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Chronic urinary tract infection and bladder carcinoma risk: a meta-analysis of case–control and cohort studies

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Abstract

Objective

This meta-analysis of published case–control and cohort studies sought to quantify the magnitude and direction of association between chronic UTI (defined as the infection of the urinary tract that either does not respond to treatment or keeps recurring) and risk of bladder carcinoma (BCa) (i.e., including mainly urothelial carcinoma, squamous cell carcinoma or adenocarcinoma).

Methods

A literature search was conducted using Medline, Embase, Ovid, Web of Science, Science Direct and Cochrane Library, which was supplemented with manual search of reference lists of the identified articles. Case–control and cohort studies examining UTI as a predictor of BCa risk published through June 2016 were eligible. Using random-effects models, odds ratios (OR) or relative risks (RR) from eligible studies were combined to synthesize summary effect estimates. The included studies were assessed for methodological quality and potential publication bias. Heterogeneity by study characteristics was examined by sub-group and meta-regression analyses.

Results

Eighteen case–control and three cohort studies published between 1963 and 2016 were eligible. Random-effects models showed that UTI was significantly associated with an increased BCa risk both in case–control studies (summary ORRE = 2.33; 95% CI 1.86, 2.92) and cohort studies (summary RRRE = 2.88; 95% CI 1.20, 6.89). The observed relationship of UTI with an increased BCa risk was independent of the study characteristics considered. No significant publication bias was detected.

Conclusions

Chronic UTI was significantly and independently associated with an increased BCa risk. However, due to the presence of high between-study heterogeneity and inconsistent patterns of adjusted confounding effects, more data are needed to clarify the role of chronic UTI in causation of BCa and if established, prompt and effective treatment of UTI may minimize a substantial proportion of BCa risk.

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Abbreviations

UTI:

Urinary tract infection

BCa:

Bladder carcinoma

OR:

Odds ratio

RR:

Relative risk

Hazard ratio:

Hazard ratio

PRISMA:

Preferred Reporting Items for Systematic Review and Meta-analysis

MOOSE:

Meta-analysis of Observational Studies in Epidemiology Statements

NOS:

Newcastle–Ottawa Scale

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Acknowledgements

The senior author works for Faculty of Medicine, Kuwait University as a Professor of Epidemiology and gratefully acknowledges their support.

Funding

This study did not receive any specific funding.

Author information

Authors and Affiliations

  1. Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, University of Kuwait, PO Box 24923, Safat, 13110, Kuwait

    Saeed Akhtar

  2. Department of Surgery, Section of Urology, Al-Adan Hospital, PO Box 288, Sabah Al Salem, 44403, Kuwait

    Ahmad Al-Shammari

  3. Department of Surgery, Farwaniya Hospital, PO Box 33978, Al Rawdha, 7346, Kuwait

    Jarrah Al-Abkal

Authors
  1. Saeed Akhtar
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  2. Ahmad Al-Shammari
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  3. Jarrah Al-Abkal
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Contributions

SA conceived the idea, did literature search. SA, AA, JA assessed the studies and extracted the relevant data. SA analyzed the data and wrote the first draft. All authors contributed to further drafts and final manuscript.

Corresponding author

Correspondence to Saeed Akhtar.

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Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

Ethical approval for this study was neither required nor was it solicited.

Research involving Human Participants and/or Animals

This study did require direct contact with human participants.

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The requirement of seeking informed consent was not applicable in this study.

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Akhtar, S., Al-Shammari, A. & Al-Abkal, J. Chronic urinary tract infection and bladder carcinoma risk: a meta-analysis of case–control and cohort studies. World J Urol 36, 839–848 (2018). https://doi.org/10.1007/s00345-018-2206-x

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