Urology

UTI
Medicose Prep Academy

Hina Wajid

MIT Batch 13 ,RMU

URINARY TRACT INFECTIONS (UTI)

Urinary tract infection is associated with multiplication

of organisms in the urinary tract and is defined by the
presence of more than a hundred thousand organisms
per ml in midstream sample of urine.

UTI is common in women and uncommon in men.

Routes of spread

1. Ascending transurethral route

2. Bloodstream

3. Lymphatics

4. Direct extension (from vesicocolic fistula)

Ascending transurethral route
Periurethral area is heavily colonized with bacteria derived from fecal
flora. Colonization may be facilitated by lack of personal hygiene,
wearing of sanitary towels & local infections (c.g. vaginitis)

Bacteria are transferred along the urethra to the bladder, which is

facilitated by cathetrization or sexual intercourse. Transfer along the
short urethra of female is easy, while the longer male urethra
protects against transfer of bacteria to the bladder.
Ascending transurethral route

Multiplication of bacteria occurs in

the bladder, from where they can
reach the ureters and kidneys
easily, facilitated by vasicoureteric
reflux .
TYPES

Uncomplicated UTI: when

infection occurs in a patient with
functionally normal urinary tracts
is called uncomplicated UTI.
Complicated UTI:

when infection occurs in a patient with abnormal urinary

tracts e.g. with stones or associated disease c.g. diabetes
mellitus, which themselves cause kidney damage may be
made worse with infection, it is called complicated UTI.
Clinical Presentations
Asymptomatic bacteriurea

Symptomatic acute urethritis and cystitis

Acute prostatitis

Acute pyelonephritis

Septicaemia (usually Gram-negative bacteria)

LOWER URINARY TRACT INFECTION

This includes urethritis, cystitis

and prostatitis
Clinical features

Increased frequency of micturition

Dysuria: Scalding pain is felt in the urethra during micturiton

Suprapubic pain during and after micturition in case of

cystitis.

Intense desire to pass more urine after bladder has been

emptied, due to spasm of the inflamed walls.

Urine may have unpleasant odor and appear

Investigations

Urine D / R : more than

Urine culture & sensitivity 100,000 of the same.
Organism/ml indicate UTI.
Management

High fluid intake (2 liters daily)

Potassium citrate mixture (Citralka) 10 ml three times daily in

half glass of water. It alkalinizes the urine and relieves dysuria.

Antibiotics:

Ciprofloxacin (T. Ciproxin 250-500mg) 12 hourly for 1-3 days OR

Norfloxacin (T. Noroxin 400mg) 12 hourly for 1-3 days.

Acute Pyelonephritis

Mostly it
results from
ascending
infection
from bladder.
Clinical Features
Loin pain: Sudden onset of pain in one or both loins, radiating to the
iliac fossae and suprapubic area.

Urinary symptoms: dysuria and frequent passage of small amounts of

scalding cloudy urine due to associated cystitis.

Fever: 38-40 C, may be with rigors and

vomiting. Tenderness presenting the renal angle and lumbar region.

Investigations

Blood CP-
leucocystosis

Urine D/R
numerous plus
cells and
organisms.

Urine – C/S
Differential diagnosis
Acute appendicitis,

salpingitis,

cholecystitis,

diverticulitis,

perinephric abscess
Complications

Sepsis and shock

Emphysematous pyelonephritis by gas producing

organisms.

Pyonephrosis (abscess formation).

Chronic pyelonephritis.
Management
Antibiotics: Ciprofloxacin (T. Ciproxin 250,
500mg) 750mg 12- hourly for 21 days
. Ofloxacin or Septran may be used.

Symptomatic: paracetamol for fever,

potassium citrate (Citralka) for dysuria.
Scenario 1: UTI

A, a 25-year-old female, presents to the

clinic with complaints of a strong, persistent
urge to urinate, a burning sensation when
urinating, and frequent small amounts of
urine. She denies any fever, chills, or pain in
her lower back. Her urine sample shows
cloudy urine and is positive for leukocyte
esterase and nitrites.
Scenario 2: Acute Pyelonephritis

A 50-year-old man with a history of kidney

stones, presents to the emergency department
with a sudden onset of high fever, severe flank
pain on one side radiating to the groin, and
nausea. He also complains of urinary urgency
and discomfort. On examination, he has
costovertebral angle tenderness, and his urine
analysis reveals leukocytes, blood, and bacteria.
Any Question?