A think tank was convened at the fourth ICI-RS meeting, which took place June 5–7, 2013 in Bristol UK, to consider current evidence and controversies surrounding the possible role of ‘covert infection’ in the pathophysiology of refractory detrusor overactivity (DO) and other lower urinary tract disorders (LUTD). The topic was chosen because several authors from different centers worldwide have recently published evidence which supports this concept. However, to date there is inconsistency regarding terminology and microbiological definitions, which were discussed by the participants. The mechanisms whereby infection/inflammation could actually promote aberrant detrusor contractions in the human remain controversial, and are more fully described in this report. Future requirements for research into this topic were outlined. Neurourol. Urodynam. 33:606–610, 2014. © 2014 Wiley Periodicals, Inc.