Urinary Tract Infections and the Way Forward

Urinary Tract Infections and the Way Forward

The term urinary tract infection or UTI is widely known by many, either by being affected themselves or because of a loved one who has been affected by it. Simply put, it’s an infection of the urinary tract, but it is in-fact, a little more than just that. So, let us learn a little more about this.

Urinary tract infection is an infection with or without inflammation of the urinary passage. Within this, patients may present with bothersome or mild symptoms such as burning during urination, increased frequency of urination, an urgency to urinate, occasionally blood in urine and if more severe, can present with high fever, shivering and weakness, and need for hospitalization.

Occasionally, they may be diagnosed by tests when there are no symptoms.

So, who all are more susceptible for UTIs? Women, of course, have been known to suffer from the above symptoms from time to time. Children also are known to have urinary infections especially if they have certain congenital anomalies or anatomical defects of the urinary tract such as vesicoureteric reflux, ureterocele, pelvic ureteric junction obstruction, etc. But do men also suffer from UTIs? Yes, in-fact a UTI in a man is considered to be something which needs to be addressed with complete evaluation and treatment. Women, due to the proximity of the urinary, vaginal and anal passages, tend to have an increased tendency towards infections.

A few other inciting factors can be constipation, improper hygiene of the private areas, use of unprescribed washing agents to the perineal regions, incompletely treated previous UTI, self-medicating with antibiotics, post-menopausal women, not urinating after sexual intercourse and most importantly, not emptying the bladder as and when it’s full. Certain conditions can exist along with these, such as uncontrolled blood sugars and a block in the urinary passage (stones, stricture disease or narrowing, prostate enlargement), poor functioning kidneys, immobilized patients and those with chronic or indwelling catheters.

So, what do we usually do to evaluate these patients?

We ask for some basic blood tests, urine tests including urine culture and sensitivity and some scans, such as CT or ultrasound. In a few patients, additional tests may be used such as uroflowmetry, which is an objective assessment of the urinary stream, represented as a graph.

So, are all patients with urine culture showing growth considered significant? No, not necessarily. There are certain factors that we look into with regards to a urine culture report. The number of bacteria grown (1 lakh per colony forming unit is considered significant), the type of bacteria, sensitivity to antibiotics and more than a single type of organism grown.

Symptomatic and asymptomatic bacteria are important terminologies to be noted. Why is this so? Despite some having positive urine cultures, they may be asymptomatic and need not be treated until they fall into certain criteria; so pregnant women, those needing any urological procedure or those who have suppressed immunity will need treatment. Few other parameters will have to be considered before deciding that no treatment is needed. Symptomatic patients do need to be treated. Occasionally, despite severe symptoms, there may be no bacterial growth in the cultures. In certain cases, we need to rule out tuberculosis.

We need to have certain considerations while giving a sample for culture. The first void of the day is not to be given; a mid-stream clean catch sample is to be collected.

Well, now that we have established UTI in a patient, how do we treat them? Any inciting cause needs to be treated while tackling the UTI, such as a stone or prostate enlargement or certain congenital conditions like vesico-ureteric reflux of higher grades (IV or V). Children with lower grades of infection may be put on an antibiotic prophylaxis for a long period of time as decided by the doctor.

Patients are usually given antibiotics, painkillers and antispasmodics. In a few special cases, they might require in-patient hospital care with IV antibiotics, stenting of the urinary tract or diversion of urine. Extremely severe cases may need ICU care.

In case of any symptoms suggestive of infection, kindly seek help so that timely and appropriate intervention may be implemented!