Cystitis (Male) Flashcards
What is cystitis?
Cystitis is often used as a synonym for lower UTI (particularly for women), although technically it means ‘inflammation of the bladder’.
Briefly differentiate between uncomplicated and complicated UTI
Uncomplicated UTI is infection of the urinary tract by a usual pathogen in a person with a normal urinary tract and normal kidney function.
Complicated UTI is when one or more risk factors are present that predisposes the person to persistent infection, recurrent infection, or treatment failure.
What is a upper UTI?
Upper UTI includes pyelitis (infection of the proximal part of the ureters) and pyelonephritis (infection of the kidneys and the proximal part of the ureters).
What is recurrent UTI?
Recurrent UTI is repeated UTI, which may be due to relapse or reinfection, and may be defined as 3 or more UTIs in the last 12 months, or 2 or more episodes of confirmed UTI in the last 6 months.
What are the most common organisms causing UTI?
- Escherichia coli* (80%)
- Staphylococcus saprophyticus* (4%)
- Klebsiella pneumoniae* (4%)
- Proteus mirabilis* (4%)
What are the various mechanisms of entry for UTIs?
Entry of bacteria into the urinary tract may be:
- Direct, for example, from insertion of a catheter into the bladder, instrumentation, or surgery
- Via the blood stream (more likely in immunocompromised people)
- Retrograde, ascending through the urethra into the bladder
What are the risk factors for UTIs?
- Age over 50 years
- Benign prostatic hypertrophy (BPH) and other causes of urine outflow obstruction (for example, urinary tract stones, urethral stricture)
- Catheterisation
- Previous urinary tract instrumentation or surgery
- Previous UTI
- Anal sex
- Diabetes mellitus
- Immunosuppression
- Recent hospitalisation
Whar are the signs of UTIs?
- Suprapubic tenderness
- Odorous urine
- Cloudy urine
- Haematuria
What are the symptoms of UTIs?
- Dysuria (pain or discomfort on passing urine)
- Frequency
- Urgency (the desire to pass urine immediately)
- Nocturia (having to urinate during the night more frequently than usual)
- Suprapubic pain
What investigations should be ordered for UTIs?
- Urine culture and sensitivity
- Urine dipstick?
- Urine microscopy?
In which groups of patients is urine culture and microscopy not appropriate?
- Who are not catheterized
- With an indwelling catheter
- Aged over 65 years
Briefly describe the use of urine culture and sensitivity testing in diagnosing UTIs
In men with symptoms suggestive of a UTI, confirm the diagnosis by urine culture and sensitivity, by arranging collection of a mid-steam urine (MSU) or catheter specimen of urine (CSU), to determine the infecting micro-organism.
A value of ≥10² colony-forming units (CFU)/mL.
When should men be referred to urology?
- Have ongoing symptoms despite appropriate antibiotic treatment
- May have an underlying cause or risk factor for the UTI
- Have recurrent episodes of UTI (for example, two or more episodes in a 6-month period)
- Suspected upper UTI
When should a patient be referred under the cancer pathway?
Refer urgently using a suspected cancer pathway referral for an appointment within 2 weeks for men:
- Aged 45 years and over who have unexplained visible haematuria without urinary tract infection, or visible haematuria that persists or recurs after successful treatment of urinary tract infection
- Aged 60 years and over who have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test
- Consider non-urgent referral for bladder cancer in men aged 60 years and over with recurrent or persistent UTI
What is the first-line treatment for UTIs?
Nitrofurantoin 100 mg (modified-release) twice daily for 7 days.
Note: if eGFR ≥ 45ml/minute.
