Friday, April 19, 2024

Urinary tract infections

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THE URINARY TRACT makes and stores urine, and consists of the kidneys, ureters, bladder, urethra, and prostate in males.

A urinary tact infection (commonly called a UTI) occurs when one or more of these parts or the urinary system become infected with a pathogen (usually a bacteria), and cause symptoms.

UTI’s are far more common in females, where about 50 per cent of all females get a UTI in their lifetime compared to 12 per cent for males. UTIs are a common cause for doctor’s visits, as one in five females who get a UTI will have another one.

Although men are less likely to get a UTI, once they do they are more likely to get another as the bacteria may persist in the prostate. UTIs may be simple (uncomplicated) where they occur in normal urinary tracts, or complicated where they occur in an abnormal urinary tract.

What causes UTIs?

Large amounts of bacteria live normally in the rectal, genital areas, and the skin. These get into the urinary tract through the urethra and into the bladder and sometimes up to the kidneys.

Urine is normally sterile so bacteria anywhere in the urinary tract can be problematic. Some people are more prone to UTIs than others. Women are more prone as their urethra is shorter; the bacteria have less distance to travel. Also some women after they go through menopause, they lose the protective lining of the vagina thus making them more prone.

Sexual intercourse, and certain forms of contraception (diaphragm and spermicidal foam) have also been known to increase the frequency of UTIs in women. Certain medical conditions such as diabetes may increase the risk, and UTIs are also more likely if there is some abnormality in the urinary tract such as an enlarged prostate, a catheter in place, or urinary/kidney stones.

What are the symptoms?

These include feeling an urge to pass urine but only passing small amounts, burning on urination, pain or discomfort in the abdomen or pelvis on urination, and sometimes blood in the urine. If the infection has spread to the kidneys, symptoms may include fever, back pain and chills and one needs to seek urgent medical attention.

How is it diagnosed and treated?

Simple UTIs may be diagnosed on symptoms and a simple urine test. When these recur, a urine sample should be sent to the lab (urine culture) to see if bacteria grow in the urine.

Simple cases may be treated with a short course of antibiotics, but more complicated or recurrent cases may require a prolonged course of antibiotics, and treatment of the underlying abnormality as well. (for example, an enlarged prostate or kidney stone.

Simple measures to prevent UTIs include keeping well hydrated, not delaying passing urine when needed, wiping from front to back and passing urine before and after sexual intercourse for females.

Most UTIs are uncomplicated and easily treated, but with repeat episodes (more than three per year) and in complicated cases they may require special investigations and treatment.

Dr Jeetu Nebhnani, MBBS, DM (Urology), is a consultant urologist and uro-oncologist, Queen Elizabeth Hospital, Cariburol Inc.

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