Sandbox:UT

Classification

UTI

Uppper

Lower

Pyelonephritis

Cystitis

Prostatitis

Uretheritis

Asymptomatic Bacteriuria

Pyelonephritis

Etiology

Pathogen

Duration and Treatment

Acute Bacterial*Chronic bacterial*Inflammatory chronic*Non-inflammatory chronic*Asymptomatic

Non-infectious

Infectious

*Traumatic cystitis*Interstitial Cystitis*Eosinophilic cystitis*Hemorrhagic cystitis*Foreign body cystitis*Cystitis cystica*Emphysematous cystitis*Cystitis glandularis

*Bacteria*Fungi*Viruses*Parasites

*Acute uncomplicated cystitis*Complicated cystitis*Recurrent/Chronic Cystitis

*urinary crystals*Chemicals*Stevens-Johnson syndrome*Spermicides

Epidemiology

• Worldwide, the prevalence of community associated UTI is 7000 per 100,000 persons.
• The prevalence of hospital associated UTI is 129, 196 and 24000 per 100,000 persons in the United States, Europe and developing countries, respectively.
• The annual incidence of urinary tract infection in women is 1200 per 100,000 persons.
• The incidence of asymptomatic bacteriuria in pregnant women is 5900 per 100,000 persons.
• The incidence of cystitis and pyelonephritis in pregnant woman having asymptomatic bacteriuria is 3300 and 66000 per 100,000 persons.
• The incidence of recurrence of urinary tract infection in young healthy women is 25000 per 100,000 persons and there is increase in the recurrent rates with every subsequent infection.
• The incidence of pyelonephritis among healthy women is 120 and 30-40 per 100,000 persons in the outpatient and inpatient setting respectively.
• The incidence of pyelonephritis in male population is 20 and 10 cases per 100,000 persons in the outpatient and inpatient setting respectively.
• The incidence of UTI is higher in sexually active women than postmenopausal women.
• There is high incidence of urinary tract infection in immunocompromised, elderly, diabetic, and individuals with indwelling catheters.

Journal Reference

Raas-Rothschild A, Spiegel R (2010 Jan 28). "Mucolipidosis III Gamma". GeneReviews®. PMID 20301784.

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CT Scan Emphysematous Cystitis

Table for D/D of cystitis

Diseases	Diagnostic tests			Physical Examination				Symptoms					Past medical history	Other Findings
	Urinalysis	Urine Culture	Gold Standard	Fever	Suprapubic Tenderness	Discharge	Inguinal Lymphadenopathy	Hematuria	Pyuria	Frequency	Urgency	Dysuria
Cystitis	*Nitrite +ve *Leukocyte estrase+ve *WBCs *RBCs	>100,000CFU/mL	Urinary culture	✔	✔	-	✔	✔	✔	✔	✔	✔	Recent catheterisation Pregnancy recent intercourse Diabetes Personal or Family History of UTI Known abnormality of the urinary tract BPH or HIV	Imaging studies help differentiate the type May company back pain, nausea, vomiting and chills
Urethritis	*Positive leukocyte esterase test or >10 WBCs *Mucous threads in the morning urine	-	*Gram stain *Mucoid or purulent discharge	✔	-	Urethral discharge	✔	-	✔	-	-	✔	Prior STDs Urinary tract infections New sexual partner Recent intercourse Recent catheterisation	Tachycardia, diaphoresis, hypertension, tremors, mydriasis, positional nystagmus, tachypnea
Bacterial Vulvovagintis	-	-	Gram Stain	✔	-	Vaginal discharge	✔						Number and type of sexual partners (new, casual, or regular) Prior STDs Previous history of symptomatic BV in female partner (in homosexual women)	Fishy odor from the vagina (Whiff test) Thin, white/gray homogeneous vaginal discharge Microscopy (wet prep) and vaginal pH  Clue cells
Cervicitis	-	-	culture for gonococcal cervicitis	✔	-	endocervical exudate		-	✔	-	-	✔	Abnormal vaginal bleeding after intercourse or after menopause Abnormal vaginal discharge Painful sexual intercourse Pressure or heaviness in the pelvis	1-a purulent or mucopurulent endocervical exudate 2-Sustained endocervical bleeding easily induced by a cotton swab 3->10 WBC in vaginal fluid, in the absence of trichomoniasis, may indicate endocervical inflammation caused specifically by C. trachomatis or N. gonorrhea
Prostatitis	10-20 leukocytes for acute and chronic bacterial subtypes	Identifies causative bacteria (in bacterial subtypes)	Urine Culture	✔	-	-		-	✔	✔	✔	✔	Urogenital disorders Recent catheterization or other genitourinary instrumentation History of UTIs	In acute prostatitis, palpation reveals a tender and enlarged prostate[1][3] In chronic prostatitis, palpation reveals a tender and soft (boggy) prostate[1] A prostate massage should never be done in a patient with suspected acute prostatitis, since it may induce sepsis
Epididymitis	Hematuria may be seen	✔	Culture	✔	✔	+/- urethral discharge	✔	✔	-	✔	✔	✔	Scrotal pain: starts gradually, is usually unilateral and localized posterior to the testis Scrotal swelling Scrotal wall erythema Constitutional symptoms: feeling of hotness, chills, nausea and vomiting	*Ultrasound in patients with acute testicular pain to assess for testicular torsion If equivocal do surgical exploration
Syphilis (STD)	-	-	Darkfield Microscopy	+/-	-	-	✔	-	-	-	-	-	History of STD HIV Immunosupression Previous history of chancre	May be asymptomatic Painless chancre in primary syphilis Secondary syphilis may have generalised features and condylomata late Tertiary syphilis can have neurosyphilis, cardiovascular syphilis and gummas
BPH	Recommended Hematuria may be seen	-	DRE + Serum PSA	-	-	-		✔	-	✔	✔	✔	Sudden inability to urinate Urinary tract infections Urinary stones Damage to the kidneys Blood in the urine	Involves mainly central or transitional zone Hyperplasia rather than hypertrophy Obstruction of the urethra Nocturia
Neoplasms	Recomended Hematuria may be seen	-	Imaging and biopsy	+-	-		✔	✔	-	✔	✔	-	Sudden inability to urinate Recurrent urinary tract infections Weight loss and other constitutional symptoms	Cachexia Gradual progression
Pyelonephritis	Leukocytes Nitrite +ve	Identifies causative bacteria	Imaging and culture	✔	✔ + Flank Pain	✔	✔	✔	✔			✔	History of Pyelonephritis Recent history of Hospitalisation Nephrolithiasis Immunosupression	Costovertebral angle tenderness Patient is in acute distress Look for obstructive causes