Urinary tract infection (UTI)

  • A urinary tract infection (UTI) is an infection in any part of the urinary system — kidneys, ureters, bladder and urethra.
  • Most commonly it involves the bladder and urethra.
  • Kidney infections are more serious.
  • Women are affected more commonly than men. These infections are typically treated with antibiotics along with other surgical intervention if required.

Symptoms

  • Burning micturition
  • Frequent urination
  • Lower abdominal pain
  • Passing cloudy foul smelling urine
  • Persistent urge to pass urine
  • Passing blood in urine

UTI types

Organ involvedSymptoms
Kidney (acute pyelonephritis/renal abscess/pyonephrosis/emphysematous pyelonephritis)Flank pain on involved side
Fever with chills
Nausea
Vomiting
Tenderness on palpation
Bladder (cystitis)Lower abdominal pain
Frequent small volume urination
Burning micturition
Blood in urine
Prostate (Prostatitis/abscess)Fever with chills
Burning micturition
Pus in urine
Urethra (Urethritis)Pus discharge
Burning micturition

Causes of UTI

  • Main portal of microbial entry causing UTI is through the urethra.
  • Kidney infections sometimes occur secondary to bloodstream infections.
  • Women are more prone to infections due to close proximity of urethra to anus and short urethra length.

Risk factors leading to UTI

  • Chronic indwelling catheter
  • Poorly controlled diabetes mellitus
  • Women gender
  • Urinary tract abnormality
  • Any recent urological surgery
  • Stone disease

Prevention

  • Daily fluid intake of 2.5-3.0 litre.
  • Drinking cranberry juice prevents UTI.
  • After passing urine or bowel movement, women should clean from front to back.
  • Empty the bladder after intercourse.
  • Person developing infection after sexual intercourse should use barrier method.

Diagnosis

  • Urine routine test
  • Urine culture and sensitivity test- this test tells us which bacteria is causing the infection and which medicine will be most appropriate for that bacterial infection.
  • Imaging test in form of Ultrasound/CT scan as per need.
  • Cystoscopy – in case of recurrent UTI of lower tract (bladder, urethra), to look for the source of infection. 

Treatment

  • Antibiotics are mainstay of treatment for urinary tract infections.
  • Simple uncomplicated infections such as urethritis, cystitis are usually treated with oral antibiotics such as fosfomycin, cephalexin trimethoprim/sulfamethoxazole etc. Other supportive medicines for burning and frequent urination are often prescribed.
  • For complicated infections such as acute pyelonephritis, renal abscess, emphysematous pyelonephritis, hospitalisation intravenous antibiotics are often required. 
  • Surgical intervention such as pus drainage with pigtail, DJ stent placement in kidneys etc may be required. 

Recurrent infections

  • Low dose long term oral antibiotic may be required.
  • Single dose oral antibiotic after sexual intercourse, if your infections seems to related to sexual activity.
  • Vaginal estrogens in postmenopausal women.

Published by Dr Varinder Attri

MS MCh (PGI Chandigarh), Urologist and Andrologist

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