Episode 3: Innovations in Diagnosing Bladder Conditions

Narrator: Thanks for pressing play on this podcast from the University of Portsmouth. This is the series where we share world-changing ideas and research on everything from tech and the environment to health, security and democracy. In our interviews, we're asking the big questions about how Portsmouth research is set to change the world in the near future. This time, we're facing down a problem that affects one in five of us.

John Young: So it's still a taboo subject. You know, when my parents get asked what I do for a living, they – I don't know what they say, but they certainly don't tell them the truth.

Narrator: Urinary bladder infections and diseases are a massively common problem in the UK and plenty of people suffer in silence. But sometimes leaving them a long time can make things worse. Today, John Worsey meets the team who's tackling taboo and using tech to give us faster, more accurate and more comfortable diagnoses.

John Young: And the NHS and other commissioning organisations from around the world, would then, hopefully, buy the technology and start using it.

Narrator: Let's hear how the University of Portsmouth is changing the game for UTI diagnosis.

Narrator: It's likely that you or someone you know has experienced the discomfort of a urinary tract infection at some point. The facts are there. At least one in five adults will be affected. But it's not exactly the sort of thing you chat with your friend about down the pub, is it? And that's part of the problem. So many people are suffering silently, whether it's out of embarrassment or just feeling like they don't have a choice, and ongoing bladder conditions can become a permanent limiting factor in many people's lives. John S Young is on a mission to change this.

John Young: The disease overactive bladder starts to become prevalent at age 40, 50, 55, something like that. But people are in employment and in relationships, they like to travel, to go places. And all those things become really problematic if you are frequently voiding if you have urgency and you have incontinence episodes. People feel that they smell of urine if they're wearing containment, if they're wearing sanitary towels or, sort of, disposable underwear. And so what actually happens is kind of two things, they rely on apps that tell them where the toilets are or they just – and the vast majority of cases – they just become recluse. So they just stay at home.

Narrator: John is Acting Director at the Institute of Biological and Biomedical Sciences here at the University of Portsmouth. His goal is to make a real world difference with the research taking place here.

John Young: So it's working with health care providers and working with pharmaceutical companies and organisations like that to try to find a way to apply our research in a different way. So it's not just Blue Sky Research, but genuinely applied research, which is going to benefit society.

Narrator: As a society, we've taken diseases of the urinary tract and bladder as par for the course for a long time. Now that might be set to change.

John Young: So I work on diseases of the urinary bladder or perhaps the lower urinary tract, so beyond the bladder. And the idea there is that diseases affect that part of our body are really prevalent. So they affect at least one in five adults, probably two in five adults, with prevalence increasing as we age. So if we take an individual who is 60 or 70 and took a group of 100 individuals, more than half of those would have some chronic disorder that affect that area of the body, the urinary tract, such that they suffer with a number of different symptoms including incontinence, also urgency. So where you have to dash to the bathroom every time you need to to go. It's a sudden urge to do that. And then something called nocturia, which is waking during the night in order to pee. A lot of people will tell you that it's just ageing, you know, don't worry about it, it's just ageing. You know, and it's just not good enough. You know, there are people who just, you know, their lives are taken away from them. They're not killed but they spent decades, decades dealing with urinary symptoms, decades where it gets worse. 500 years ago, people used to line the kind of gussets of their underwear with sphagnum moss to contain the urine. The people who it really matters to are people who are just essentially in nursing care homes, in hospitals or by and large just at home, kind of excluded because of their symptoms.

Narrator: Before we get on to the causes of different bladder and urinary tract infections and diseases, John explained why a diagnosis itself can be complicated even if you do make it along to your local GP.

John Young: There are a whole host of different symptoms, and what I want to do is to find the means to diagnose the basis of those symptoms because there are a number of different diseases which all present in a similar fashion. So there's a small number of tests that they can do, some of which are really invasive, and they're not very accurate at distinguishing those diseases based on the current methods that we have. And so you've probably seen a little dipstick test. So somebody gives a urine sample and you dip it into some urine. They're really cheap but not very good at all at detecting infection. You can have a questionnaire and a questionnaire is fine, but if you have coffee, if you've had a large volume of water, if you're sitting next to a bathroom, you know, you've got a bathroom nearby or something like this, or you've got a back problem and you like to get up and wander around, you might pee more frequently. And so actually those symptom questionnaires are very subjective. So we might have the same symptoms, but we might score them differently.

John Worsey: Yes.

John Young: So then there's a host of different invasive tests and one of those, which is quite commonly used in every single hospital throughout the world, is called -- it's called urodynamics and particularly something called cystometry, and it's measuring pressures in the bladder. And it involves taking two probes, one of -- they're both the same width as my little finger, and one of those goes into your urethra and then the second probe would go into another abdominal orifice. And the idea is to measure changes in bladder pressure and they're looking for a particular hallmark. Now, that's fine were it not for the fact that the test is, obviously, as well as being invasive, it's going to be really uncomfortable for the individuals. It's also really expensive. So between a 1,000 and 1,500 pounds per time.

John Worsey: Good grief.

John Young: And you can introduce an infection. So the research that we do is to try to find better ways to distinguish the basis of those diseases.

John Worsey: Right.

Narrator: There's a risk of infection, embarrassment, discomfort and an uncomfortable wait for some fairly non-specific results. But the added problem is that similar symptoms present for a range of different diseases, being able to identify the cause quickly is crucial in giving patients a more efficient treatment earlier.

John Young: A whole host of different symptoms. They're also true of bladder cancer, of a disease called overactive bladder, type two diabetes and a disease called interstitial cystitis. So if we can't understand the basis of these symptoms, we can't effectively manage those symptoms clinically because somebody presents the symptoms and they go to the GP or their pharmacist and they say, I've got these symptoms. And then the pharmacist, or the health care practitioner, somebody in the nursing home, GP, they have this challenge of trying to understand why that person is suffering from the disease.

John Young: I'm interested to know about storage and there about the symptoms that are described as symptoms associated with problems in storage. Where that sensation of how much urine there in the bladder is changed somewhat. So what we can't do is we can't study how these diseases develop, and we can't understand how the diseases respond to treatment because we don't have a really quick and easy way to do that. So there's 85% of people for whom, despite clinical trials showing that the drugs are effective, for whatever reason, the drugs are not effective for them. And that plus the side effects means that they're poorly tolerated. People just say, actually, it's not worth it because I'm getting these terrible symptoms, you know, having no saliva and being really badly constipated, and it's actually only affecting my symptoms a little bit.

Narrator: But a solution could be at hand.

John Young: So imagine a scenario where you could measure chemicals in urine, where you just get somebody to get a urine sample and then you can measure those chemicals. And in doing so, you can see how the disease is progressing. You can give a drug and see how that patient's urine and the chemicals in the urine respond to those -- the treatment you give them. And there's a whole host of things. But essentially the approach that we're trying to take actually fits better with the patients we're trying to deal with, some of whom are in a nursing home and they're not likely to want to go to a tertiary urology department for a host of tests. [Inaudible]. Some of them they just couldn't have -- they couldn't lie down and have things stuck upside --stuck inside them. That would be wrong in those individuals. And there are lots of people that wouldn't want to just go to a GP surgery or maybe a urology centre because it would be a bit embarrassing for them. So it could be that they could give a urine sample and go to a chemist, pharmacist and have a test in there. So that's, that's what we see as the future for diagnosing the basis of the symptoms and then more effectively treating them.

Narrator: There's a need for more accurate on the spot testing that isn't invasive and gives a clear view of exactly what the patient is suffering from. Given the expense of more invasive tests and the long wait sufferers might have to endure before they can get treatment, it seems like a no brainer to fast track some sort of solution. What's more, an early diagnosis might well make a difference to life and death, for example, in the case of some cancers. But how close are we to something affordable and easy to roll out? John, explains the nitty-gritty of how he sees his vision working.

John Young: Now we've got chemicals we know give us the ability to distinguish disease from not disease or just this disease from the same disease. Overactive bladder from other diseases. So we know that it works. What we now need is a platform, some kind of means to detect these chemicals. And the idea is to use the smartphone. So a person appears on something that looks like a dipstick, like a pregnancy test, and it creates a sort of unique layout. And then the health care practitioner takes a picture with a smartphone and then it interprets the what they're seeing looks at the sort of signal, which will be some shades of grey.

John Worsey: Yeah.

John Young: It's higher and lower. They have to put in the person's agenda and their age. Because that's really important because they affect the chemicals that we see in the bladder and then it tells them the probability that they have that disease.

Narrator: So a smartphone app that diagnosis a pee signature like a regular QR code scanner. How on earth do you go about getting the data to build it? With a grant from Innovate UK and CEP squared, the team embarked on the ICURe programme, which brought in a researcher called Dr Sepinude Ferusmund.

John Young: She says she spoke to patients. She spoke to carers. She spoke to all the health care practitioners, to commissioners, to companies, etc., etc. Essentially, we worked out as a result of that what we needed was something at the point of care where samples aren't sent away to our lab to be processed. All the individuals I talked about need something for a rapid test, something that doesn't require expertise, creates a kind of biophysical trace that needs to be processed and interpreted. And it's not straightforward and that's partly why it's so expensive. So we knew that we needed to have something at the point of care.

Narrator: An app that allows GP surgeries, pharmacies and hospitals to interpret results on the spot. Sounds like an amazing solution. John told us what the next steps might be in getting these concepts closer to being realised and used in everyday health care situations.

John Young: And what I'd like to understand are the different shades of grey. So if we find some individuals who have particular profiles, we can then start -- we might start to treat them differently as well. So we've been working with two collaborators, one at Portsmouth and one of the University of Brighton, to evaluate the platform to detect these chemicals. It's Anastasia Callahan's platform at the University, so she takes RNA and we think of RNA like bits of -- bits of wire and she's able to shape bits of wire so that they have exactly the same shape as the chemicals that we want to detect. And so the chemicals bind specifically to them, it's ever so slightly different, it doesn't bind. And then we get a signal. And then the idea is that the platform detects five chemicals and then when the chemicals are bound, we get a colour or a particular shade. So we can detect the individual components of what we're doing now. The next stage is to create a prototype of the dipstick.

John Worsey: Yeah.

John Young: And -- and develop the app alongside.

John Worsey: Right.

John Young: And the idea would be that we create a thousand of these dipsticks. We have a bunch of health care practitioners that are collaborators and have the app. And then we have the funding so that they get research nurses and things to recruit participants. They get the data, independently analyse the data. And we just prove to the clinical community that this works.

John Worsey: Yeah.

John Young: And then the NHS and other, sort of, commissioning organisations around the world, would then, hopefully, buy the technology and start using it. It's also the case that using this approach of being quite disruptive, would lead others to try to innovate in this area.

John Worsey: Yeah.

Narrator: There's a lot of work to do before we're close to turning the tap off on the prevalence of urinary complications. John's team is in a 2 year prototype development cycle, identifying the exact chemicals and concentrations to give each disease its unique fingerprint in the app. They also have to take into account variations in things like age and gender, which can both have an influence on the algorithm. Here's hoping that on behalf of all the people suffering silently, it can make it to the mainstream very soon and give people their lives back.

Narrator: Thank you for listening to this episode of Life Solved from the University of Portsmouth. If you go to port.ac.uk/research, you can hear more about how the project is progressing. Tell us what you think via social media and share this podcast using the hashtag life solved.

Narrator: Next time we explore the role of the oceans in our world economy.

Steve Fletcher: I guess for a long time the environmental cost of economic development hasn't been included in the products that we buy and the lifestyles that we lead.

Narrator: Make sure you subscribe in your podcast app to get every episode of Life Solved automatically. And please do tell us what you think with the review and rating. If you get a moment. Shout about this podcast using the hashtag Life Solved. Thanks for listening. I'll be back with more world changing ideas from the team at Portsmouth next time.