification tests (NAATs)—is recommended for accurate detection and management.
URL: https://www.cdc.gov/trichomoniasis/about/index.html

 

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