This document provides information on urinary tract infections (UTIs). It defines different types of UTIs and describes the signs of pyelonephritis. It discusses how to determine if a urine culture is positive and what imaging may be needed. The document emphasizes the importance of early diagnosis and prompt treatment of UTIs. It describes the typical causative organisms of community-acquired and nosocomial UTIs. Signs and symptoms of cystitis are outlined. Treatment recommendations include common antibiotic options and duration of treatment for UTIs.
A urinary tract infection (or UTI) is caused by a bacterial infection in the urinary tract. The urinary tract is the body's drainage system for removing wastes and extra water. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra.
Normally, bacteria that enter the urinary tract are quickly removed by the body before they cause symptoms. But sometimes bacteria overcome the body’s natural defenses and cause infection, thus leading to a UTI.
Urinary Tract Infections are the 2nd most popular type of infection in the body. Women are especially prone to UTIs for anatomical reasons. *One factor is that a woman’s urethra is shorter, allowing bacteria quicker access to the bladder. Also, a woman’s urethral opening is near sources of bacteria from the anus and vagina. For women, the lifetime risk of having a UTI is greater than 50 percent.
A Microbiology topic on Urinary Tract Infection, covering various subtopics like the causative organism, clinical features and more importantly, the lab diagnosis.
Reference: Textbook of Medical Microbiology, Ananthnarayan & Paniker
A urinary tract infection (or UTI) is caused by a bacterial infection in the urinary tract. The urinary tract is the body's drainage system for removing wastes and extra water. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra.
Normally, bacteria that enter the urinary tract are quickly removed by the body before they cause symptoms. But sometimes bacteria overcome the body’s natural defenses and cause infection, thus leading to a UTI.
Urinary Tract Infections are the 2nd most popular type of infection in the body. Women are especially prone to UTIs for anatomical reasons. *One factor is that a woman’s urethra is shorter, allowing bacteria quicker access to the bladder. Also, a woman’s urethral opening is near sources of bacteria from the anus and vagina. For women, the lifetime risk of having a UTI is greater than 50 percent.
A Microbiology topic on Urinary Tract Infection, covering various subtopics like the causative organism, clinical features and more importantly, the lab diagnosis.
Reference: Textbook of Medical Microbiology, Ananthnarayan & Paniker
Urinary tract infection- a detailed medical study martinshaji
HAPPY PHARMACIST DAY
An infection in any part of the urinary system, the kidneys, bladder or urethra.
Urinary tract infections are more common in women. They usually occur in the bladder or urethra, but more serious infections involve the kidney.
A bladder infection may cause pelvic pain, increased urge to urinate, pain with urination and blood in the urine.
this study details all about UTI
please comment
thank you
Urinary tract infection- a detailed medical study martinshaji
HAPPY PHARMACIST DAY
An infection in any part of the urinary system, the kidneys, bladder or urethra.
Urinary tract infections are more common in women. They usually occur in the bladder or urethra, but more serious infections involve the kidney.
A bladder infection may cause pelvic pain, increased urge to urinate, pain with urination and blood in the urine.
this study details all about UTI
please comment
thank you
Urinary Tract Infection with Nursing ManagementSwatilekha Das
Urinary Tract Infection introduction, definition, common microorganisms, classification, predisposing factors, clinical manifestations, pathophysiology, diagnostic studies, medical management and nursing management along with assessment, nursing diagnosis, goal, nursing interventions and expected outcome after the intervention.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. Today’s Goals
Be able to define the various types of UTIs
Describe the classic signs of pyelonephritis
Be able to determine if a urine culture is positive
Know the types of imaging needed and who needs
imaging
Explain why we care so much about early diagnosis and
prompt treatment
Friday, October 18, 2013
3. Definitions
UTI—inflammatory response of the urothelium to
bacterial invasion.
Uncomplicated—Healthy patient with normal urinary
tract.
Complicated—compromised patient or one with a
functional or structural abnormality.
Recurrent
– Reinfection—infection from different bacteria outside the urinary
tract.
– Persistent—focus from within the urinary tract that is never
eradicated.
Friday, October 18, 2013
4. Bacteriuria: the presence of bacteria in the urine
Significant bacteriuria: 105 organism or more per milliliter
Pyuria: the presence of white blood cells in urine
Pyuria with 5 or more cells per microscopic
high-power field: reliable indicator of UTI
The absence of such pyuria does not reliably
exclude UTI
Friday, October 18, 2013
6. The normal urinary tract is sterile
for many reasons:
Eradication of bacteria by urinary and mucous
flow:
secretory peptides target cytoplasm of
bacteria
Urothelial bactericidal activity
Urinary secretory IgA
Blood group antigens in secretion alter
bacterial adhesion
Friday, October 18, 2013
7. Defenses
Primary Defense
– Flow of Urine
– Voiding
Secondary Defense
–
–
–
–
–
Lactoferrin
pH
IgA
IL-6
IL-8
– Tamm-Horsfall
Friday, October 18, 2013
8. Classification
Isolated—first infections or those isolated by 6 months(3040% of women).
Unresolved—insufficient treatment
– Resistance
– Development of resistance
– Two species one is resistant
– Rapid reinfection before completion of therapy on
initial organism
– Azotemia(poor concentration of drug)
– Papillary necrosis + azotemia
– Staghorn Calculi(mass and concentration of bacteria
Friday, October 18, 2013
too great)
11. Epidemiology
7 million office visits annually(1.2% female, 0.6% male)
Prevalence increases with hospitalization, disease, number
of infections,
Susceptible females—2 infections in 6 months = 66%
chance of developing infection in the next 6 months.
Prophylaxis changes the time to recurrence not the chance
of recurrence.
Pregnancy increases the clinical acuity of infections.
Friday, October 18, 2013
15. Nosocomial UTI
catheter associated
Short Term
Long Term
E.coli
Enterococcus
Enterobacter
E.coli
Proteus
Candida
Proteus
Providencia
Morganella
S.aureus
Pseudomonas
Friday, October 18, 2013
Pseudomonas
18. Escherichia coli
E. coli (serotypes: 02, O4, O6) which are
fimbrinated strains adhering to uroepithelial cells, leading to colonization and
infection is the commonest cause of urinary
tract infections.
Friday, October 18, 2013
19. Gram negative bacilli
Pseudomonas, Proteus, and Klebsiella
infections often follow catheterization and
gynecological surgery (nosocomial
pathogen).
Infection with proteus may be complicated
by phosphate stone formation as it is urea
leads to alkaline pH.
Friday, October 18, 2013
21. What parts of the urinary
tract can get infected?
Urethra - Urethritis
Urinary bladder – Cystitis
Ureters – Ureteritis
Kidneys - Pyelonephritis
Friday, October 18, 2013
23. Incidence
1-3% of all GP consultations
5% of women each year with symptoms. Up
to 50% of women will suffer from a
symptomatic UTI during their lifetime.
UTI in men is much rarer
A proportion of patients may be
symptomatic in the absence of infection called 'urethral syndrome'
24. What are the signs and symptoms
of UTI?
Cystitis
Frequency
Urgency
Dysuria – painful voiding
Pain or discomfort in
suprapubic or perineal
area or lower back
Cloudy or foul-smelling
urine
Friday, October 18, 2013
25. Causes
The most common cause is bacterial infection
– Eschericia coli is the pathogen in 70% of
uncomplicated case of lower urinary tract infections.
– Other organisms include Proteus mirabilis, Klebsiella
pneumoniae, Staphylococcus saprophyticus,
Staphylococcus aureus and Pseudomonas species.
Urethral Syndrome -not associated with any
infection
Rarely kidney or bladder stones, prostatism,
diabetes
26. Prevention
Drinking plenty of fluids helps prevent
cystitis in the first place.
If cystitis follows sexual intercourse, some
advise passing urine soon after to try and
prevent it.
There is no evidence to suggest a link
between lower urinary tract infection and
use of bath preparations
27. Beware!
Pregnant
Under age 12
Males
Systemically ill (fever, sickness, backache)
Catheterised patients
Kidney or bladder stones
28. Investigation
Urine dipstick
– can be done in the surgery and will be positive for nitrates and
leucocytes (leukocyte esterase test). This helps to differentiate
those with UTI from the 50% with urethral syndrome.
Urine microscopy and culture reveals significant bacteruria
(usually >105 /ml).
Asymptomatic bacteruria
– is present in 12-20% of women aged 65-70 years and does not
impair renal function or shorten life so no treatment
– in 4-7% of pregnant women and associated with premature
delivery and low birth weight and always requires treatment.
29. Differential Diagnosis
Urethral syndrome
Bladder lesion e.g. calculi, tumour.
Candidal infection
Chlamydia or other sexually transmitted disease.
Urethritis
Drug induced cystitis (e.g. with
cyclophosphamide, allopurinol, danazol,
tiaprofenic acid and possibly other NSAIDs)
30. Complications and Prognosis
Ascending infection can occur, leading to development of
pyelonephritis, renal failure and sepsis.
In children, the combination of vesicoureteric reflux and
urinary tract infection can lead to permanent renal
scarring, which may ultimately lead to the development of
hypertension or renal failure. 12-20% of children already
have radiological evidence of scarring on their first
investigation for UTI.
Urinary tract infection during pregnancy is associated with
prematurity, low birth weight of the baby and a high
incidence of pyelonephritis in women.
Recurrent infection occurs in up to 20% of young women
with acute cystitis.
31. Management Issues - General
50% will resolve in 3 days without
treatment
No evidence to support “drink plenty”
It is reasonable to start treatment without
culture if the dipstick is positive for nitrates
or leucocytes.
32. Management Issues - General
Culture is always indicated in
–
–
–
–
–
Men
Pregnant women
Children
Those with failure of empirical treatment
Those with complicated infection
33. Self care
Drink slightly acid drinks such as cranberry
juice, lemon squash or pure orange juice
(poor trial evidence for this)
Try a mixture of potassium citrate available
from your pharmacist (little evidence but
widely recommended)
34. Principles of Antimicrobial Therapy
Treatment of UTI should result in sterile
urine.
Antimicrobial levels in urine.
Resistant clones present 5-10% of cases
with empiric treatment.
Friday, October 18, 2013
35. Antibiotics
Trimethoprim is an effective first line treatment.
Cephalosporins are as effective as trimethoprim
but more expensive and more likely to disrupt gut
flora.
Nitrofurantoin is as effective as trimethoprim but
more expensive and frequently causes nausea and
vomiting
The 4-quinolones (ciprofloxacin, norfloxacin,
ofloxacin) are effective in the treatment of cystitis.
To preserve their efficacy, they should not usually
be used as first line therapy
36. Antibiotics
3 days of antibiotic is as effective as 5 or 7 days
Single dose antibiotic results in lower cure rates
and more recurrences overall than longer courses.
In relapse of infection (i.e. reinfection with the
same bacteria), treatment with antibiotic for up to
6 weeks is recommended.
37. Urinary Tract Infections
T re a tm e n t o f R e c u rre n t C y s titis
R e c u r r e n t C y s t it is
R e la p s e
S e e k o c c u lt s o u r c e o f in f e c t o n
U r o lo g ic e v a lu a t io n
R e in fe
D ia p h r a g m a n
C o n s id e r c h a n g in
m e th
T r e a t lo n g e r ( 2 - 6 w e e k s )
c t io n
d s p e r m ic id e
g c o n tr a c e p t iv e
o d
U r o lo g ic e v a lu a t io n n o t
r o u t in e ly in d ic a t e d
³ 3 U T I/y r
³ 2 U T I/y r
N o r e la t io n t o c o it u s
T e m p o r a lly
r e la t e d t o c o it u s
D a ily o r t h r ic e
w e e k ly p r o p h y la x is
P o s t c o it a l
p r o p h y la x is
P a t ie n t in it ia t e d t h e r a p y
38. Antibiotics for UTI in Pregnancy
Cephalosporins and penicillins are recommended
in pregnancy because of their long term safety
record
Nitrofurantoin is also likely to be safe during
pregnancy
Quinolones, Trimethoprim and Tetracyclines are
not recommended for use during pregnancy
Seven days of treatment is required.
Urine should be tested regularly throughout
pregnancy following initial infection.
41. Clinical Manifestations
Classic signs of cystitis
–
–
–
–
–
–
–
–
–
Enuresis
Frequency
Dysuria
Hesitancy
Suprapubic discomfort
+/- UTI signs
Chills
Nausea
Flank pain
Classic signs of pyelonephritis
Friday, October 18, 2013
In
older children and
adults
42. But… In Infants
Fever! Fever!!
Fever!!!
Lack classic signs
Irritabilty
Poor feeding
Vomiting
Diarrhea
Friday, October 18, 2013
Present in <1/2 of infants with UTIs
43. Risk factors
Female (30%:10%)
–
–
–
Shorter urethral length
Urethral opening close to the anus
Exposure to spermicide
» Has antimicrobial activity, disrupt the periurethral
flora content
Friday, October 18, 2013
45. Diagnosis
Urine Collection
– Suprapubic
Aspiration
– Catheterized
specimen
– Voided
specimen
Friday, October 18, 2013
Urinalysis
– Sensitive to
colonies of
30K/ml or less
– Bacteria seen
on microscopy
with no growth
may be vaginal
flora
46. Specimen collection
Samples should be collected before the start
of antibiotics.
Transport within 2 h. if delay is suspected
then refrigeration at 4C or boric acid.
Mid stream urine.
Adhesive bags; in infants.
Friday, October 18, 2013
47. The Positive Culture
Suprapubic
– Any number of pathogens
– Should be completely sterile
Transurethral
– 103 colony forming units
Clean catch
– 105 colony forming units
Friday, October 18, 2013
48. Know the Adequacy of Your
Tests
“standard urinalysis”
– Urine dipstick
– Microscopy
“enhanced urinalysis”
–
–
–
Nitrites
Leukocyte esterase
Microscopy
Gram stain
84% sensitivity
Neither is sensitive enough to rule out UTI
15% of UTIs missed if culture not done
Friday, October 18, 2013
49. UTI - Who should be studied?
Acute pyelonephritis All febrile UTIs
Males of any age with first UTI
Girls younger than 3 years with first UTI
Girls older than 3 years with second UTI
Girls older than 3 years with first UTI with:
– Family history of UTIs
– Abnormal voiding pattern
– Poor growth
– Hypertension
– Abnormalities of urinary tract
– Failure to respond promptly to therapy
Friday, October 18, 2013
50. Urinary Tract Infections
Clinical Manifestations
Feature
Cystitis Pyelonephritis Urosepsis
Dysuria,
frequency
Suprapubic pain
+
+ or -
+ or -
+
+ or -
+ or Ğ
Fever,
tachycardia,
hypotension etc.
CVA tenderness
-
+
+
-
+
+ or -
Duration of
symptoms (days)
1Ğ7
1Ğ2
<1 - 1
51. Imaging Techniques
Indications
– Evaluation of
obstruction
– Persistence of
fever after 5-6
days of treatment
– Diabetes
Mellitus
– TB, fungus, urea
Friday, October 18, 2013
splitting
55. A 3y/o boy has fever, shaking chills, and flank pain
consistent with a diagnosis of pyelonephritits.
Of the following, the BEST procedure to perform
immediately to define the anatomy of the genitourinary
tract is:
–
–
–
–
–
A. cystoscopy
B. intravenous pyelography
C. radioisotopic renography
D. renal ultrasonography
E. voiding cysourethrogram
56. Urinary Tract Infections
Acute Uncomplicated Pyelonephritis in Women
Mild-to-moderate illness
– Outpatient therapy
– Fluoroquinolone 7 - 14 days
Severe illness
– Hospitalization required
– Parenteral cephalosporin, fluoroquinolone or
aminoglycoside, after afebrile - oral therapy (10 - 14
day total)
Pregnancy - avoid fluoroquinolones
57. What determines a positive urine culture?
Suprapubic?
Transurethral?
Clean-Catch?
Suprapubic
13-15% of end stage renal disease
Any number of pathogens
Due to Transurethral
103 colony forming units
Undiagnosed/Untreated UTI in childhood
Clean catch
Why do we care so much about prompt diagnosis and
105 colony forming units
treatment?
27-64%
Friday, October 18, 2013
of those with pyelonephritis develop renal scarring
59. Emphysematous Pyelonephritis
/ Pathogenesis
Acute bacterial and fungal infection:
-- E. Coli: 70~90%
-- Klebsiella, Proteus, Clostridium and
Candida
Gas in upper urinary tract:
-- iatrogenically via upper tract manipulation
-- fistula to bowel
-- ascending infection
60. Emphysematous Pyelonephritis /
pathogenesis
Gas extension: renal and hepatic vein
Diabetics predisposed to gas formation:
-- high glucose level throughout tissue
-- diabetic microangiopathic disease
-- immunodeficient-like state
66. XGP / Incidence
0.6% of all surgically proven renal infection
Women : men = 4:1
More commonly in diabetics
5th ~ 7th decades
Almost always unilateral
67. XGP / Pathogenesis
Not been elucidated
Play a role:
-- urinary tract anomalies, obstruction, chronic
infection, renal ischemia, immunodeficiency and
abnormal lipid metabolism
Diagnosis: made by histological examination of
surgically removed kidney
Characteristic: foamy macrophage
Culture: proteus mirabilus (50%), E. Coli (20%)
68. XGP / Clinical findings
Quite nonspecific:
-- anemia, malaise, leukocytosis, pyuria, flank
pain or flank mass …
Children: weight loss or failure to thrive
Associated:
-- renal calculi: 75%
-- CPN: 78%
69. XGP / Radiological findings
Renal ultrasound: hypoechoic mass
Advent CT: accurate with sensitivity (90%)
-- poor enhancing mass, thickened
Gerota’s fascia
70. XGP / Management
Absolutely no medical therapy
Open surgical nephrectomy: standard care
XGP kidney: extension to hilium and contiguous
organ
71. Treatment
Cystitis—3 Days
– 7 Days if duration of
symptoms, Diabetes, age
greater than 65, or
pregnancy
Pyelonephritis
– Women
» 7 days uncomplicated
without sepsis
» Inpatient 10-14 days
Friday, October 18, 2013
Comlicated Pyelonephritis
– 14-21 day course
Prophylaxis
– Endocarditis—Amp/Gent
or Vanc/Gent
– Indwelling catheter—2
Doses(prior susceptibility)
– Catheter removal—preop
and 72 hours after
– TURP—Pre and Post Op
72. Urinary Tract Infections
Candidates for Prophylaxis
Women with ≥ 3 symptomatic uncomplicated
infections per 12 months
Pregnant women with asymptomatic
bacteriuria or previous symptomatic UTI is
pregnancy
Men with recurrent UTIs
79. Chronic bacterial prostatitis
History
– Bladder outflow obstruction
– Dysuria; perineal, low back, or testicular pain
– Hematuria, hematospermia, painful ejaculation
Physical examination
– Variable prostate exam
Relapsing UTI in men is the hallmark of chronic
bacterial prostatitis
– GNR most common; also Enterococcus and S. saprophyticus
80. Chronic bacterial prostatitis
Management
– Difficult to eradicate given poor penetration of
antibiotic into the non-inflamed prostate
– Bactrim and fluoroquinolones
» Doxycycline and macrolides second-line
–
–
–
–
Prolonged treatment required
Recheck prostatic fluid after treatment
Alpha-blockers to reduce symptoms
Suppressive therapy
82. Prostatodynia
History
– Persistent pelvic, suprapubic, infrapubic, scrotal,
inguinal, or perineal pain
– Lower tract obstruction and dysuria
– Absence of systemic symptoms
Physical exam usually unremarkable
No bacteria identified and no evidence of
inflammation present
Limited course of antibiotics, alpha blockade
Editor's Notes
Prostatis will affect 50% of men at some time in their life; 2 million visits a year
Fungal infections (ie Aspergillus) seen more often in immunocompromised patients
Most pts with dx of prostatitis are adults with perineal, lower back pn, lower abd pain, or ejaculatory complaints.
Most don’t have bacteriuria and thus there is little bacterial evidence of infection
Inflammatory response: in expressed prostatic secretions, semen, post massage urine, or prostate tissue
First 2 tubes should be sterile or have a colony count smaller by an order of magnitude
The diagnosis of prostatitis requires VB3 to have 10 fold increase in colonies over VB1
3 tube approach gives us sample of urethra (1), bladder (2), and prostate
2 tube approach: obtain urine before and after massage– if WBC appear, prostatitis can be inferred
NOT A SUBTLE DIAGNOSIS
Systemic symptoms include malaise, myalgias, or occasional toxic appearance
Prostate massage may cause bacteremia or vas infection.
Urine culture will generally reveal the pathogen.
These antibiotics will penetrate the prostate well under circumstances of inflammation
Bladder outflow obstruction: frequency, dribbling, diminished stream, hesitancy, and urgency
Usually seen in older men
Dysuria etc more often seen in younger men
Prostate may be enlarged, asymmetrical, boggy, or tender
Prostate fluid has high pH and makes it difficult for antibiotics to penetrate
Bactrim is the main choice as it diffuses into and concentrates into prostatic fluid
May sometimes take up to 8 –12 weeks
Alpha blockers may be of benefit in acute prostatitis as well
Suppressive therapy includes daily Bactrim, prostate reduction procedures
**** 1/3 have symptomatic and bacteriologic cure; 1/3 have symptomatic cure; 1/3 have no improvement****
Prostate abscess: immunocompromised, diabetes, indaquate initial therapy, foreign bodies, gu obstruction.
Imaging may be necessary to document the abscess (might be felt on physical examination)
1. Empiric course of abx in case of occult infection though there is no data to support this