UTI's part 1 Flashcards
definitions sepcific infections and inflamm of urinary tract
General definition of UTI
UTI is a broad term that refers to a variety of clinical conditions, ranging from asymptomatic presence of bacteria in the urine to severe life threatening conditions to the kidneys such as pus pyelonephritis and urosepsis.
it is a bacterial infetion in both adults and children
Epidemiology of UTI’s
- out pt relevance
- causes of UTI in
- children - example of obstruction causing UTI
- young females - predisposinf factors
- young males
- adults
- A very serious problem in clinical and outpatient practice,
- common cause of nosocomial infections. •
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In children younger than 5 years of age, most common reasons are congenital anomalies,
- e.e vesicle ureteric reflux and obstruction.
- Good example for obstruction is pelvic ureteric junction obstruction (it means stenosis).
-
In young females, most common are recurrent uncomplicated UTI
- specific example in females is cystitis.T
- female predisposing rUTI factors = URETHRAL anatomy in women
- females have shorter 2-4cm, and wider- 7mm urethra.
- Female urethra is adjacent to vagina and anus.
- In young males most common reason of UTI is STDs.
- In adults most common is Iatrogenic via retrograde instrumentation
Specific definitions to know for UTI that
Divides UTI from Surgical POV
C A C U R I C U
U C U C I R C A
Uncomplicated UTI
Complicated UTI
Isolated UTI
Reccurent UTI
Unresolved UTI
Catheter associatied UTI
Clinically significant bacteruria
Assymptomatic bacteruria
Uncomplicated UTI:
means acute or sporadic or recurrent UTI in patients with anatomically or functionally normal urinary tract OR without comorbidity
MC is cystitis in women
consequence is that it leads to embarassed urodynamics
https://www.niddk.nih.gov/health-information/diagnostic-tests/urodynamic-testing#urodynamic
Complicated UTI- DEF
WHy is it the most surgically imprtant
mc change in complicated uti and the most common cause for this change
2nd mc change and the possible causes (congenital/non congenital)
other possible causes of complicated UTI
mos severe complicated cause of complicated UTI
definition cUTI (most important surgically) =
UTI in patients with an abnormal urinary tract. from anatomical or functional changes in the tract.
It is the most common type of UTI and predominant in MEN
- The most common change in the urinary tract = embarrassed urethral function from incomplete bladder emptying secondary to Bladder Outlet Obstruction (BOO).
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Reasons Other than BOO for complicated UTI is:
- Renal & Bladder stonesAssoc w/ UTI
- Surgical Complications causing colon-vesicle fistulas
reasons for BOO
most comon cause (prostate)
subvesicular causes (cong/noncong)
most severe cause
most common complication of most severe cause
most comon causes (prostate)
-
BPH!! no1 cause of BOO w (benign prostatic hyperplasia) & prostate cancer (pCa)
- both rx by surgery so it’s why BOO is most surgeical important
- BOO is also very common in men making cUTI mc type of UTI
subvesical obstruction - cong/ non cong
- Congenital: stenosis of bladder neck known as Marions disease -
- Non congenital / acquired cause of BOO most common in young and adult male is stricture of the ureter
Most complicated reason for bladder outlet obstruction
-
spinal cord injury.
- can damage peripheral innervation (sympathetic and parasympathetic) of bladder. (know the innervations).
- NB- Most common complications as a result of this damage to the innervation of UB are; disturbances in act of urination, this includes incontinence or retention of urine.
- can damage peripheral innervation (sympathetic and parasympathetic) of bladder. (know the innervations).
Other reasons for complicated UTI
- Renal stones - Bladder stones
- Complication in surgery is colon-vesicle fistulas
Isolated UTI: definition
an interval of at least 6 months between infections, very prolonged period of onset of these infections.
Recurrent UTI: definition
- 2 types of causes of reccurent UTI
- causes of bacterial resistance
- Re-infection; this means infection by different bacterial agents, according to previous one, usually after a long period of time, for example after several months.
- Bacterial persistence; it means infection by the same bacterial agent, from the focus in the urinary tract.
Worldwide accepted classification of prostatic syndrome;
NIH 1995 four categories:
- Category I - Acute bacterial prostatitis (ABP)
- Category II - Chronic bacterial prostatitis (CBP)
- Category III - Chronic pelvic pain syndrome (CPPS)
- Category IV - Asymptomatic inflammatory prostatitis (AIP)
Examples of Reccurent UTI
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Chronically infected prostate e.g chronic bacterial prostatitis according to NIH classification
- test bac in urine and prostatic secretions should be the same
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Bacterial infection with renal stones;
- according to the chemical composition of the stone the most common type is struvite.
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Urinary diversion
-
d/2 bladder fistula
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Fistulas types
- ureteric vaginal fistula
- vesico-vaginal fistulas after extended gynaecological operation.
- vesicle-intestinal fistula
-
Fistulas types
- after radical cystectomy for bladder cancer
- bilateral uretero-cutaneostomy….
- Bladder reconstruction in rare cases this is usually from the small intestine.
- ureto-sigmoidostomy
- ureto-ileo-cutaneostomy (brickers)
-
d/2 bladder fistula
Fistulas causing R-UTI
vesicle-intestinal fistula
vesico-vaginal fistulas after extended gynaecological operation.
ureteric vaginal fistula
Types of Urinary diversion (after cystectomy for bladder cancer
- bilateral uretero-cutaneostomy….
- ureto-ileo-cutaneostomy (brickers)
- ureto-sigmoidostomy
- Bladder reconstruction in rare cases this is usually from the small intestine.
what is an Unresolved infection
unresolved UTI is an Inadequately treated UTI,
caused by
- Bacteria with natural or acquired resistance to treatment.
- Infection with multiple agents, a good example of this hospital acquired infections usually multiple and different agents (nosocomial).
- Repeat reinfection
Clinically significant bacteriuria definition
Means more than 10^5 cfu/ml
- colony forming units, microbiology that estimates the number of viable bacteria in the urine) NB!!
Asymptomatic bacteriuria
is it treated?
Midstream sample of urine showing clinically significant bacteriuria (over 10^5CFU) in 2 consecutive urine samples in women and in men without symptoms of urinary tract.
- Good example is pregnancy.
Always treat asymptomatic bacteriauria!!!!! NB
typical example of asyx bacteruria
pregnancy
what is Catheter associated UTI
UTI in patients w/ an indwelling transurethral or suprapubic catheter or catheter placed before 48hrs
Medical terminology/ Nosology in relevance to UTI
- kidney
- bladder
Pyelonephritis- inflammation of the kidney
Cystitis-Inflammation of UB and bladder wall . three forms) Acute, Chronic and recurrent
Painful bladder - symptoms lasting more than 6 months, the special form is interstitial chronic pelvic pain syndrome (CPPS)
Medical terminology (nosology) for UTI
-prostate
- Prostatitis- inflammation of prostate gland regardless of etiology
- Special form of acute bacterial prostatitis is prostatic abscess;
- it is a pus focus, which may lead to urosepsis (this is an emergency in urology).
- etio = complicationof transrectal US guided prostate biopsy
- may be self drained through the ureter or rectum.
- For abscess treatment ALWAYS called incision and drainage.
- it is a pus focus, which may lead to urosepsis (this is an emergency in urology).
Medical terminology (nosology) for UTI
- epididymis
- testes
- vas deferens
- Epididymitis - inflammation of epididymis —- further reading
- Bilateral epididymitis is often linked with inflammation of vas deferns (deferentitis).
- causes Obstructive azoospermia and male infertitility.
- Epididymo-orchitis - inflamm of epydidymis and testes
- Isolated Orchitis - inflamm of testes d/t Viral infection e.g. mumps
Medical terminology (nosology) for UTI
-inflammation of scrotal skin (2)
- Phlegmona of the scrotum
-
Fournier’s gangrene - extreme urgency in urology.
- Morphological examination= necrotic inflammation of the scrotum.
- This life threatening condition is caused by aerobic bacteria, the most common being gram negative e.g. proteous, plus anaerobic bacteria such as clostridium.
- Regardless of operation in emergency the mortality rate is high - 40% of cases.
Medical terminology (nosology) for UTI
–inflamm of glans & prepuce
- –mc complication
- -special form
-
Balanitis - inflamm of glans penis Postitis - inflamm of inner layer of foreskin (prepuce) ,Balanopostitis = inflamm of glans penis & prepuce
- Most common complication of these recurrent chronic conditions is phimosis;
- requires surgical treatment by circumcision.
- special form is Balanitis xerotica obliterans
- Precancerous condition, it may transform to invasive SCC of the penis
- complications = 1)meatal stenosis(cong) 2) meatal stricture (aquired) or 3)phimosis
- rx- circum & histological investigation to exclude SCC, dilation of stenosis
Medical terminology (nosology) for UTI
- inflamm of cavernous body
- iatrogenic cause of carvernitis
- inflamm of urethra
-
Cavernitis - inflammation of cavernous body of the penis,
- it may form penile abscess.
- Treatment for abscess is incision and drainage. It’s an urgent condition.
- causes
- intracavernous injection of vasoactive substances as a second line treatment of erectile dysfunction.
- Priapism
- it may form penile abscess.
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Urethritis - inflamm of urethra
- sx = penile pain & discharge
Specific infections of the UT
Genitourinary tuberculosis, the most common site of extra pulmonary TB
Candidiasis
Urinary schistomiasis (bilharziasis)
Urinary filariasis
Actinomycosis
Echinococcosis (hydatid disease)
Do not mistake specific UTI with sexually transmitted diseases
