This document discusses understanding and management of urinary tract infections (UTIs) in women. It defines key terms related to UTIs and notes that almost half of all women experience at least one UTI in their lifetime. It discusses signs and symptoms of UTIs as well as diagnostic tests and appropriate antibiotic treatment. It also addresses dilemmas around culture-negative UTIs, recurrent UTIs, asymptomatic bacteriuria during pregnancy, and management of diseases of the urinary system in elderly women. The document emphasizes that appropriate decision making is important in surgical management of UTIs and treatment of asymptomatic bacteriuria during pregnancy.

1. Understanding &
Management of UTI in
women
Dr.ARUL VELUSAMY MS MCh

2. Definitions
Bacteriuria
Pyuria
Uncomplicated UTI
Complicated UTI

3. Definitions
Isolated
Unresolved
Recurrent - Reinfection, Bacterial
persistence

4. Incidence
5 - 14 yrs - 1%
Young Adulthood - 4 %
Per Decade -1 - 2 %
Almost half of all women would experience
UTI at least once in their lifetime

5. Ponder
Would I get this infection again?
Why again & again?
Why me?

6. Signs & Symptoms
Urgency
Frequency
Dysuria
Suprapubic pain
Fever & chills
Loin pain

7. What shall I do?
Urine Routine
No pus cells - observe
Pus cells - start antibiotic & give urine c/s
Persistent symptoms, complicated UTI -
imaging

8. What decides UTI?
Bacterial Adherance - Fimbriae, Type 1 pili,
P-pili, S-pili
Phase variation
Epithelial cell receptivity
Natural defence - Flora, urine, immunity

9. Dilemma
Urine Analysis - Pyuria , No Organism
Sterile pyuria - TB, Malignancy, Stones
FASTIDIOUS organisms

10. False negative
Dilute Urine
Early infection

11. Urine culture
How to collect?
Significant
Asymptomatic

12. Antibiotic of choice
Concentration in urine
Bacterial resistance
Antibiotic formulary

13. Recurrent UTI
presentation
Lab Diagnosis
Persistence
Re-infection

14. Bacteriuria in pregnancy
Incidence - 2 to 7%
Spontaneous resolution - unlikely
Incidence of pyelonephritis upto 40%
Smooth muscle atony
Ureteric obstruction
Increased GFR
Penicillin, cephalosporin, Nitrofurantoin

15. DUS
Elderly female patient
Obstructive symptoms - occasional
Predominantly irritative symptoms
Dilatation & cystoscopy evaluation
Common but missed often

16. Take home
Incidence of UTI is slightly higher in female
Genotype may decide recurrent UTI
Imaging is not always required
Culture negative symptomatic patients should be
managed prudently
Appropriate antibiotic and duration
Decision making is the key in surgical management
Asymptomatic bacteriuria in pregnancy should be
treated

17. THANK YOU