Urinary Tract Infections

A urinary tract infection (UTI) is a common type of infection that occurs in the urinary tract. UTI is associated with multiplication of the organism in the urinary tract, and is defined by the presence of more than one million organisms per ml in a midstream sample of urine.

Classification

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A.

Lower UTIs

Infection of the lower part of the urinary tract

  • Acute cystitis
  • Acute urethritis
  • Acute prostatitis

Upper UTIs

Infection of the upper part of the urinary tract.

  • Subclinical pyelonephritis
  • Acute pyelonephritis
  • Chronic pyelonephritis
  • Renal cortical abscess
  • Perirenal abscess

 B.

Uncomplicated

  • Anatomically and physiologically normal urinary tract
  • Normal renal function
  • No associated disorder which impairs defense mechanism

Complicated

  • Abnormal urinary tract
  • Impaired renal function
  • Associated disorders

Causes —

Anatomical

  • Short urethera(females)
  • Sexual intercourse
  • Renal calculi
  • Vesical fistula
  • Incomplete voiding
  1. Diverticulum
  2. Vesicoureteric reflex
  3. Obstruction
  • Damaged urothelium
  1. Instrumentation
  2. Indwelling catheter
  3. Surgery

Functional

  • Incomplete voiding
  1. Neurogenic
  2. Physiological
  3. Recent infections

Abnormal urinary tract

  • Neurological abnormality
  • Chronic prostatitis 
  • Cystic kidney
  • Analgesic nephropathy
  • Renal scarring

Associated disorders

  • Diabetes mellitus     
  • Immuno-suppressive therapy

Symptoms And Signs–

Lower UTI

  • Cloudy offensive urine
  • Dysuria
  • Frequency
  • Haematuria
  • Loin pain
  • Lower abdominal pain
  • Malaise
  • Nocturia
  • Strangury
  • Suprapubic pain
  • Urgency

Upper UTI

  • Anorexia
  • Diarrhoea
  • Fever with chills and rigors
  • Loin pain

  • Nausea
  • Septicaemia
  • Vomiting

Investigations–

  • Urine analysis
  • Urine culture
  • Total blood count
  • Blood culture
  • CT scan- abdomen
  • Intravenous pyelogram (IVP)
  • Kidney scan
  • Kidney ultrasound
  • Voiding cystourethrogram

Treatment—

  • Underlying abnormality must be corrected.
  • Medicines

Complications–

  • Sepsis
  • Kidney damage or scarring

Prevention–

  • Maintain hygiene during menstrual period
  • As a general rule, do not use any product containing perfumes in the genital area.
  • Take shower baths

  • Urinate before and after sexual activity.
  • Wipe from front to back after using the washroom
  • Wear cotton-cloth underwear and pantyhose, and change both at least once a day.
  • Drink lots of non-alcoholic fluids(preferably plain water)
  • Use estrogen cream in the vagina area post menopause to reduce the chance of further infections.

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