Urinary Tract Infections

Question 1

What is the most common causative organism for UTIs?

Answer 1

E.coli

Question 2

What are the symptoms of urinary tract infections?

Answer 2

Urinary frequency
Dysuria
Urgency
Foul-smelling urine
Suprapubic pain
Confusion in the elderly

Question 3

What are the risk factors for UTIs?

Answer 3

Women - Family history, sexual activity, diaphgram use, pregnancy, oestrogen deficiency
Men - PBH, renal stones, urethral strictures, urinary catheter

Question 4

What are the investigations required for UTI?

Answer 4

• urine dip which will be positive for leucocytes and nitritres.
• For men, children, women > 65 and pregnant women a mid stream urine sample should be sent for culture

Question 5

What is the treatment for UTIs in non pregnant women?

Answer 5

Immediate abx for severe symptoms and watch and wait with a delayed prescription in women with mild symptoms.
First line - Nitrofurantoin or trimethoprim

Question 6

What is the supportive care for patients with a UTI?

Answer 6

• Drink plenty of fluids
• Take regular paracetamol and ibuprofen

Question 7

What is the management of UTIs in pregnant women?

Answer 7

Send urine culture away and prescribe immediate antibiotics for all pregnant women with symptoms of UTIs
Treatment: Nitrofurantoin (but avoid Near term!!), avoid trimethoprim in first 12 weeks, or amoxicillin

Question 8

Should you prescribe abx for asymptomatic bactururia?

Answer 8

In pregnant women - Yes
In catheters - No

Question 9

What are the symptoms of pyelonephritis?

Answer 9

Fever, rigors, loin pain, nausea and vomiting, symptoms of LUTIs.

Question 10

What are the investigations for pyelonephritis?

Answer 10

• Bedside tests including dipstick.
• FBC, UEs, CRP, ESR, blood cultures
• Mid stream urine sample for culture
• Renal ultrasound/other imaging

Question 11

What are the complications of UTIs?

Answer 11

Sepsis, renal and peri-renal abscess, AKI, emphysematous pyelonephritis

Question 12

What is uncomplicated vs complicated pyelonephritis?

Answer 12

Uncomplicated - non-pregnant, pre-menopausal women with no urological abnormalities
Complicated - Patient with structural/functional abnormality or men

Question 13

What is the treatment of uncomplicated vs complicated pyelonephritis

Answer 13

Uncomplicated - Oral ciprofloxacin or trimethoprim
Complicated - IV Gentamicin

Question 14

What are the complications for pyelonephritis?

Answer 14

• Renal failure,
• sepsis
• Renal abscess formation,
• Emphysematous pyelonephritis

Question 15

What is emphysematous pyelonephritis?

Answer 15

Severe necrotising infection of the renal parenchyma which causes gas formation

Question 16

What can cause poor response to pyelonephritis treatment?

Answer 16

Renal abscess or kidney stones

Question 17

What can cause chronic pyelonephritis?

Answer 17

Chronic vesicoureteral reflux.

Question 18

What can be used in recurrent pyelonephritis to assess for scarring?

Answer 18

DMSA scans

Question 19

What is the treatments for recurrent UTIs?

Answer 19

Lifestyle advice
Short/long term abx use
Investigate in elderly patients

Question 20

What are the risk factors for acute prostatitis?

Answer 20

• UTIs
• Epididymitis,
• Catheter use
• Previous urethral surgery
• Prostate stones

Question 21

What is the presentation of acute prostatits?

Answer 21

Perineal/prostate pain, LUTS and systemic symptoms such ad fever/myalgia

Question 22

What are the investigations for acute prostatitis?

Answer 22

History and examination, DRE, midstream urine sample, STI screen.

Question 23

What is the management of acute prostatitis?

Answer 23

Ciprofloxacin or ofloxacin for 14 days or STI treatment

Question 24

Describe features of chronic prostatitis

Answer 24

Rarely associated with acute prostatitis but may follow chlamydia urethritis.