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UROLOGY > 6: Urological Infections > Flashcards

6: Urological Infections Flashcards

1
Q

what are 5 factors that normally keep the urinary tract sterile and resistant to bacterial colonisation

A
  • emptying of bladder during micturition
  • vesico-ureteral valves
  • immunological factors
  • mucosal barriers
  • urine acidity
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2
Q

what does ascending colonisation of bacteria from the urethra lead to in the bladder

A

cystis

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3
Q

what does ascending colonisation of bacteria from the urethra lead to in the kidney

A

pyelonephritis

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4
Q

give 6 risk factors for developing a urinary tract infection and explain

A
  1. female - short urethra and closer to rectum
  2. obstructions - stones, enlarged prostate, retroperitoneal fibrosis
  3. neurological conditions affecting bladder empyting - MS, stroke
  4. pregnancy - enlarged uterus, hormonal effects on relaxation of musculature
  5. abnormal renal tract - vesico-ureteric reflex in children, indwelling urinary catheter
  6. impaired host defence - DM, immunosuppression
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5
Q

at which ages is prevelance of UTIs most common for women and why

A
  • infancy - Genetic abnormalities in urinary tract diagnosed early on
  • pre school (5-10) - children first taking responsbility for their own toilet trips (not hygenic)
  • 20-30 ‘Honeymoon Cystitis’ - due to increase in sexual activity
  • 25-28 - Pyelitis of pregnancy
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6
Q

why does prevelance of UTIs drastically increase for men over age 60

A

due to BPH - enlarged prostate causing obstruction of urine

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7
Q

what is the most common causative organism of UTIs

A

coliforms (gram negative organisms) e.g. E.coli

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8
Q

what are virulence factors of E.coli which cause UTIs

A
  • flagellar: movement
  • pili: attachment
  • capsular polysaccharide: colonisation
  • haemolysin, toxins: damages host membranes and causes renal damage
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9
Q

what are less common causative organisms of UTIs

A
  • proteus
  • enterococci
  • coag negative staph
  • staph aureus
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10
Q

what is the difference between cystitis and pyelonephritis

A

cystitis: lower UTI
pyelonephritis: upper UTI

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11
Q

what are signs and symptoms of cystitis

A
  • dysuria (may be due to other causes of inflammation)
  • cloudy urine
  • nocturia or frequency
  • uregency
  • suprapubic tenderness
  • haematuria
  • pyrexia (usually mild)
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12
Q

what are signs and symptoms of pyelonephritis

A
  • high fever +/- rigors
  • loin pain and tenderness
  • nausea/vomiting
  • +/- symptoms of cystitis
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13
Q

what are some other causes of inflammation that may lead to dysuria

A
  • STIs
  • post sexual intercourse
  • contact w irritants
  • symptoms of menopause, atrophic vaginitis or vaginal atrophy
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14
Q

define an uncomplicated UTI

A

infection by a usual organism in a patient with a normal urinary tract and normal urinary function
- may occur in males and females of any age

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15
Q

what is a complicated UTI

A

> 1 factors that predispose to persistent infection, recurrent infection or treatment failure for previous uncomplicated UTI
- abnormal urinary tract
- virulent organism
- impaired host defense (immunosuppression)
- impaired renal function
- suspected pyelonephritis

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16
Q

when are urine cultures not required

A

in healthy, non-pregnant women of child bearing age (uncomplicated UTI) no need for urine culture

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17
Q

how are complicated UTIs investigated

A
  • Mid-stream urine – cleansing not required, ideally holding labia apart in women
  • Clean catch in children
  • Culture urine within 4 hours of collection, refrigerate or use boric acid preservative
  • urine dipstick to aid diagnosis as visual changes such as cloudy urine will be present
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18
Q

what type of patients are urine dipsticks not useful in

A
  • patients >65 (asymptomatic infection common)
  • catheterised patients
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19
Q

what criteria makes urine dipsticks useful

A

if patient presenting with just 1 of the following:
- dysuria
- new nocturia
- cloudy urine present

20
Q

if a urine dipstick is negative for nitrites and positive for LE what does it suggest the causative organism is

A

Staphylococcus saprophyticus

21
Q

when should imaging of the urinary tract be considered

A
  • all children with UTI
  • valuable in septic patients to identify renal involvement (i.e. pyelonephritis)
22
Q

how should a UTI be treated

A
  • increase fluid intake
  • regular analgesia
  • address underlying disorders
  • antibioticsL 3 day for uncomplicated, 7 day for complicated lower UTI e.g. pregnant, male, underlying disorders
23
Q

what is the choice of antibiotics for women with cystitis

A
  • nitrofurantoin - 100mg bd for 3 days
    - not effective in renal failure
    - cannot be used in final trimester
  • trimethoprim - 200mg bd for 3 days
    - cannot be used in 1st trimester of pregnancy
24
Q

what is the choice of antibiotics for men with cystitis

A
  • trimethoprim - 200mg bd for 7 days
  • nitrofurantoin - 100mg bd for 7 days
25
Q

how is pyelonephritis/septicemia treated

A
  • Pyelonephritis 7-14 day course
  • Use agent with systemic activity (NOT nitrofurantoin)
  • Possibly IV initially unless good oral absorption and patient well enough/tolerating orally
    - Cefalexin
    - Co-amoxiclav/Trimethoprim (only if culture results available and susceptible)
    - Ciprofloxacin (effective as a 7 day course)-Gentamicin
26
Q

what measures will help to prevent UTIs

A
  • encourage hydration
  • promote good hygiene practises
  • encourage post-coital voiding
  • avoid unnecessary catheterisation
27
Q

how long do you have to culture urine after taking a sample

A

within 4 hours of collection
refrigerate or use boric acid preservative if not

28
Q

what is bacteruria

A

defined on an MSU as >10^5 colony forming units/ml
- absence of bacterial growth or white cells on an MSU makes UTI v unlikely

29
Q

do you treat asymptomatic bacteruria or not and why

A

NO
- actively harmful as it replaces low virulence organisms with something worse

30
Q

what are the 2 exceptions to treating asymptomatic bacteruria

A
  1. pregnancy women (inc risk of preterm labour)
  2. prior to urological surgery
31
Q

what other abx options are there for treating UTIs

A
  • cefalexin, augmentin, ciprofloxacin
  • IV: augmentin, taozcin, gentamicin, meropenem
32
Q

how are multi-resistant organisms (MGNO) treated

A
  • in community, some can be treated w trim or nitro if sensitive +/- oral fosfomycin
  • IV meropenem
33
Q

how are recurrent UTIs in women managed

A
  • excluse structural causes w USS +/- cystoscopy
  • advise fluid intake, avoid synthetic pants, expensive/perfumed soaps
34
Q

what are non-abx treatments for recurrent UTIs

A
  • topical oestrogens if post-menopausal
  • cranberry tablets
  • D-Mannose
  • methenamine hippurate
35
Q

how are abx prescribed for recurrent UTIs

A
  • post-coital - single dose of abx
  • self start at first sign of symptoms
  • low dose finite 3-6 month prophylactic abx course
36
Q

what is intravesical treatement for recurrent UTIs

A
  • GAG layer replacement instillations
  • intravesical gentamicin
37
Q

what is the typical history of epididymo-orchitis

A

acute infection of testis/epididymis
- younger men: STI e.g. chlamydia, gonorrhoea
- older men: coliforms
- gradual onset
- unilateral
- recent H/O viral infection e.g. mumps or drug induced e.g. amiodarone

38
Q

how would a patient w testicular torsion present

A
  • under 40s
  • SUDDEN onset - wake from sleep (>24 hours unlikely to be torsion)
  • unilateral pain
  • high lying, laterally orientated testis
  • Prehn’s/cremasteric reflex
39
Q

how is testicular torsion managed

A

emergency scrotal exploration
- reduction and orchidopexy of torted testis if viable
- if non-viable then orchidectomy
- orchidopexy of contralateral testis

40
Q

how is orchitis managed

A
  • send urine for MSU and NAAT
  • USS to exclude abscess or tumour
  • PO doxy +/- IM ceftriaxone in younger men & PO ciprofloxacin in older men
  • IV abx if septic or unwell
  • 10-14 day course
  • swelling can take 6-8 weeks to settle
41
Q

What is positive Prehn’s sign?

A

Pain is relieved when elevating testicle (eg. In epididymo-orchitis)
- this result is negative in testicular torsion ie. pain is not relieved from elevating testicle

42
Q

what are the causes of ATN

A

ischaemia:
- shock
- sepsis

nephrotoxins:
- aminoglycosides
- myoglobin secondary to rhabdo
- radiocontrast agents
- lead

43
Q

what are the investigation findings of ATN (expected lab results)

A
  • raised urea, Cr, K
  • muddy brown casts in urine
  • can also present as dark amber, cloudy urine with granular epithelial cell casts
44
Q

what is decompression haematuria

A
  • occurs commonly after catheterisation for chronic urinary retention due to the rapid decrease in the pressure in the bladder
  • usually does not require further treatment and resolves spontaneously over a few days
45
Q

what is the purpose of cyproterone acetate

A
  • prevents paradoxical increase in symptoms with GnRH agonists
  • GnRH agonists may cause ‘tumour flare’ when started, resulting in bone pain, bladder obstruction and other symptoms

UROLOGY (8 decks)

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