1. Principal: S H Medical College
URINARY
TRACT
INFECTION
Dr Kulwant Singh
Principal: S H Medical College
Jamshedpur

2. URINARY TRACT INFECTION
Second most common infection following respiratory infections
UTI occur when bacteria (E. coli) from the digestive tract get into the opening of the urinary tract and multiply
Bacteria first infect the urethra, then move to the bladder and finally to the kidneys
UTI tend to occur more in women than men

3. URINARY TRACT INFECTION
Urinary tract is normally sterile due to the fact that bacteria moving upwards are regularly washed out by urination
Normal flora found in the urethra consist of lactobacillus and staphylococcus to name a few

4. URINARY TRACT INFECTION
Importance of Urinary Tract Infections is demonstrated by the fact that 20% of women between ages suffer one attack per year
Approximately 50% of women develop a UTI during their lives and there is a prevalence rate of 5% per year of asymptomatic or covert bacteriuria in non-pregnant women between ages 21 and 65

5. TYPES URINARY TRACT INFECTION LOWER TRACT INFECTION
UPPER TRACT INFECTION
URETHRITIS
PROSTATITIS
CYSTITIS
PYELONEPHRITIS
PERI NEPHRIC ABSCESS

6. URINARY TRACT INFECTION
AETIOLOGY
Background
1. Bacterial infections of urinary tract are a very common reason to seek health services
2. Common in young females and uncommon in males under age 50
3. Common causative organisms
Escherichia coli (gram-negative enteral bacteria) causes most community acquired infections
Staphylococcus saprophyticus, gram-positive organism causes 10 – 15%
Catheter-associated UTI’s caused by gram-negative bacteria: Proteus, Klebsiella, Seratia, Pseudomonas

7. PATHOGENESIS BACTERIA GET ACCESS FROM URETHRA AND ASCENDS
URINARY TRACT INFECTION
PATHOGENESIS
BACTERIA GET ACCESS FROM URETHRA AND ASCENDS
FEMALES ARE MORE PRONE DUE TO:
SMALL URETHRA
GRAM NEGATIVE ORGANISM RADIATE FROM PERI ANAL AREA TO URETHRA
SEXUAL INTERCOURSE
SUSCEPTIBILITY OF EPITHELIUM

8. URINARY TRACT INFECTION
PATHOGENESIS
WHETHER BLADDER INFECTION ENSURES IT, DEPENDS ON THE FOLLOWING:
FLUSHING AND DILUTING OF MICURITION AND VOIDING
ANTIBACTERIAL PROPERTIES OF BLADDER MUCOSA AND URINE
SIZE OF INOCULUM

9. PATHOGENESIS FEMALE SEX AND INTERCOURSE PREDISPOSES
URINARY TRACT INFECTION
PATHOGENESIS
FEMALE SEX AND INTERCOURSE PREDISPOSES
PREGNANCY: URETERAL TONE AND URETHRAL PERISTALSIS DECREASES
OBSTRUCTION IN FREE FLOW OF URINE: TUMOR, STRICTURE, CALCULI AND BPH ETC.
CATHETERISATION, URETHRAL DILATATION, CYSTOSCOPY

10. (1) the elimination of bacteria by voiding
URINARY TRACT INFECTION
PATHOGENESIS
The normal bladder is capable of clearing itself of organisms within 2 to 3 days of their introduction.
Defense mechanisms
(1) the elimination of bacteria by voiding
(2) the antibacterial properties of urine and its constituents
(3) the intrinsic mucosal bladder defense mechanisms
(4) an acid vaginal environment (female)
(5) prostatic secretions (male)

11. URINARY TRACT INFECTION
PATHOGENESIS
Two potential routes :
(1) the hematogenous route, with seeding of the kidney during the course of bacteremia
(2) the ascending route, from the urethra to the bladder, then from the bladder to the kidneys via the ureters.

12. Hematogenous Infection
URINARY TRACT INFECTION
PATHOGENESIS
Hematogenous Infection
Because the kidneys receive 20% to 25% of the cardiac output, any microorganism that reaches the bloodstream can be delivered to the kidneys.
The major causes of hematogenous infection are S. aureus, Salmonella species, P. aeruginosa, and Candida species.

13. Hematogenous Infection
URINARY TRACT INFECTION
PATHOGENESIS
Hematogenous Infection
Chronic infections (skin, respiratory tract)
blood circulation kidney (cortex)
small abscess renal tubular
renal pelvis renal papillary

14. The ability of host defense Urinary tract mucosal cells damaged
URINARY TRACT INFECTION
PATHOGENESIS
ASCENDING INFECTION
The ability of host defense
Urinary tract mucosal cells damaged
The power of bacterial adhesions(toxicity)
organisms urethra,periurethral tissues
bladder ureters renal pelvis
renal medulla

15. Voiding dysfunction is characterized by some or all of the following:
URINARY TRACT INFECTION
PATHOGENESIS
Voiding dysfunction is characterized by some or all of the following:
urgency
frequency
dysuria
hesitancy
dribbling of urine
overt incontinence
secondary to a UTI or to local irritants such as pinworm infestation

16. (1) the elimination of bacteria by voiding
URINARY TRACT INFECTION
PATHOGENESIS
The normal bladder is capable of clearing itself of organisms within 2 to 3 days of their introduction.
Defense mechanisms
(1) the elimination of bacteria by voiding
(2) the antibacterial properties of urine and its constituents
(3)the intrinsic mucosal bladder defense mechanisms
(4) an acid vaginal environment (female)
(5) prostatic secretions (male)

17. PATHOGENESIS CONTINITUATION OF UTI DEPENDS :
URINARY TRACT INFECTION
PATHOGENESIS
CONTINITUATION OF UTI DEPENDS :
Female sex and intercourse predisposes
Pregnancy: ureteral tone decreased, ureteral peristalsis decreased
Obstruction in free flow of urine
Catheterisation , urethral dilatation, cystoscopy
Vesico-ureteric reflux: it occurs during voiding -- pressure increase in bladder, flow from bladder to kidney
Impaired defence
Neurogenic: spinal injury, sclerosis

18. HISTORY AND PHYSICAL EXAMINATION Age-related Risk Factors for UTI
URINARY TRACT INFECTION
HISTORY AND PHYSICAL EXAMINATION
Age-related Risk Factors for UTI
Advanced Age
Fecal incontinence/impaction
Incomplete bladder emptying or neurogenic bladder
Vaginal atrophy/estrogen deficiency
Pelvic prolapse/cystocele
Insufficient fluid intake/dehydration
Indwelling foley catheter or urinary catheterization or instrumentation procedures

19. CLINICAL PRESENTATION
URINARY TRACT INFECTION
CLINICAL PRESENTATION
Cystitis
dysuria (burning or discomfort on urination)
frequency
nocturia
suprapubic discomfort

20. CLINICAL PRESENTATION
URINARY TRACT INFECTION
CLINICAL PRESENTATION
Fever with chill & rigor
Haematuria
Strangury
Ineffectual desire
Cloudy urine
Offensive urine
Pain lower abdomen

21. CLINICAL PRESENTATION
URINARY TRACT INFECTION
CLINICAL PRESENTATION
Uncomplicated
Cystitis
Urethritis
Female >>> male
Sequel rare

22. CLINICAL PRESENTATION
URINARY TRACT INFECTION
CLINICAL PRESENTATION
Complicated
Pyelonephritis
Prostate obstruction
Relapse +++

23. WBC ++++ Urine: C & S Cystoscopy Ultra Sound IVU P/R
URINARY TRACT INFECTION
INVESTIGATIONS
WBC ++++
Urine: C & S
Cystoscopy
Ultra Sound
IVU
P/R
PID

24. FLUID ++ ALKALI EMPTYING OF BLADDER
URINARY TRACT INFECTION
TREATMENT
FLUID ++
ALKALI
EMPTYING OF BLADDER
HYGIENE

25. Recurrent infections resulting from bacterial persistence.
Recurrent U.T.I.s
that are reinfection.
Unresolved
infection
Isolated infections
Classification of U.T.I.
Recurrent infections resulting
from bacterial persistence.

26. To limit the period of suffering.
URINARY TRACT INFECTION
TREATMENT
ROAD MAP OF TREATMENT
To limit the period of suffering.
To minimise the severity of suffering.
To arouse the immunity of the patient to prevent reinfection.
To avoid dialysis and kidney transplantation.
To reduce the cost of treatment.

27. Burning pain with frequent urge.
URINARY TRACT INFECTION
TREATMENT
Eryngium aquaticum
Burning pain with frequent urge.
Prostatic fluid from slightest provocation
Tenesmus of bladder
Frequency / dysurea
Urine burns like fire

28. Eupatorium purpereum TREATMENT Strangury BHP Chill runs upward
URINARY TRACT INFECTION
TREATMENT
Eupatorium purpereum
Strangury
BHP
Chill runs upward
Burning while urinating
Cystitis in pregnant women
Sweetish smell urine

29. Chimaphila umbellata TREATMENT Plethoric young women BHP
URINARY TRACT INFECTION
TREATMENT
Chimaphila umbellata
Plethoric young women
BHP
Urine scanty loaded with ropy mucopurulent sediment
Burning and scalding pain Violent tenesmus
Urinate only when bends forward and with feel wide open

30. Equisetum TREATMENT Fullness of bladder not relieved by urination
URINARY TRACT INFECTION
TREATMENT
Equisetum
Fullness of bladder not relieved by urination
Sharp cutting / burning pain
Right lumber region painful
Constant desire to urinate
Aggravation immediately after urination

31. Epigea repens TREATMENT Chronic cystitis / dysurea Strangury
URINARY TRACT INFECTION
TREATMENT
Epigea repens
Chronic cystitis / dysurea
Strangury
Urge in continency
Mucopus and uric acid deposition and renal calculi

32. Petroselinum TREATMENT Urge in continence
URINARY TRACT INFECTION
TREATMENT
Petroselinum
Urge in continence
Burning and tingling in urethra
Dysurea with BHP
Ameliorate by rubbing the urethra

33. PRUNUS SPINOSA TREATMENT Forked urine – slow stream
URINARY TRACT INFECTION
TREATMENT
PRUNUS SPINOSA
Forked urine – slow stream
Cramping pain in bladder < walking
Sudden urge
Violent pain Thinking of complaints ameliorates

34. CANNABIS SATIVA TREATMENT Burning in bladder while urinating
URINARY TRACT INFECTION
TREATMENT
CANNABIS SATIVA
Burning in bladder while urinating
Stitches in urethra
Urethra sensitive
Urine scalding and spasmodic closure of sphincter
Fear of going to bed
Time passes slowly
Tickling sensation as of dropping water.

35. CANTHARIS TREATMENT Inflammation are violent Cystitis Strangury
URINARY TRACT INFECTION
TREATMENT
CANTHARIS
Inflammation are violent
Cystitis
Strangury
Haematuria with pain
Violent burning ,cutting ,stabbing pain
Urging for urination
Urine comes drop by drop with pain

36. PARIERA BRAVA TREATMENT
URINARY TRACT INFECTION
TREATMENT
PARIERA BRAVA
Radiating pain to thigh during efforts to urinate
Sensation as if the bladder is full
Urethritis
Urge incontinency
Contains thick stringy mucus

37. THUJA OCC. TREATMENT Fixed ideas Anger from contradiction
Ill effects of vaccination
Urethra inflamed
Frequent urination with pain
Sudden urge
Left sided
Tickling in Urethra.
Must be used inter-currently to prevent reappearance

38. TEREBINTHINA TREATMENT Confusion of mind Irritability
URINARY TRACT INFECTION
TREATMENT
TEREBINTHINA
Confusion of mind
Irritability
Concentration difficult
Bleeding mucous membrane
Strangury
Urethritis
Urine scanty with odor of violet
Urine smoky , coffee ground

39. BERBERIS VULGARIS TREATMENT Indifferent / anxiety
URINARY TRACT INFECTION
TREATMENT
BERBERIS VULGARIS
Indifferent / anxiety
Changeability /wandering pain
Pain aggravate by pressure
Left sided
Sticking / cutting / burning
Bubbling sore sensation in kidney
Frequent maturation
Burns when non urinating
Associated with renal calculi

40. ARSENIC ALBUM Restlessness Fear of death Anxiety
URINARY TRACT INFECTION
TREATMENT
ARSENIC ALBUM
Restlessness
Fear of death
Anxiety
Burning like fire > by heat
Putrid discharges
Thirst unquenchable for small quantity
Craves of acids / warm food
Burning urethra during urination
Dysuria
Urine is black

41. APIS MEL TREATMENT Fearfulness , can not help crying Apathy
URINARY TRACT INFECTION
TREATMENT
APIS MEL
Fearfulness , can not help crying
Apathy
Sudden shrill piercing screams
Ailment from suppressed sexual desire
Burning / stinging pain with swelling
Thirstlessness
Craving for sour
Nephritis / cystitis / prostatitis
Strangury
Last drop burn and smart

42. NITRIC ACID Irritable/ Vindictive/ Headstrong Sensitiveness to noise
URINARY TRACT INFECTION
TREATMENT
NITRIC ACID
Irritable/ Vindictive/ Headstrong
Sensitiveness to noise
Discontented
Pain appear suddenly and disappear suddenly
Discharges are offensive
Love fat and salt ,hate meat and milk aggravates
Urine cold on passing
Burning stinging after urination
Frequent urge at night

43. Dysurea –Scalding during pregnancy Severe tenesmus
URINARY TRACT INFECTION
TREATMENT
POPULUS TREMULOIDS
Urethritis
Dysurea –Scalding during pregnancy
Severe tenesmus
Pain behind pubis at the end of Urination
B.H.P.