Lower Urogenital Dysfunction

Question 1

Some functions of commensals

Answer 1

Compete for resources with more virulent organisms
Produce their own AMPs
Keep innate immune cells in an attentive state
Lower vaginal pH

Question 2

Which bacterial is of particular significance to protection of the female urinary tract?

Answer 2

Lactobacillus – decrease vaginal pH through lactic acid production, generating H2O2
Occupy the chemical resources that would otherwise be available for exploitation by pathogenic organisms

Question 3

What are some things that may disrupt commensals?

Answer 3

Excessive cleaning
Frequent douching
Use of spermicides

Question 4

Defenses along the urinary tract

Answer 4

Physical force of urine flow
Exfoliation
Antimicrobial proteins – AMPs, Tamm-Horsfall protein

*with the exception of the urethra, innate and adaptive leukocytes are absent from the lower urinary tract during times of health

Question 5

Act as one-way valves to prevent urine from backing up toward the kidneys

Answer 5

Points where the ureters attach to the bladder (ureterovesical junction, UVJ)

Question 6

Why is the lower urinary tract epithelia elastic?

Answer 6

So that it can handle the physical force and pressure of urine flow – it is transitional epithelium

Question 7

How does exfoliation contribute to defense from pathogens?

Answer 7

Exfoliated bladder cells are epithelial cells that are sloughed off from the surface of the urinary tract – ejects pathogens into urine for removal

Question 8

How do you get descending UTIs?

Answer 8

Rare – hematogenous spread, sepsis

Question 9

What are some risk factors for UTIs at varying ages?

Answer 9

foreskin, anatomic GU abnormalities
1-15 –> anatomic GU abnormalities
16-35 –> sexual intercourse, diaphragm use
36-65 –> Surgery, prostate obstruction, catheterization
>65 –> incontinence, catheterization, prostate obstruction

Question 10

Species that cause UTIs and their treatments

Answer 10

UPEC - adults –> TMP-SMX, chipper, NFT

Enterobacter spp, Klebsiella - children –> TMP-SMX, cipro

Pseudomonas aeruginosa - Nosocomial –> Carbenicillin, tetracycline, cipro

Question 11

What allows UPEC bacteria to adhere to the bladder epithelia?

Answer 11

Pili

Question 12

How does the body respond to UTI?

Answer 12

With exfoliation and neutropihl recruitment –> painful urination, lower abdomen discomfort, low grade fever, frequent urination

Question 13

What is used for diagnostic UTI?

Answer 13

Activation of neutrophils results in degradation and release leukocyte esterase