UTI

Question 1

Why are UTIs more common in women?

Answer 1

Shorter length of female urethra allows bacteria from the vagina to enter the bladder relatively easily, especially after sexual intercourse.

Question 2

Why are UTIs more common in post-menopausal than pre-menopausal women?

Answer 2

Altered hormonal conditions after menopause that cause an alteration in the normal vaginal bacterial floral that normally compete with pathological bacteria.

Question 3

What are the symptoms and signs of lower UTIs/cystitis?

Answer 3

• Increased urinary frequency and urgency
• Dysuria
• Frank haematuria
• Malaise
• Suprapubic discomfort
• Cloudy/offensive smelling urine

Question 4

What are the symptoms and signs of upper UTIs/pyelonephritis?

Answer 4

• Begins with symptoms of lower UTI
• Gradually increasing unilateral loin pain
• Pyrexial
• Rigors
• Malaise

Question 5

What investigations would you do for a UTI?

Answer 5

Urine dipstick
- Nitrates, leucocytes, blood, protein

MSU sample for microscopy
- Must contain >100,000 bacterial and WCs per mL to diagnose UTI

Question 6

What additional investigations would you order for pyelonephritis?

Answer 6

• Blood cultures

* CT or US upper tract imaging

Question 7

Why do you order CT/US upper tract imaging when investigating pyelonephritis?

Answer 7

Excludes pyonephrosis (an obstructed, infected kidney usually caused by a ureteric stone) 
- Can cause severe sepsis unless decompressed urgently with nephrostomy tube

Question 8

What are the differentials of pyelonephritis?

Answer 8

• Pyonephrosis
• Appendicitis
• Pelvic inflammatory disease
• Ruptures abdominal aortic aneurysm

Question 9

What is the treatment for a simple lower UTI for women?

Answer 9

3-day course of :

• Trimethoprim
• Cephalexin
• Nitrofurantoin

Question 10

What is the treatment for pyelonephritis?

Answer 10

• 24-48hrs IV gentamicin or temocillin

- Followed by 10 day course of oral Abs

Question 11

What is a complicated UTI?

Answer 11

Anatomical/pathological abnormality that predisposes patients to developing UTIs:

• Vesico-ureteric reflux
• Urinary tract stones
• Urinary tract tumours
• Incomplete bladder emptying

Question 12

What factors suggest a complicated UTI?

Answer 12

• Infections that do not respond - Frank haematuria after infective symptoms have
• Hx stone disease
• Recurrent pyelonephritis

Question 13

With a complicated UTI what is the additional investigation that needs to be performed?

Answer 13

• Cystoscopy

- US/CT of upper urinary tract

Question 14

What investigations would you need to order in a man with an UTI?

Answer 14

Bladder US to exclude chronic urine retention

Question 15

What is a recurrent UTI?

Answer 15

o >3 episodes of infection per year

Question 16

What is the management of a recurrent UTI?

Answer 16

• Low-dose prophylactic Abs
  OR
• Take 1 Ab after sexual intercourse if this is the causative factor
  OR
• Self-start’ a 3-day course of Abs at onset of infective symptoms

Post-menopausal women
- Topical vaginal application of oestrogen creams