Urinary tract infection

Published on 23/06/2015 by admin

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Chapter 36 Urinary tract infection

Chapter contents

Lower urinary tract 281
Benign prostatic hyperplasia (BPH) 282
Prostate cancer 283
Prostatitis 283
Urinary stones 283
Renal cancer 284
Bladder cancer 284

Lower Urinary Tract

Infections include:

• Cystitis.
• Urethritis.

More common in females. Common pathogens are Escherichia coli, Pseudomonas spp., Streptococcus spp., Staphylococcus spp.

Signs and Symptoms

• Urinary frequency.
• Dysuria.
• Suprapubic pain and tenderness.
• Haematuria.
• Smelly, cloudy urine.

These conditions are the ones most commonly seen by complementary healthcare practitioners. More serious upper urinary tract conditions, such as glomerulonephritis or pyelonephritis, are more likely to refer themselves directly to orthodox medical care. It is worth noting, however, that a relatively straightforward cystitis or urethritis can develop into an upper urinary tract condition if not treated appropriately.

Investigations

• Midstream urine sample is cultured.

Very often, a broad-spectrum antibiotic is given without a sample being taken, but if the infection does not clear then a culture needs to be grown to identify the type of bacteria and the most effective antibiotic for that strain.

Treatment

• A short course of antibiotics (see Chapter 29 ‘Antimicrobials’, p. 219).
• Plenty of water.
• Paracetamol or ibuprofen to ease symptoms.

Benign Prostatic Hyperplasia (BPH)

• Common in men over 50 years old.
• Urinary frequency and urgency with decreased urinary flow.
• Nocturia.
• Complications: infection due to the incomplete emptying of the bladder.

Laboratory Tests

The prostate-specific antigen (PSA) is elevated with a large benign prostate. Whether this level indicates a more pathological condition, i.e. malignant prostate, depends on the age group.

• PSA Levels

• Under 50 years of age: below 2.5 ng/mL.
• Under 60 years of age: below 3.5 ng/mL.
• Under 70 years of age: below 4.5 ng/mL.
• Under 80 years of age: below 6.5 ng/mL.

Treatment

• Alpha-Adrenoceptor Antagonists

• Can create partial reversal of smooth muscle contraction in the enlarged prostate and bladder base.
• Alpha-adrenoceptor antagonists are also helpful in patients with hypertension if they are not too specific (see Chapter 31 ‘The nervous system’, p. 244).

• 5-Alpha-Reductase Drugs

• Prevent the synthesis the production of the androgen dihydrotestosterone from testosterone.
• Can take several months before they work.

Adverse Effects

Both reduce sexual performance.

• Serenoa repens (Saw Palmetto)

Experimentally appears to inhibit 5-alpha-reductase but no well-constructed clinical studies have yet be run to say definitively whether this herb is effective with BPH. However, the possibilities are there (Fagelman & Lowe 2001).

Adverse Effects

There are no serious side effects.

Prostate Cancer

By 80 years of age, 80% men have some degree of malignancy.

Signs and Symptoms

Initially not dissimilar to benign prostatic hyperplasia (BPH), or there might be a history of BPH. Plus:

• blood in the urine or semen
• painful ejaculation
• lower back pain extending into hips and upper thighs.

Laboratory Tests

PSA; see above.

Treatment

• Patient might be in an age group that dies of old age first, so observation is used.
• Zinc supplementation.
• Removal of prostate (prostatectomy).
• Radiotherapy.
• Hormonal treatments: Chapter 39 ‘Chemotherapy’ (p. 310).

Prostatitis

• Acute or chronic inflammation of prostate.
• Common pathogens: Gonococcus, E. coli, Staphylococcus, Streptococcus.
• Some chronic prostatitis can be non-bacterial.

Signs and Symptoms

• Frequency.
• Dysuria.
• Nocturia.
• Urgency.
• Urethral discharge.
• Low back pain.

• Treatment

Antibiotics. However, chronic prostatitis does not always respond to antibiotics and can prove difficult to treat.

Urinary Stones

• Most kidney stones are composed of calcium phosphate or calcium oxalate.
• Their cause is usually unknown.
• Abnormally high urinary calcium (hypercalciuria) increases the risk of developing kidney stones.
• High doses of calcium will not cause hypercalcaemia (abnormally high calcium in the blood).

Causes

• Gout.
• Hypercalcaemia.
• Dehydration.
• Infection.
• Renal disease.
• Some drugs, e.g. diuretics can create dehydration. Tetracyclines bind readily to calcium.

Signs and Symptoms

• Can be asymptomatic.
• Kidney: loin pain, haematuria, possible proteinuria.
• Ureter: severe colic, tenderness over course of ureter, enlarged kidney.
• Bladder: frequency, haematuria, gravel in urine.
• The presence of stones will increase the chance of urinary tract infection.

Treatment

• Wait for stones to pass.
• Removal of stones: surgically or by lithotripsy (breaking up stones using shock waves).
• Antibiotics.
• Painkillers.
• Treatment of underlying problems.

Renal Cancer

Signs and symptoms

• Painless haematuria.
• Low-grade fever.
• Anaemia.
• Weight loss.
• Abdominal mass.
• Loin pain.
• Hypercalcaemia.

Treatment

• Surgical removal.
• Radiotherapy.

Bladder Cancer

• Uncommon below the age of 40.
• More common in men.

Signs and Symptoms

• Painless haematuria.
• Nocturia.
• Frequency, urgency, and hesitancy.
• Pain and weight loss: late features.

Therefore many features are similar to prostate conditions.

Treatment

• Surgery: the degree of this will depend on how far the cancer has progressed.
• Radiotherapy.
• Chemotherapy.

Reference

Fagelman E, Lowe FC. Saw Palmetto berry as a treatment for BPH. Reviews in Urology. 2001;3(3):134-138.

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Chapter 36 Urinary tract infection

Chapter contents

Lower urinary tract 281
Benign prostatic hyperplasia (BPH) 282
Prostate cancer 283
Prostatitis 283
Urinary stones 283
Renal cancer 284
Bladder cancer 284

Lower Urinary Tract

Infections include:

• Cystitis.
• Urethritis.

More common in females. Common pathogens are Escherichia coli, Pseudomonas spp., Streptococcus spp., Staphylococcus spp.

Signs and Symptoms

• Urinary frequency.
• Dysuria.
• Suprapubic pain and tenderness.
• Haematuria.
• Smelly, cloudy urine.

These conditions are the ones most commonly seen by complementary healthcare practitioners. More serious upper urinary tract conditions, such as glomerulonephritis or pyelonephritis, are more likely to refer themselves directly to orthodox medical care. It is worth noting, however, that a relatively straightforward cystitis or urethritis can develop into an upper urinary tract condition if not treated appropriately.

Investigations

• Midstream urine sample is cultured.

Very often, a broad-spectrum antibiotic is given without a sample being taken, but if the infection does not clear then a culture needs to be grown to identify the type of bacteria and the most effective antibiotic for that strain.

Treatment

• A short course of antibiotics (see Chapter 29 ‘Antimicrobials’, p. 219).
• Plenty of water.
• Paracetamol or ibuprofen to ease symptoms.

Benign Prostatic Hyperplasia (BPH)

• Common in men over 50 years old.
• Urinary frequency and urgency with decreased urinary flow.
• Nocturia.
• Complications: infection due to the incomplete emptying of the bladder.

Laboratory Tests

The prostate-specific antigen (PSA) is elevated with a large benign prostate. Whether this level indicates a more pathological condition, i.e. malignant prostate, depends on the age group.

• PSA Levels

• Under 50 years of age: below 2.5 ng/mL.
• Under 60 years of age: below 3.5 ng/mL.
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