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Urinary Tract Infection

Urinary Tract Infection. Overview. Urinary Tract Infection. Upper UTIs 2 Pyelonephritis. Lower UTIs 1 Cystitis Urethritis Epididymitis Prostatitis. UTIs are one of the most common bacterial infections in adult women 3. Overview. Anatomy. Urinary Tract Infection. Mesonephric Tissue

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Urinary Tract Infection

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  1. Urinary Tract Infection

  2. Overview Urinary Tract Infection

  3. Upper UTIs2 • Pyelonephritis • Lower UTIs1 • Cystitis • Urethritis • Epididymitis • Prostatitis UTIs are one of the most common bacterial infections in adult women3 Overview

  4. Anatomy Urinary Tract Infection

  5. Mesonephric Tissue • Mesonephric Duct • MetanephricBlastema Mesonephric tissue Mesonephric duct Embryology

  6. Seminal vesicles • Vas deferens • Epididymis Mesonephric ducts persist  Mesonephric duct Testes Vas deferens Bladder Prostate Seminal vesicle Male Development Descended testes

  7. Upper vagina • Uterus • Oviducts Paramesonephric ducts persist  Paramesonephric duct Ovary Developing uterus Female Development

  8. Female urethras are shorter  fecal flora contamination and colonization of urinary tract is more likely1,2 Bladder Bladder Short Urethra Long Urethra Anatomy

  9. Physiology Urinary Tract Infection

  10. Protection from UTI:1 • Acidic environment • Vaginal flora • Cervico-vaginal antibodies • Fecal flora enter the urethra and ascend into the urinary tract1,2 • Women  bladder (cystitis) • Men  prostate (prostatitis) Bladder Anal canal Physiology

  11. UropathogenicE. coli have adhesions for binding to vaginal and uroepithelial cells1 Uropathogenic E. coli

  12. WOMENwhoare non-secretors of histo-blood group antigens may have E. coli-binding gangliosides on their vaginal epithelial cells1 Blood Group E. coli

  13. Microbiology Urinary Tract Infection

  14. Women with Acute Cystitis:1 E. coli is by far the major cause of UTIs in women1 10% 10% 80% S. saprophyticus causes about 10 % of UTIs in young, sexually active women1 Infection: Women

  15. Men with Acute Prostatitis:1 3% 11% Men have a much wider variety of microbes that cause prostatitis1 7% 6% 58% 9% 6% Infection: Men

  16. Children < 5 years old:1 Male infants were predominantly infected with Klebsiella pneumoniae1 10% 20% 40% 30% Infection: Children

  17. Pathology Urinary Tract Infection

  18. Women are more likely to get a UTI after becoming sexually active1,2 • Clitoral massage allows bacteria to gain entry into the bladder1,2 • Diaphragm placement on the cervix may promote bacterial colonization1,2 • Spermicides raise vaginal pH and promote the colonization of E. coli1,2 Post-Coital UTIs

  19. Pregnancy Predisposes Women to UTIs1,2 • Weight of the uterus may cause urinary stasis • Progesterone causes smooth muscle in the ureters to relax • Pregnant women are slightly immunocompromised Pregnancy

  20. Menopause Predisposes Women to UTIs1,2 • Atrophy of vaginal mucosa • Rise in vaginal pH • Healthy vaginal lactobacillus replaced by pathogenic bacteria Menopause Lactobacillus near a squamous epithelial cell

  21. Very Rare! Acute cystitis in Men is … • Causes include:1,2 • Congenital abnormalities • Uncircumcised penis • Insertive rectal intercourse • Intercourse with a partner who has vaginal colonization of E. coli • HIV infection Cystitis in Men

  22. The majority of urethritis in Men is associated with STDs1,2 • Neisseria gonorrhoeae • Chlamydia trachomatis • Mycoplasma hominis • Ureaplasmaurealyticum Depiction of N. gonorrhoeae Urethritis in Men

  23. Prostatitis in men mostly occurs when pathogens enter the prostate via intraprostatic reflux of urine1 Prostatitis Prostatitis

  24. Prostatic hyperplasia predisposes Men over 50 to UTIs1,2,3 • Prostatic hyperplasia causes:2,4 • Chronic urinary retention • Incomplete bladder emptying Prostatic Hyperplasia

  25. Epidemiology Urinary Tract Infection

  26. Symptomatic Infection Prostatic Hyperplasia Pregnancy Neonates Young children Asymptomatic Bacteriurea Prevalence (%) Epidemiology

  27. Over 50% of Women will have a UTI 3-11% of all pregnant women will have asymptomatic bacteriuria during pregnancy2,3 25-30% will develop pyelonephritis3 40% of these women will develop acute cystitis3 Adult Women

  28. 15-20% of 65-70 year old women • 20-50% of women greater than 80 Have Bacteriuria1 • Estrogentherapy has been shown to:1 • Reduce vaginal pH • Restore vaginal flora • Decrease incidence of bacteriuria Post-Menopausal Women

  29. Risk Factors Urinary Tract Infection

  30. Risk Factors

  31. Clinical Presentation Urinary Tract Infection

  32. The usual symptoms of urinary frequency, urgency, and suprapubic pressure are not helpful for pregnant women4 Sex-Specific Symptoms

  33. Common Symptoms Based on Age1 Children

  34. Treatment Urinary Tract Infection

  35. Treatment

  36. Prognosis Urinary Tract Infection

  37. Pyelonephritis

  38. Femaledistribution peaks at age: • 0-4 • 15-35 • 80 • Maledistribution peaks at age: • 0-4 • 85 Incidence: Pyelonephritis

  39. Predominance of Men 60% Male 40% Female Incidence: Sepsis

  40. Prostatitis • Prostatic abscess • Epididymitis • Seminal vesiculitis • Pyelonephritis • Bacteremia • Septic shock Complications in Men

  41. Complications:1 • Preeclampsia • Fetal hypoperfusion • Low birth weight • Premature labor • Fetal mortality • Maternal pyelonephritis UTIs and Pregnancy

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