Recurrent UTIs

Question 1

what is complicated UTI?

Answer 1

structural or functional abnormality

Question 2

Reasons for unresolving UTIs?

Answer 2

Unresolved:

• resistance
• 2 species
• stones
• papillary necrosis
• not taking meds

Question 3

2 kinds of recurrant UTIs

Answer 3

1. Reinfection

2. Bacterial persistance

Question 4

why bacterial persistance cause?

Answer 4

• stones
• prostatitis
• foreign body
• congenital
• obstructive
• fistulae (colo-cystic from diverticulitis)
• tumour
• papillary necrosis
• Medullary Sponge Kidney

Question 5

causes of UTIs in elderly?

Answer 5

incontience
catheters
hospital acquired

Question 6

Cause of UTIs in 30s-60s?

Answer 6

prostatic obstruction
pregnancy
vaginal prolapse
catheters

Question 7

common UTI bacteria?

Answer 7

e.coli 85%
kelbs, proteus/pseudomonas/serratia

staph: epi, sapro, Aureus
streps

Question 8

why ecoli good at UTI infections?

Answer 8

serogroups can invade cells for iron
K capsular antigen for neutrophil resistance
Pili to bind to the cells

Question 9

urinalysis on dipstick detects what 2 things?

Answer 9

leucyte esterase

nitrites

Question 10

MSU

write what 3 things next to it?

Answer 10

Microscopy
Cultures
Sensitivities

Question 11

classic Abx in urology

Answer 11

Bactrim: trimethoprim + sulfa
Fluroquinolones: Norfloxacin/ciprofloxacin (if resistant)
Nitrofurantoin: for prophylaxis

Question 12

side effects of Nitrofurantoin?

Answer 12

peripheral polyneuropathy, pulmonary fibrosis, hepatotoxicity

Question 13

classic beta lactams for UTIs

Answer 13

cephalex

amoxy-clav

Question 14

what is pyonephrosis?

Answer 14

pus in the dilated collecting system

infected, obstructed upper collecting system due to a stone etc.

Question 15

why think pyonephrosis?

Answer 15

if they are not improving, think about obstruction

Question 16

acute pyelonephritis symptoms?

Answer 16

fever
loin pain
+/- dysuria, freq, urgency

Question 17

pyelonephritis investigations?

Answer 17

CT or U/S image to exclude pyonephrosis, hydronephrosis

Question 18

strangury means

Answer 18

need to urinate, little satisfaction post voiding, only small drops

Question 19

recurrent UTI investigations

Answer 19

MSU
cystoscope
Ultrasound
random gluscose

Question 20

how to improve post-menopausal recurrent UTIs

Answer 20

topical peri-urethral oestrogen

Question 21

what are non bacterial sources of UTIs?

Answer 21

TB
stones
cancer
viral
fungal
parasites