GENITOURIN

ARY
INFECTIONS
MISBAH KALEEM 2021-
54
DEFINITIONS

• Urinary tract infections: UTI is defined as inflammatory

response of the urothelium to bacterial invasion.
• Cystitis: Inflammation of the bladder.
• Acute Pyelonephritis: Acute kidney infection.
• Bacteriuria: Presence of bacteria in urine.
• Pyuria: Presence of WBC in urine.
• Uncomplicated UTI: Urinary tract is structurally and
functionally normal.
• Complicated UTI: anatomical or functional abnormality.
• Diabetes
• Immunosuppression
• Isolated UTI: 6 months
• Recurrent UTI: >2 infections in 6 months(diff organisms)
• Persistent UTI: 2 or more infections with the same
organism
• IF YOU DO NOT see bacteria you cannot label it UTI.
RISK FACTORS FOR BACTERIURIA

• Diabetes Mellitus
• Female sex
• Increasing age(tissue integrity compromised)
• Indwelling catheters
BACTERIURIA CAUSES

●E.coli associated bacteriuria makes up the most common

cause in community acquired setting overwhelmingly
●Whereas
●Nosocomially E.coli > Gram negatives > gram positive
bacteria are implicated
●Staphylococcus Saprophyticus
●Klebseilla pneumonia
ROUTES OF INFECTION

• Ascending
• Haematogenous
FACTORS INCREASING
BACTERIAL VIRULENCE
• Adhesion mechanisms: Pili (gram –ive E. coli)
• Extracellular capsule
• Toxins
• Enzyme production: Proteas produce urease which
break down urea to ammonia. (struvite stones)
INVESTIGATIONS OF UTI

• Dipstick of MSU specimen: Leukocyte esterase produced by

neutrophils and causes a colour change in a chromogen salt
on the dipstick.
• Nitrite testing: Gram negative bacteria convert nitrates to
nitrites and are detected by a dipstick which form a red azo
dye.
• Blood
• pH: normal pH (5.5-6.5), Alkaline pH associated with UTI.
(Proteas)
• Microscopy of MSU
GENERAL TREATMENT

• Antimicrobial drug therapy (Empirical

therapy((flouroquinolones; cipro)) before culture is
available)
• Bacterial resistance to drug therapy (MRSA)
• Definitive treatment (Urine and bacterial cultures)
• General prevention (Drink fluids, cranberry juice etc)
ACUTE PYELONEPHRITIS

• Inflammation of kidney and renal pelvis.

Symptoms:
• Fever
• Flank pain
• Bacteriuria
• Pyuria
• Elevated WBCs
• LUTS (hesitancy, poo/intermittent stream, straining,
incompletevoiding, frequency, urge incontinence)
Differential Diagnosis:
• Cholecystitis
• Pancreatitis
• Diverticulitis
• Appendicitis
Risk Factors:
• Females
• VUR(vesicoureteral reflux)
• Diabetes
• Catheters
Infective Organisms:
• E. Coli
• Proteas
• Klebsiella
• Staphylococcus
• Pseudomonas
ACUTE PYELONEPHRITIS
 INVESTIGATIONS AND
TREATMENT
• Only Fever: Culture urine and start oral antibiotics.
• Systemically Unwell:
1. Resuscitate
2. Culture urine and blood
3. IV fluids and antibiotics
• Arrange X-ray KUB and USS (underlying abnormality)
• In case of pyonephrosis or perinephric abcess (drain via
percutaneous nephrostomy tube)
PYELONEPHROSIS

●Infection following
●Pyelonepritis
●Hydronephrosis
●Renal calculus/ ureteropelvic junction obstruction

●Kidney becomes multilocular sac containing pus and

purulent urine
PERINEPHRIC ABSCESS

●A perinephric abscess is a collection of suppurative material

in the renal parenchyma or perinephric space, with a
presentation that is insidious (> 14 d). This abscess formation
occurs secondary to urinary tract obstruction and/or
hematogenous spread from infection sites
PERI-URETHRAL ABSCESS

• Peri-urethral abcess can occur in association with

urinary catheterization and in association with
gonococcal urethritis.
• Bulbar urethra is commonly involved.
• Bacteria passes through the buck’s fascia gaining access
to periurethral tissues.
• Can spread to perineum, buttocks, and abdominal wall.
PRESENTING FEATURES

• Scrotal swelling
• Fever
• Urinary Retention
• Urethral Discharge
• Tender inflammed area
MANAGEMENT

• Abcess should be incised and drained

• Suprapubic catheterization
• Parenteral antibiotics
ACUTE EPIDIDYMITIS

• It is an inflammatory condition of the epididymis, often also

involving the testis and is usually caused by bacterial infection.
• Clinical course of less than 6 weeks.
• Infection spreads from urethra or bladder.
• Organisms:
1. N. gonorrhoeae
2. C. trachomatis
3. E. coli
4. M. tuberculosis
• Anti-arrythmic drug (Amiodarone
PRESENTING FEATURES

• Fever
• Testicular swelling
• Scrotal pain
• Reactive hydrocele
TREATMENT

• Bed rest
• Scrotal elevation
• Analgesia
• Antibiotics
PROSTATITIS CLASSIFICATION
PROSTATITIS
PATHOPHYSIOLOGY

• Organisms (Gram –ve and Gram +ve)

• Acute bacterial prostatitis is often secondary to infected
urine refluxing into the prostatic ducts that drain the
posterior urethra.
• Resulting edema and inflammation may obstruct the
prostatic ducts trapping the uropathogens within
RISK FACTORS

• UTI
• Acute Epidydimitis
• Indwelling urinary catheters
• Transurethral surgery
PRESENTING FEATURES

• Acute onset of fever, chills, nausea and vomiting.

• Pain (perineal, prostatic, suprapubic, groin)
• Urinary symptoms (irritative, hesitency, dysuria)
• DRE: prostate is swollen and tender(boggy)
INVESTIGATIONS

• Blood tests
• Urinalysis, urine culture
• Blood cultures
• Urethral swabs
TREATMENT

• Antibiotics
• Analgesics
• Treat urinary retention: urethral, suprapubic, or in-and-
out catheter.
• Complication (prostatic abscess)
GENITOURINARY TUBERCULOSIS

• Kidney: Haematogenous spread results in granuloma

formation in the renal cortex associated with caseous
necrosis of renal papillae and deformity of the calyces.
• Ureters: results in stricture formation.
• Bladder: Bladder wall becomes edematous, red, and
inflammed, with ulceration and tubercles.
• Prostate and seminal vesicles: haematogenous spread
causes cavitation and calcification.
• Epididymis: descending renal infection or
haematogenous spread.
• Fallopian tubes
• Penis
INVESTIGATIONS

• Urine dipstick test

• Urine culture (sterile pyuria) PCR done
• CXR and sputum culture
• Tuberculin skin test
• Renal tract imaging: Xray, USS
• Cystoscopy and biopsy
TREATMENT

• Medical: ATT (2 months of Isoniazid, rifampicin, and

pyrazinamide, and ethambutal followed by 4 months of
isoniazid and rifampicin.
• Surgical
1. Nephrectomy of non-functioning kidney
2. Regular imaging with IVU
3. Bladder disease may require surgical augmentation
THANKYOU