Lyme disease or Lyme borreliosis is a systemic arthropod-borne zoonosis caused by Borrelia spirochaetes, the incidence of which has recently been increasing with the geographical spread of infected ticks. It is well established that the bacteria can invade the skin (causing erythema migrans), musculoskeletal system (giving rise to Lyme arthritis), cardiovascular system (causing Lyme carditis), and the nervous system (Lyme neuroborreliosis) [1].

There are rare reports that Lyme disease may also affect the urinary bladder. A study of chronic neurological manifestations of erythema migrans in 44 patients seen between 1985 and 1987 in the Federal Republic of Germany (West Germany) reported that 11 of these patients (25%) suffered from 'bladder dysfunction'; no further details were given of the symptoms associated with this [2]. In 1990, Chancellor et al. [3] reported a case of Lyme disease presenting with urinary retention; the patient then went on to suffer lower extremity paralysis, and both the urinary retention and the paralysis responded to intravenous ceftriaxone therapy. Three years later, Chancellor et al. [4] described a series of seven patients with neuroborreliosis who also suffered from lower urinary tract dysfunction. Finally, last year Kim et al. [5] reported a case of neurogenic bladder in Lyme neuroborreliosis, which did not respond to intravenous ceftriaxone. These two case reports and two case series were not controlled.

The aim was to carry out the first systematic study to compare the prevalence of symptoms of urinary bladder detrusor dysfunction in a group of Lyme disease patients and a group of matched controls.

Seventeen serologically positive Lyme disease patients and 18 control subjects were studied. The mean age, sex ratio, mean body mass, and mean arterial blood pressure for each group are shown in Table 2, from which it can be seen that the two groups were matched in respect of all these parameters.

Six of the Lyme disease group (35%) had symptoms of detrusor dysfunction compared with none (0%) of the controls (Fisher exact probability test, P=0.008).

This first systematic controlled study confirms that Lyme disease is associated with urinary bladder detrusor dysfunction. That the prevalence in the present study was over a third indicates that it is important that urological complications of Lyme disease be checked for in patients with this infection.

Further urological studies in Lyme disease are warranted, including assessment of the prevalence of detrusor dysfunction in larger sample sizes and laboratory evaluation of urinary bladder function by urodynamic studies. Studies also need to be carried out to evaluate the response to antibiotic therapy.