This document discusses various urinary tract infections including cystitis, pyelonephritis, prostatitis, and urethritis. It describes the typical symptoms, causes, and treatments for each condition. Common causative bacteria include E. coli, S. saprophyticus, and P. mirabilis. Complications of pyelonephritis can include renal abscesses, pyonephrosis, and emphysematous pyelonephritis. Chronic cystitis may be due to recurrent infections, bladder stones, or interstitial cystitis. Prostatitis syndromes can range from acute bacterial infections to chronic inflammatory conditions. Balanitis and balanoposthitis are foreskin inflamm

1. Urogenital tract infections

2. Urinary tract infections
Introduction
⚫Upper urinary tract infections :
◦ Pyelonephritis
⚫Lower urinary tract infections
◦ Cystitis
◦ Urethritis
◦ Prostatitis

3. Urinary tract infections
⚫Uncomplicated
⚫Complicated
◦ Factors: Functional or anatomical anomaly of
the urinary tract, gender (male), pregnancy,
great age, diabetes, immunosuppression,
urologic infections in childhood, prolonged
catheterization, hospital-acquired infections,
late (> 7 days) detection.

4. General symptoms of urinary tract
infection
⚫Dysuria, frequent urination
⚫Hematuria
⚫Fever
⚫Nausea / vomiting
⚫Pain

5. Urinary tract infections
Objective examination data
⚫ Physical examination:
◦ Palpation-induced pain in the lumbar region
(pyelonephritis)
◦ Urethral discharge (urethritis)
◦ Pain during digital rectal exam (prostatitis)
⚫ Laboratory studies : Urinalysis
◦ + Leukocyte esterase
◦ + Nitrites
● Gram-negative infection sign
◦ + Leukocytes
◦ + Erythrocytes

6. Urinary tract infections
Bacteriological studies
⚫ Urine culture = >105 CFU/mL
⚫ Urine culture had to be more then one hundread thousand to be
significant otherwise the less amt. every time we can see in our organism
but they are not causing any type of problem.
⚫ The most common causes of cystitis, prostatitis, pyelonephritis
◦ Escherichia coli (most frequent type of bacteria which cause UTI)
◦ Staphylococcus saprophyticus
◦ Proteus mirabilis
◦ Klebsiella
◦ Enterococcus
⚫ The most common causes of urethritis
● Chlamydia trachomatis
● Neisseria Gonorrhea ( most commonly causing urethritis)
● In ancient time they use 3 glass test in first stream has high
leucocytes and bacteria & we suspect that it urethral problem and
middle stream from the bladder and last from the kidney
Urine culture is most imp thing to do in all kind of UTI. And though it take
2-3 days but we exactly know by this that which bacteria is causing the
problem also what amt. of bacteria is seen and is it significant or also
sensitivity on antibiotic.

7. Determination of probable localization of urinary tract
infections by urine portion

8. Acute pyelonephritis
⚫Infectious inflammation of the renal
parenchyma and pelvicalyceal system
⚫The classic triad:
●Fever
●Chilling
●Pain in the lumbar region

9. Acute obstructive pyelonephritis
Methods of elimination of obstruction
Retrograde ureteral
stenting
Percutaneous
nephrostomy

10. Acute pyelonephritis
Complications
Renal abscess
frequenctly seeing in the case and here we have pus
in the kidney

11. Renal abscess: Treatment:Percutaneous drainage
drainage of pus endoscopically or directly from the
place

12. Acute pyelonephritis
Complications
Pyonephrosis ( not very common/rare as compare
to renal abscess)
so here structure of the parenchyma and the
system is destroyed not till the end but their is
some how regenerated in passive tissue here to
make nephractomy in this case better chance.

13. Acute pyelonephritis
Complications
Emphysematous pyelonephritis(rarest)
Renal parenchyma destruction and gases in the
retroperitoneum cavity due to infection
High amt. of mortality rate
Additional complication is diabetes
🡪 Emergency nephrectomy

14. Treatment of Acute pyelonephritis
⚫ drain the kidney
⚫ Also try to stenting first
⚫ puncture by nephrostomy tube and drain
the kidney
⚫ shriking of the tissue after the
inflammation

15. Renal parenchyma atrophy resulting from frequent,
recurrent infections

16. Cystitis
⚫ inflammation of the mucosa of urinary
bladder
⚫ Directions of cystitis are:
◦ infective,non infective,bacterial,non
bacterial,interstitial cystitis,cystitis while
pregnancy
⚫ Diagnoses:
◦ urinary analysis & urine culture
◦ ultrasound as we can measure the thickness of
the wall of urinary bladder

17. Acute bacterial cystitis
Frequent attacks of symptoms
of acute cystitis, which does not
obey standard treatment 🡪 A
cystoscopy is needed to
exclude the tumor.

18. Chronic cystitis
⚫Recurrent bacterial infection( a patient did not take
medicine like if they feel better they leave the
medication)
⚫Urinary bladder concrements
⚫Reasons pateint want to treated but can’t due to
this reason:
⚫Chemical impact (for example, chemotherapy for
tumors)
⚫Interstitial cystitis - Inflammatory infiltration of
unknown etiology into the submucosa.
⚫Stone disease,cancer and so on which is making
some kind of invasion in mucosal & sub mucosal
layer

19. Classic cystoscopic image of interstitial cystitis
Determination:
by taking sample and take biochemical analysis
biopsy from bladder
galactine,alactine & interleukins all type of
microbiology should be check
Treatment:
it is cystectomy which is removal of bladder

20. Urethritis
⚫ Primary - Mostly sexually transmitted infection
⚫ Secondary - Result of prolonged catheterization
⚫ According to the pathogen
◦ Gonococcal
◦ Non-gonococcal (chlamydia)
⚫ The main symptoms : Urethral discharge,
dysuria
⚫ Treatment - According to the pathogen by
doing the swap test

21. Prostatitis
⚫ Prostatitis syndrome - Pain of varying intensity and non-
clear localization in the penis, perineum, scrotum, lumbar
region; Urination disorders here pain migrates
⚫ Acute bacterial prostatitis - Hospitalization and intensive
antibiotic therapy are needed to prevent sepsis.
Complication causes shock
⚫ Prostate abscess - Surgical drainage of pus with a perineal
or rectal approach is required
⚫ Chronic prostatitis/Chronic pelvic pain syndrome –
Complicated, long-lasting inflammatory disease; Complex
treatment is needed

22. Epididymitis and Orchitis
⚫ Acute or chronic
⚫ Infection caused by mostly catarrhal causes
⚫ It may be a complication of viral parotitis
⚫ It may be a manifestation of Tuberculosis
⚫ It is necessary to differentiate with the testicular tortion
⚫ Treatment – Bed rest, testis elevation, anti-
inflammatory and antibacterial therapy.

23. Balanitis and balanoposthitis
⚫Balanitis - Inflammation of the foreskin of
the penis
⚫Balanoposthitis – Inflammation of the
foreskin and the head of penis
⚫this two happens becz the patient nit
clean the gland properly
⚫Diabetes mellitus

24. Tuberculosis of the genitourinary
system
⚫ Mycobacterium tuberculosis hematogenous spread
from the lung.
⚫ Damages the kidney (abscess,), Ureter (stricture +
hydronephrosis), urinary bladder (sclerosis/shrinking of
bladder), testis and epididymis (chronic
orchiepididymitis)
⚫ Important clinical signs : Hematuria and sterile pyuria.

25. Tuberculous calcification of the
left kidney
Distal stricture of the left
ureter due to tuberculosis

26. Urinary bladder
tuberculosis.
Cystoscopic image

27. BPH
⚫ BPH occurs in transitional zone
⚫ after 45 all male are under the danger of having
BPH disease
⚫ Enlargement of the prostate & starts it enlargement
from transitional zone
⚫ Depends on Androgen: due to
dehydrotestosterone is changing to testosteron so
we have some hyperplasia of the tissue
⚫ Their is no aptosis so tissues are not dying nor they
are cancerous they are adenomas tissue
⚫ In hyperplasia of prostate all the stroma,muscle &
all the substances will be inlarge & it starts from
transitional zone

28. ⚫ Low urinary tract symtoms, low pressure of urine going outside
dribbling, high frequency of urination, all kind of urea can be seen such
as nictoria, nocturea, polakurea,strangurea.
⚫ Cathederiztion can be helpful
⚫ Frequent complication: urinary retention
⚫ Treatment: depends on residual urine, conservative, surgery in
medication we can give them alpha blocker as alpha adreno receptores
are located on bladder neck and other medication is 5 alpha reductase
inhibitor this medication stops the changes from the testosteron into
the dehydrotestosteron as it is stopping enlargement of prostate
⚫ Diagnosis: ultrasound, gold standerd by digital rectally by evaluating the
size of prostate
⚫ Check bladder on ultrasound which is linearly overextended then check
prostate which is enlarge within the bladder then tell patient to go to
pee & again check the bladder their will be residual urine
⚫ Marker: PSA (prostste specific antigen) is nrml from 0-4 nanogram in
millilitre & it elevates due to 3 main reasons:
1. BPH
2. inflammation of prostate
3. prostate cancer