Please find the power point on Urinary Tract Infection (Pyelonephritis, Cystitis). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you

1. Infection
1.Urinary tract infection
2.Renal tuberculosis
Sunil Kumar Daha

2. Urinary tract infection

3. Introduction
• UTI is term to describe acute urethritis and
cystitis
• Accounts about 1-3% visit in general
medicine practice
• In women, prevalence about 2% at age of 20
years, increasing by 1% in subsequent decade
• In men, uncommon except in first year of life
and over 60 years

4. Spectrum of presentation of urinary
tract infection
• Asymptomatic bacteriuria
• Symptomatic acute urethritis and cystitis
• Acute pyelonephritis
• Acute prostatitis
• Septicaemia (usually gram –ve bacteria)

5. Pathophysiology
• Urine is excellent culture media for bacterias
• Urothelium of susceptible persons may have
more receptors to adhere virulent strains of E.
coli
• Organisms easily ascent into bladder in female
• Organisms may also be introduced by
Minor urethral trauma during sexual intercourse
Instrumentation of bladder

6. Risk factors
• Incomplete bladder emptying
Bladder outlet obstruction( BEP, Ca prostate,
urethral stricture, vesico-ureteric reflux)
Neurologic (Multiple sclerosis, spina bifida,
diabetic neuropathy)
Uterine prolapse

7. Continue..
• Foreign bodies
Urethral catheter or ureteric stent
Urolithiasis
• Loss of host defences
Atrophic urethritis and vaginitis in post
menopausal women
Diabetes mellitus

8. Most common causative agents
• E.coli
• Klebsiella
• Proteus spp
• Pseudomonas spp, streptococci and
staphylococcus epidermidis

9. Clinical features
• Abrupt onset of frequency and urgency
• Scalding pain in urethra (dysuria)
• Suprapubic pain during and after voiding
• Intense desire to pass more urine due to
spasm of inflamed bladder wall (strangury)
• Urine may appear cloudy, unpleasant odour
• Microscopic or visible hematuria
Pyrexia and rigor if upper tract or septicaemia

10. Investigations
• All patients
Dipstick (nitrite, leucocyte esterase, glucose)
Microscopy/ cytometry for WBCs, organisms
Urine culture
• Infants, children, and anyone with recurrent
infection
Full blood count, urea, creatinine
Blood culture

11. Continue..
• Pyelonephritis, males, children, women with
recurrent infections
Renal tract ultrasound or CT
Pelvic examintion in women, rectal examination
in men
• Continuing hematuria or other suspicion of
bladder lesion
Cystoscopy

12. Management
• Antibiotics in all cases of proven UTI
• Trimethoprim- usual choice for initial T/t
• Ciprofloxacin, norfloxacin, cefalexin equally effective
• Co-amoxiclav or amoxicillin only for sensitive
• Penicillins and cephalosporins are safe in pregnancy
• Antibiotic T/t for 3 days is norm
• In severe infection antibiotics for 7-14 days
• Seriously ill patient need intravenous therapy
• Fluid intake of 2L/day recommended

14. Renal Tuberculosis

15. Introduction
• Arise from haematogenous infection from distant focus
• Lesion are usually unilateral
• May ulcerate
• Mycobacteria and pus cells discharged in urine
• Sometimes superadded infection
• Extension of renal abscess leads to perinephric abscess
• Kidney progressively replaced by caseous material
(putty kidney)
• Often associated with bladder.
• Tuberculous epididimo-orchitis without apparent
infection of bladder

16. Clinical features
• Occurs 20-40 years of age
• More common in male
• Unrinary frequency : earliest symptom (may be only) &
increasing progressively.
• Sterile Pyuria
• Pain
• Haematuria
• Malaise and weight
• Evening pyrexia

17. Examination
• Unusual for tuberculous kidney to be palpable
• Nodules and thickening
– Prostate
– Seminal vesicles
– Vasa
– Scrotal content

18. Investigations
• Bacteriological
• X-ray
• Intravenous urography
• Cystoscopy
• Chest X-ray

19. Treatment
• Anti-tubercular therapy
• Urinary tract is reviewed in first week of therapy
(scarring & stricture)
Operative treatment
• Should be conservative aiming to remove large foci of
infection & correct the obstruction
• Optimum time for surgery : 6-12 weeks after starting ATT
• Repertoire of procedure is needed

20. Summary
• Consider when symptoms of cystitis continue
despite treatment
• Is a cause of sterile pyuria
• Cause chronic inflammation and scarring
through out urinary tract
• May cause obstructive lesions through out
Urinary tract.

21. References
• Bailey & Love’s Short Practice of Surgery, 26th
Edition
• SRB’s textbook of surgery, 5th edition

22. Thank You