Urinary Tract Infections

Urinary tract infections are a common problem. They are commonly picked up in the community due to painful urination (dysuria), frequency and offensive urine.

Lower urinary tract symptoms involve the bladder and are very common. Occasionally, they may also involve the kidney and may require admission into hospital.

Workup

Generally, your GP will diagnose a UTI on a urine sample. A urinary tract ultrasound is commonly requested to ensure there is no anatomical abnormality to predispose to infections. A uroflow and residual is helpful to ensure there is adequate bladder emptying and can also suggest lower urinary tract dysfunction.

Urinary tract infections in women

Uncomplicated infections in women are very common and do not necessarily indicate a problem. However, urological opinion is often required if the infections are common and recurrent, or if they do not resolve.

Generally a cystoscopy is performed to ensure the bladder looks normal. Ingrowth of skin into the first part of the bladder (squamous metaplasia of the trigone) is a normal variant but cauterisation or “burning” of this area can often help so that the skin subsequently heals in a smooth manner preventing bacteria from adhering to the bladder.

Other ways to prevent infections include voiding after intercourse, use of natural yoghurt and topical vaginal oestrogens are also very helpful in the post-menopausal period. Antibiotics can be prescribed at the time of symptomatic infections or around intercourse if this is a precipitant. Sometimes, women prefer long-term low-dose antibiotics for a period of 6 months or more to break the cycle of infections.

Urinary tract infections in men

Urinary tract infections in men are generally abnormal. Because of the penis, it is difficult for bacteria to make their way into bladder. Very commonly, a predisposing factor is found and this needs to be corrected so that future infections can be avoided. Generally infections in men will be referred for a urological opinion.

The most common predisposing abnormality that is found is an enlarged prostate obstructing the bladder by causing dysfunction and inadequate bladder emptying. Other common abnormalities include urethral strictures, bladder stones and occasionally bladder cancers.

Bladder outflow obstruction from an enlarged prostate can be seen with a uroflow and residual showing a very slow flow and incomplete bladder emptying. The enlarged prostate can also be seen on imaging such as the urinary tract ultrasound or CT.

Generally a “rebore” or transurethral resection of the prostate (TURP) is recommended rather than medical therapy alone to definitively correct the problem to prevent the risk of further infections.