Urinary Tract Infection

Urinary tract infections (UTIs) commonly affect both women and men. In general, the term UTI includes bladder and kidney infections; however, your doctor may specify between infections located only in the bladder, the prostate, and more severe infections in the kidneys (pyelonephritis). Bacteria are the cause of most infections. They enter the bladder by traveling up the urethra (where urine passes) from the outside world. In most cases, your primary care doctor can treat the infection with antibiotics without additional investigation. When the infection persists or recurs often, you may require a more extensive evaluation by a urologist. If the infections are difficult to clear or recur, your urologist will often check additional lab tests to see if there is an underlying cause.

Urinary tract infections are more common in females. The length of the urethra is much shorter, and this offers an easier route for bacteria to get into the bladder. Many natural mechanisms guard against these infections. Your body’s immune system, the natural “flushing action” of emptying your bladder and urine acidity levels can usually stop infections before they start.

Symptoms of a Urinary Tract Infection

A variety of symptoms may accompany a UTI:

• burning when urinating
• frequent or urgent urination
• waking up often to urinate
• bloody urine
• inability to control urination
• bladder or kidney pain
• fever or rigors

Most UTIs in adults are isolated events, and if they resolve with standard antibiotics then no further evaluation may be recommended. For simple infections, a one or two day course of antibiotics may do. More complicated infections may require 7 – 14 days. In some situations, chronic infections may develop that can call for low dose antibiotics for 30 to 90 days duration. Many factors in your medical history may guide your doctor in your treatment. After the infection has been treated, it is not uncommon to still have persistent symptoms related to the swelling caused by infection. These may last for up to six weeks and may require medicines to calm the bladder or sooth the burning. It is very important to complete all the antibiotics your doctor prescribes and to contact the office if your symptoms worsen or are accompanied by high fever. A follow-up visit may be scheduled to recheck the urine for infection. Together with your doctor, most urinary tract infections resolve quickly without becoming more serious

Risk Factors for UTIs

A variety of factors can influence how bacteria get into the bladder to cause UTIs. Some risk factors include:

• Poor hygiene – After using the bathroom, females need to wipe the vaginal area from front to back to avoid introducing bacteria to the urethra. Going from back to front can relocate bacteria from the rectum to the urethra.
• Sexual activity – The mechanics of sex can force naturally occurring vaginal bacteria into the urethra. This is perhaps the most common cause of adult UTI’s. Likewise, anything put into the vaginal area regularly can accomplish the same result, not just sexual activity. Similar effect may be seem with vaginal hygiene products, horseback riding, straddle-type seats, as well as clothing items associated with vaginal pressure like thong underwear or leotards.
• Retained urine in the bladder – If your bladder is not emptying completely, the remaining urine is stagnant and becomes infected more easily.
• Blockages in the urinary tract – Any blockage, such as from an enlarged prostate or kidney stone, can result in poor emptying and lead to infections.
• Medical illnesses – Diabetes in particular can impair the immune system and predispose to a variety of infections.

Diagnosing A UTI

The simplest tests involve a urinalysis with a bacterial culture of the urine. This confirms the actual type of bacteria and tests which antibiotics will be effective for your infection. Additional evaluation by x-rays, which may include a kidney ultrasound, IVP (intravenous pyelogram) or CT scan, gives information about the anatomy of your urinary tract. Kidney stones, blocked kidneys, and bladder malformations are common things that doctors look for with these tests. Sometimes cystoscopy, where a small scope is inserted into your bladder through the opening of the urethra, is performed. It is a very simple and quick procedure that can give a lot of information about your bladder.

URINE CULTURE

The best way to fully assess for the presence of infection requires growing any bacteria found in the urine and testing antibiotics against it. Some symptoms that suggest infection may NOT be infection, and a urine culture helps to clarify this. For women, a catheter may be necessary to get a sample of urine that is not contaminated with bacteria from the vagina. If you are collecting a urine specimen in the doctors office, make sure to use good technique. Women need to spread the labia with one hand, wipe off the opening, let the urine stream start, and then catch a sample mid-stream. Men need to make sure to completely retract the foreskin, clean the meatus, let the stream start, and then catch a sample mid-stream. Incorrect collection will lead to incorrect diagnosis and treatment.

X-RAY IMAGING

In some instances abnormalities of the urinary system can lead to recurrent infections or symptoms of infection. Poor drainage from birth defects of the urinary system, obstruction from stone or cancer, or stones themselves can be the source of recurrent UTI. A CT scan or IVP can aid in detecting these problems and potentially resolve the issue following treatment.

CYSTOSCOPY

By using a lighted scope to examine the lower urinary tract (bladder and urethra), your doctor can look for abnormalities that can lead to recurrent infections. These include stones, tumors, narrowing of the urethra or areas of the urethra with poor drainage (urethral diverticulum). The procedure is usually short, has limited discomfort, and can be done in the office.

Treatment of UTIs

Urinary Tract Infections (UTI’s) and recurring UTIs are common, but incredibly painful. The good news is, treatment is usually simple. In most cases, your primary care doctor can treat the infection with antibiotics without additional investigation.

Many natural mechanisms guard against these infections. Your body’s immune system, along with the natural flushing action when emptying your bladder and can usually stop infections before they start. Most UTIs in adults are isolated events, and if they resolve with standard antibiotics then no further evaluation may be recommended. For simple infections, a one or two day course of antibiotics may do. More complicated infections may require 7–14 days.

If the infections are difficult to clear or recur, your urologist will often test further to see if there is an underlying cause. The simplest tests are simple and determine the actual type of bacteria and which antibiotics will be effective for your infection. Additional evaluation by x-rays, which may include a kidney ultrasound, IVP (intravenous pyelogram) or CT scan, gives information about the anatomy of your urinary tract. Kidney stones, blocked kidneys, and bladder malformations are common things that doctors look for with these tests. Sometimes cystoscopy, where a small scope is inserted into your bladder through the opening of the urethra, is performed. It is a very simple and quick procedure that can give a lot of information about your bladder.

Special Considerations