UTI AND PROSTATITIS

Question 1

What are the most common causes of UTI?

Answer 1

E. Coli causes 75-90% of the acute UTI

S.saprophyticus is the 2nd most common cause of UTI in young sexually active women

Question 2

What are the manifestations of urethritis?

Answer 2

Dysuria- discomfort during voiding

Question 3

What are the manifestations of asymptomatic bacteria (ABU)?

Answer 3

No symptoms

Urine testing reveals bacteriuria

Question 4

What are the manifestations of cystitis?

Answer 4

Dysuria
Urgency
Increased frequency
Suprapubic tenderness- pre or post voiding
Small volume voiding
Increased number of WBCs in the urine (pyuria)

Question 5

What are the manifestations of hemorrhagic cystitis?

Answer 5

Visible blood in urine
Irritative voiding symptoms
May be confused with glomerulonephritis but does not present with hypertension or abnormal renal function

Question 6

What are the manifestations of the pyelonephritis?

Answer 6

Irritative voiding symptoms
Fever
Flank pain and tenderness
Costovertebral angle tenderness
Nausea and vomiting
Urine contains WBC casts
Can lead to sepsis, septic shock and death

Question 7

What is difference between reinfection and relapse?

Answer 7

Reinfection- recurrent UTI occurs more than 2 weeks after preceding UTI
Relapse- recurrent UTI occurs less than 2 weeks after preceding UTI

Question 8

What are the risks factors for UTI?

Answer 8

Abnormalities in the urinary tract
Catheters
Diabetics
Immunosuppressed patients
Congenital abnormalities 
Sexual intercourse
Pregnant woman 
Postmenopausal women with bladder or uterine prolapse

Question 9

How is acute cystitis in symptomatic young men diagnosed?

Answer 9

Urine culture greater than 1000 CFU/mL

Question 10

How is acute uncomplicated pyelonephritis diagnosed?

Answer 10

Urine culture 10000 /ml

Question 11

How is asymptomatic bacteruria diagnosed?

Answer 11

Women- 2 specimens with same species of at least 100,000 CFU/mL
Men- single specimen with one bacterial species of at least 100,000 CFU/mL

Question 12

How to confirm pyuria and bacteriuria?

Answer 12

Pyuria- Dipsticktest for leukocyte esterase

Bacteriuria- dipstick for nitrites s. Saprophyticus and E. Faecalis are nitrites negatives

Question 13

What are the lab tests to confirm pyelonephritis?

Answer 13

Antibodies coated bacteria
WBC casts
Ureteral catheterization on extreme cases due to invasive

Question 14

Which groups benefit from treatment of asymptomatic bacteriuria?

Answer 14

Mostly affects elderly population
No treatment needed except for:
Pregnant women
Patients with renal transplants
Patients undergoing GU tract procedures

Question 15

What are the correlations of UTI and pregnancy?

Answer 15

About 1/3 of untreated UTI in pregnancy develop into pyelonephritis which is associated with low birth weight and premature infants
Pregnant women are screened by urine culture at 12-16 weeks gestation
2 urine samples at least 100,000 CFU/mL

Question 16

Ow to prevent UTI?

Answer 16

Maintain high fluid intake
Drink cranberry juice
Empty bladder as soon as feeling urge of peeing
Avoid foods that irritate bladder

Question 17

What are the manifestations of acute bacterial prostatitis?

Answer 17

Irritative symptoms
Obstructive - hesitancy, poor or interrupted stream
Incomplete emptying
Warm,tender, enlarged and boggy prostate on exam
Do not massage prostate to avoid sepsis

Question 18

What are the manifestations of chronic bacterial prostatitis?

Answer 18

Persistent bacterialinfection of prostate greater than 3 months
Common cause of recurrent UTI
Irritative symptoms
No prostate symptoms between episodes
Prostate may be normal,tender or boggy

Question 19

What are the manifestations of chronic non bacterial prostatitis/chronic pelvic pain syndrome?

Answer 19

Painful ejavulation
Pain along inner aspects of the thighs
No recurrent UTI
Prostate tender in 50%

Question 20

What are the 2 mechanisms of postatitis?

Answer 20

Reflux of infected urine to prostate via ejaculatory and prostatic ducts
Ascension of urethral infection during intercourse

Question 21

How is chronic bacterial prostatitis diagnosed?

Answer 21

VB2- urine pre massage of prostate is negative

VB3- urine post massage positive for bacterial counts, leukocytes

Question 22

How is chronic non bacterial inflammatory prostatitis diagnosed?

Answer 22

VB2- negative

VB3- negative for bacteria, positive for leukocytes

Question 23

How is chronic non bacterial non inflammatory prostatitis diagnosed?

Answer 23

VB2- negative

VB3- negative, no leukocytes