from API

1. Urinary tract infection

2. Definition:- a condition in which
bacteria enter, persist and
multiply within the urinary tract.

3. Causes:-
Mostly gram negative bacteria such as
1. Escherichia coli(only some strains)
2. Klebsiella
3. Enterobacter
4. Psuedomonas
5. Proteus

4. Incidence:-
The incidence of UTI is 0.5 to 0.7
episodes per person per year
in females of whom 25% of them
have recurrences.

5. Host Factors Predisposing to Urinary
Tract Infection
1. Anatomical factors
Posterior urethral value
Vesico-ureteric reflux
Urethral stricture
Benign prostatic hypertrophy
2. Functional factors
Neurogenic bladder

6. 3. Other factors
Males and females
Diabetes mellitus
Immunosuppression (post-transplant)
Calculi
Congenital abnormalities
Foreign bodies: catheters, stents
Females
Post-menopausal state (oestrogen deficiency)
Voiding habits
Spermicidal jelly
Vaginal douching
Perineal hygiene

7. Aetiopethogenesis:-
females:-periurethral colonisation
Males:- preputial colonisation (uncircumcised males).
weakened host defences ->
urethral colonisation and mucosal adhesion of bacteria
occurs.
•Sexual intercourse
•Catheterisation
•instrumentation
may also help transfer of bacteria into the bladder. When
•vesicoureteric reflux
•ureteral dilatation are present
infection ascends via the ureter to reach the renal
parenchyma.

8. Clinical features:-
Depend ?
Upper? Lower?
constitutional irritative voiding symptoms.

9. Lower urinary tract infection
Include cystitis and urethritis:-
May be asymptomatic or present with
•Frequency
•Urgency
•Dysuria
•Nocturia
•Urge incontinence
•Suprapubic pain
•Sensation of incomplete bladder emptying.

10. Prostitis and seminal
vesiculitis
symptoms of prostatic infection are
•Frequency
•Dysuria
•perineal or groin pain
•difficulty in voiding
•Painful ejaculation.

11. Pylonephritis
Infection of the renal parenchyma is called pyelonephritis.
•Acute
•Chronic

12. Symptoms of acute Pylonephritis
•fever with shaking chills
•Myalgia
•Nausea
•Vomiting
•loin pain which develop rapidly over a period of hours to days.

13. Chronic Pylonephritis
•May be unilateral or bilateral.
•Develop as a result of infection or vesicoureteric reflux in early
childhood.

14. Symptoms of Chronic
Pylonephritis
•adults with chronic pyelo-nephritis do not have bacteriuria
•remain asymptomatic for long and present later with
hypertension
•or renal functional impairment.

15. Modalities of Diagnosis
1. Microscopic examination:-
• Early morning sample is ideal.
• random samples may also be used foe
regular testing.
 If more then 5WBCs/hpf -> pyuria is defined.
 While in child bearing age group females
more then 10WBCs/hpf.

16. 2. Urine ulture
• A clean catch mid stream urine sample
should be collected.
 Growth of more then 105cfu(colony forming
units) of a single bacterial strain signifies a
positive culture.
 suprapubic aspirate one cfu is significant.
 In catherised sample 103 cfu is significant.

17. 3. Intravenous urography
• Provides anatomical details of kidney, minor
and major calyces, renal pelvis, ureter and
urine.
• Useul to assess Post void residual bladder
urine.
• medullary sponge kidney, renal papillary
necrosis causing obstruction to ureters and
radiolucent staghorn calculi are better
diagnosed.

18. 4. Voiding Cystourethrography:-
•to assess the urinary bladder and urethra,
especially in children with:-
 posterior urethral valve
 vesicoureteric reflux
 Neurogenic Bladder
 diverticulae
 vesical fistulae.

19. Treatment