URINARY TRACT INFECTIONS

 

What is a UTI?

  • A UTI is an infection which can involve any part of the urogenital tract (kidney, ureter, bladder, urethra, prostate, testicles/epididymis)

  • Usually when people refer to a UTI, they mean infection of the bladder (cystitis)

  • The infection may ascend to the kidney (pyelonephritis), which is more severe

  • The infection may also spread to the prostate (prostatitis) or testicles/epididymis (epididymo-orchitis) in men

 

What causes a UTI?

  • If bacteria which normally live in the genital area are introduced into the urinary tract via the urethra (water pipe), they can multiply and cause an infection

  • Female urethras are much shorter, which explains why UTIs are more common in women

  • The most common bacteria causing UTIs is E.Coli

  • In many young women sexual intercourse may cause UTIs on occasion

 

Some conditions may increase the risk of UTIs including:

  • Obesity

  • Diabetes

  • Immunosuppression (from medications such as prednisolone, methotrexate, etc)

  • Increase age and post-menopausal state

  • Anatomical abnormalities in the urinary tract

  • Incomplete bladder emptying (high post-void residuals)

  • Kidney/bladder stones

 

What are the symptoms of a UTI?

  • Burning/stinging when passing urine (dysuria)

  • Frequent passage of urine (frequency)

  • Strong urge to pass urine (urgency)

  • Bladder/lower abdominal pain

  • Fever

  • Blood in urine (haematuria)

  • Smelly or cloudy urine

  • Flank pain – if the infections spreads to the kidney(s) (pyelonephritis)

 

How are recurrent UTIs evaluated?

  • Urine culture – to prove infection exists or is cleared after antibiotics

  • Blood tests – including kidney function

  • Imaging with kidney tract ultrasound or CT scan to look for:

    • Post void residual volume – remaining urine volume in bladder after voiding

    • Rule out bladder, kidney stones and other anatomical abnormalities (eg. cancer)

  • Flow rate/bladder scan – performed in the office at Geelong urology

  • Cystoscopy – to look for anatomical abnormalities in the urethra and bladder

 

How can recurrent UTIs be prevented/treated?

  1. Antibiotics – best if based on a specific culture result to ensure the bacteria are sensitive to this antibiotic

    • A longer course is usually required for recurrent cases (up to 2 weeks)

 

   2. Conservative measures

  • Increasing fluid (water) intake (>2.5L per day) – to keep flushing the urinary tract and any bacteria present (please check if you have any medical conditions, for which fluid restriction is required)

  • Good genital hygiene (eg. wiping front to back, not using soap)

  • Voiding after intercourse

  • Ensure the bladder does not get too full (timed voiding)

 

    3. Medications/supplements

  • Cranberry tablets/juice

  • Hipprex – a urinary antiseptic

  • Antibiotics

    • Self-start antibiotic course at first sign of UTI

      • Important to send a culture before the first dose

    • Post-coital prophylaxis (if UTIs appear to be related to sex)

    • Prophylactic course (3-6 months) of low daily dose of antibiotic

  • Vaginal pessaries – for post-menopausal women with atrophic vaginitis