Health Awareness blog

     Urinary tract infection is the infection of urinary tract where there is a present of bacteria in the urine. Infection is most often due to bacteria from the patient’s own bowel flora and been transfer to urinary tract may be via the bloodstream.

      UTIs are more common in women compared to men. Majority of women will have a UTI some time during their life. The main reason is because women have shorter urethra compared to men.

Risk factors

• Pregnancy
• Genital and urinary tract malformations
• Urinary tract obstruction
• Instrumentation to genital and urinary tract
• Urethral reverberations at sexual intercourse
• Calculus
• Prostatic obstruction
• Bladder diverticulum
• Spinal injury
• Trauma
• Urinary tract tumor
• Diabetes mellitus
• Immunosuppression
• Decrease estrogen level (during menopause)

Types of UTI 

• Pyelonephritis : infection of the kidney
• Cystitis : infection of the bladder
• It can be simple and complicated UTI

Symptoms: 

General symptoms:

• Frequency / dysuria / haematuria
• Urinary incontinence
• Urinary retention
• Fever associate with nausea and vomiting
• Urgency and stangury
• Abdominal pain (loin pain, suprapubic pain, right and left iliac fossa pain)

Acute pyelonephritis:

• Loin and flank pain
• Dysuria (painful urination)
• Frequency
• Fever
• Rigors
• Cloudy or blood stained urine

Cystitis:

• Frequency
• Urgency
• Dysuria
• Haematuria (blood stained urine)
• Usually no fever, but you might experience of mild fever

 What signs might be revealed by your doctor during examination? 

• Loin tenderness
• Enlarged bladder
• Large prostate
• Renal mass
• Meatal ulcer
• Vaginal discharge
• Hypertension
• Signs of chronic renal failure

 Investigations: 

• Urinalysis (Urine FEME) Colony count of greater than 100 000 organisms/ml is significant ( In fresh mid stream specimen of urine).
• Urine microscopy – in UTI, there is presentation of pus cells and organisms (usually Gram negative rods)
• Urine culture and sensitivity – to look for the organism and the sensitivity of the antibiotic. Usually done if there is recurrent infection.
• Full blood count – to look for haemoglobin and white cell count.
• Urea and electrolytes.
• Serum creatinine level – to look for renal function.

Common organisms that cause UTI 

• Escherichia Coli – it cause >70% of all simple UTI
• Proteus
• Klebsiella
• Pseudomonas
• Faecal streptococci

 Treatment: 

• Drink plenty of clear fluid.
• Urinate often.
• Antibiotics will be prescribed by your doctor – Some antibiotics of choice are bacampicillin, amoxicillin and trimethoprim (antibiotics should be change according to urine culture and sensitivity result)
• Analgesic or pain killer should be prescribed if loin pain is present
• Mist potassium citrate or other type of urinary alkalinizer can be given to relief the symptom of dysuria. However, it shouldn’t be given to patient that suffers for renal failure and hypernatremia.
• Try to avoid sexual intercourse during infection.
• Double voiding (going again after 5 minutes).
• Voiding after sexual intercourse may prevent reinfection.
• Keep the hygiene.

 What if the treatment fail or you suffer for recurrent UTI?

• Wrong antibiotics.
• Failure to complete the course of the antibiotics.
• Resistant organisms.
• There is underlying obstruction of the urinary tract.
• Renal or bladder calculus (or stones).
• Urinary tract tumor.
• Urinary retention.
• Specific infection (e.g.: tuberculosis).
• Further investigations is needed includes IVU (intravenous urography), KUB (kidney ureter bladder) x-ray or ultrasound and cystoscopy.

 Complications:

• Recurrent infection causes considerable morbidity.
• It can cause severe renal disease including end stage renal failure.
• Common source of life threatening Gram Negative septicemia.

• Prostate gland is the largest accessory gland of the male reproductive system.
• The prostate gland grows at various stages of a man’s life. The aetiology of the condition is unknown. This growth does not usually cause problems until later in life, when individuals develop BPH.
• BPH is very common, affecting about 50% of men over age 50 and 90% of men over age 80. However, only 10% of the affected men will present with symptoms.
• Untreated BPH may lead to various complications like bladder stone, urinary tract infection, diverticulae of the bladder, bladder and kidney enlargement. It also will affect the kidney function and will cause renal failure.

Symptoms of BPH:
The severity of the symptoms depends on the degree of the obstruction.

• Difficulty in  starting urination
• Poor stream
• Voiding symptoms (hesitancy, weak stream, prolonged voiding, post voiding dribbling, feeling of incomplete emptying)
• Decreased flow rate
• Post void residual urine
• Storage symptoms (urge, frequency, nocturia, urge incontinence)
• Decreased bladder capacity
• Urinary retention
• Haematuria (blood stained urine)

 Signs:
• Occasionally, patient will present with palpable bladder.
• Smell of stale urine on patients.
• Enlargement of kidney
• Per rectal digital examination will reveal smooth and enlarged prostate gland
• Signs of uremia –nausea, vomiting, itchiness

 Investigations:
• Full blood count
• ESR
• Urine investigations – UFEME
• Serum creatinine – to look for kidney  function
• Tumor marker like PSA (prostate specific antigen) and PAP (prostatic acid phosphatase) – to exclude malignancy
• MSU (midstream specimen of urine)
• USS (ultrasound scan) – to assess upper urinary tract (to look for hydronephrosis or enlargement of the kidney), bladder, residual urine
• If operation was done, the resected prostate should be sent for histology to rule out carcinoma.
• Cystoscopy – to check for diverticulae, tumor or stone 

Treatment:
• Patients with mild to moderate symptoms – managed by ‘watchful waiting’. This is because symptoms following therapy sometimes even worse than symptoms without therapy.
• Patients with moderate symptoms can be treated medically with beta-blocker such as daxazosin and competitive inhibitor of 5 alpha-reductase such as finasteride. Finasteride will decrease prostatic volume with an increase in urine outflow. Some studies have been done showing that BPH medications may increase risk for erectile dysfuntion.
• TURP (transurethral resection o the prostate) – a device will be inserted through the urethra to resects some prostate tissue to release the obstruction. This will be decided by your urologist when there is deterioration in renal function or there is upper tract dilatation.
• Open prostatectomy is another surgical option and reserve for very large glands. (TURP carries a lower morbidity and mortality with shorter stay in hospital)
• Microwave hyperthermia, balloon dilatation and prostatic stents are all being tried, but evidence from long term randomized prospective controlled trials is not yet available.
• Acute urinary retention needs an urgent attention because the patient will be presented with severe suprapubic pain. Bladder catheter will be inserted immediately. If it fails, SPC (suprapubic percutaneous catheter) will be inserted through your suprapubic region to release the urine.