Urinary Tract Infection Diet

Beat Urinary Tract Infections Ebook

UTI Be Gone by Sherry Han is a simple e-book that describes how you can eliminate urinary tract infection quickly and naturally. The report will show you how to almost immediately stop the pain caused by UTI and how to cure it with literally no side effects. This is an e-book that shows users exactly how to defeat urinary tract infections 100% naturally, and never resort to antibiotics ever again. Urinary tract infections sufferers may have to see their personal and social lives ruined as they will constantly wake up to the burning sensation and tingling. Sherry Han will show people how she got rid of this disease within a few weeks. Since Sherry Han released the program, she has received many positive comments from customers regarding their success. Continue reading...

Uti be gone Natural Urinary Tract Infection Cure Overview


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Urinary Tract Bladder Infection

Urinary tract infection (uTi) is an example of what is termed a secondary problem in MS. UTI is not a direct result of the demyelina-tion process but occurs as the result of (secondary to) the retention of urine in the bladder. Mild infection may result only in increased frequency and urgency of urination, whereas severe infection produces fever and generalized illness. The incidence of urinary tract infection is higher than normal in (1) those who have a flaccid bladder, because bacteria may grow in the retained urine (2) those who need to perform intermittent self-catheterization and (3) those who have an indwelling Foley catheter, which may provide bacteria with a direct route into the bladder. Women generally are at higher risk for the development of bladder infection than men. The diagnosis of a urinary tract infection is made by a urine culture, in which urine is collected in a sterile fashion and tested for the presence of bacteria. The presence of bacteria in the urine does...


The term catheter-associated UTI is commonly applied to any UTI that develops in a patient who has an indwelling bladder catheter in place, whether or not the infection is accompanied by local or systemic symptoms or signs (50). Catheter-associated UTI is the most common form of nosocomial infection in acute care hospitals, and is almost universally present among patients with chronic indwelling catheters in the community and in long-term care facilities (50). Predisposing factors include the presence of the catheter itself, female gender, duration of catheter use, violations of the closed catheter drainage system or of other principles of appropriate catheter care, and (in the acute care setting) absence of antimicrobial therapy (50). Causative organisms are divided between Gram-negative bacilli (among which non- . coli species, including Pseudomonas aeruginosa and Providencia stuartii, are much more prominent than in uncomplicated UTI), Gram-positive cocci (including...

Routing Prevention Of Infection

Urinary tract infection Bacteriuria must be symptomatic Three of the following without catheter Fever > 38 C or chills Dysuria, frequency, urgency Private room or cohort Emphasize standard precautions Utilize antimicrobial soap waterless Limit patient transport Dedicated equipment disinfection

Vital Genitourinary Infections

Acute hemorrhagic cystitis Viruses rarely infect the urinary tract (Table 36-6). Urethritis can complicate infections with HSV. Acute hemorrhagic cystitis, an unusual disease of young boys, has been associated principally with adenoviruses 11 and (rarely) 21. Glomerulonephritis is sometimes observed as a manifestation of immune complex disease in chronic hepatitis B infections (see Chapter 22). It is safe to predict that future research may reveal that some cases of idiopathic glomerulonephritis are also caused by chronic persistent infections with other viruses yet to be identified (see Chapter 10). Cytomegalovirus persists asymp-tomatically in renal tubules (Fig. 20-8), from which cytomegalic cells as well as virus are shed into the urine. When primary infection or reactivation of CMV occurs during renal transplantation, rejection of (he graft may be accelerated (see Chapter 20). The human polyomaviruses BK and JC (Chapter 18) also persist in the urinary tract and are reactivated by...

Dysuria frequency and urgency

These are cardinal symptoms of urinary tract infection, the commonest condition to affect the urinary tract. Dysuria is pain experienced prior to. during or following micturition, usually in the urethra or suprapubic region. When due to urinary infection, it is often described as a burning sensation, even akin to passing broken glass. Urinary frequency describes an increased frequency of micturition without implying any increase in the total urine volume. Urgency is a strong desire to pass urine which may be followed by incontinence if the opportunity to urinate is not available. In general, dysuria, frequency and urgency arc associated with disorders of the lower urinary tract - bladder, prostate and urethra. Although commonly due to urinary tract infec- General Pain passing urine (dysuria) tion, tumours, urinary calculi or urinary tract obstruction should also be considered. Dysuria alone may be due to infection of the urethra, as in gonorrhoea, when there may also be urethral...

Urinary Tract Infections And Schistosomeinfected Bladders

A report from Egypt demonstrated that males between the ages of 10 and 25 infected with S. hematobium consistently had a load of 103-105 bacterial organisms per milliliter of urine (28). Bacteriuria in endemic regions is 10 times greater than in nonendemic regions. In Western populations, most bladder infections comprise monocultures of Escherichia coli (88 ) or Proteus mirabalis (10 ), the remainder divided over a range of organisms (29). In Egypt, Escherichia coli is the most common cause of bacterial infections in bladders affected by schistosomiasis, although mixed cultures, with anaerobes and Escherichia coli, can occur (29-31). Bacterial infections in schistosomal bladders seldom, if ever, disappear totally, and it has been postulated that this constant presence of predominantly mixed infections may act synergistically on naturally occurring carcinogens in the urine (29). Stasis of urine as a result of the many obstructive complications of bladder schistosomiasis, and if eggs...


Cystitis connotes infection limited to the urinary bladder. It is a clinical syndrome characterized by irritative voiding symptoms (e.g., dysuria, frequency, and urgency) and bacteriuria pyuria, in the absence of flank pain or fever to suggest renal or systemic involvement (1). In children too young to report voiding symptoms, cystitis may manifest nonspecifically as incontinence, irritability, or a change in the appearance or odor of the urine (2,3). Although many patients with what appears clinically to be simple cystitis in fact have occult involvement of the upper urinary tract, since such patients usually respond as well to optimal regimens for cystitis as do patients with infection limited to the bladder the clinical presentation is sufficient to guide management decisions (4). As with all other types of UTI except prostatitis, cystitis is more common among females than males throughout life (2,3,5,6). The incidence is greatest among sexually active young women and...

The Mediators Expressed by Mast Cells and Their Role in the Inflammatory Response

Mast cells have been incriminated in such diverse diseases as allergy, asthma, rheumatoid arthritis, atherosclerosis, interstitial cystitis, inflammatory bowel disease, progressive systemic sclerosis, chronic graft-vs-host disease, fibrotic diseases, sarcoidosis, asbestosis, ischemic heart disease, keloid scars, and malignancy (3). The mediators released by mast cells can independently and, in synergy with macrophage- and T-cell-derived cytokines, induce much of the inflammatory pathology observed in inflammation and serve to orchestrate a complex immune response. Histamine, LTB4, LTC4, PAF, and PGD2 may have multiple effects on inflammatory cell recruitment (eosinophils), smooth muscle hyperplasia, and vascular dilatation (80,81). Tryptase, chymase, and TNF-a from mast cells activate fibroblasts, leading to collagen deposition and fibrosis. Mast cell-derived TNF-a regulates NF-KB-dependent induction of endothelial adhesion molecule expression on endothelial cells in vivo (49). Mast...

Health Supplement Alert Cranberry

Cranberries and cranberry juice are a commonly used remedy for the prevention of urinary tract infections (UTIs) and for the relief of symptoms from UTIs. The use of cranberry juice in combination with antibiotics has been recommended by physicians for the long-term suppression of UTIs. Cranberries are thought to act by preventing the bacteria from attaching to the walls of the urinary tract. The suggested amount is 6 ounces of the juice two times daily. Extremely large doses can produce gastrointestinal disturbances such as diarrhea or abdominal cramping. Although cranberries may relieve the symptoms of a UTI or prevent the occurrence of a UTI, their use will not cure a UTI. If an individual suspects a UTI, medical attention is necessary.

Factors Predisposing to Infection

It is well established that the elderly are at both increased risk for acquiring many types of infections and for increased severity of illness when an infection occurs (1). Predisposing factors, which in part account for this phenomenon, include decrements in host defenses with age that are made worse by chronic disease, undernutrition, and certain medications that are commonly prescribed to older persons. Some of these factors are organ specific. For example, the increased prevalence of urinary tract infection in the elderly is due in part to age-related changes in the urinary tract, which include anatomic changes (e.g., prostatic hypertrophy) and altered physiology (e.g., increased bladder residual volume). Furthermore, the elderly are more likely to be hospitalized, undergo invasive procedures, and suffer procedure-associated complications that compromise mucocutaneous and other barriers to infection. Moreover, hospitalization and chronic illness increase the risk of colonization...

Critical Thinking Exercises

Bartlett, age 80, has been prescribed a sulfonamide for a urinary tract infection and is to take the drug for 10 days. You note that Ms. Bartlett seems forgetful and at times confused. Determine what problems might be associated with Ms. Bartletts mental state and her possible noncompliance to her prescribed treatment regimen. 2. Mr. Garcia is receiving sulfisoxazole for a recurrent bladder infection. When keeping an outpatient clinic appointment, he tells you that he developed a fever and sore throat yesterday. Analyze the steps you would take to investigate his recent problem. Give a reason for your answers. 3. Ms. Watson has diabetes and is taking tolbutamide (Orinase). Her primary care provider prescribes the combination drug sulfamethoxazole and trimethoprim (Septra) for a bladder infection. Discuss any instructions information you would give too Ms. Watson in the patient education session.

Other molecular tests

The bladder tumour antigen (BTA) assay quantifies degradation products of substances within the basal lamina and lamina propria of the bladder, presumably resulting from tumour-derived enzymatic destruction and or erosion of the bladder wall. The original BTA test was an agglutination strip assay on voided urine. It was replaced by the STAT, and then the TRAK assays as revisions were made to improve sensitivity and specificity. The sensitivities for the Bard BTA test were 38 for grade I and 71 for grade III TCCs, while those for the BTA TRAK, a sandwich enzyme immunoassay, were 55 and 66 for grades 1 and 2 respectively, and 86 for grade 3 cancers.37,38 False positives were noted in both assays in patients with benign prostatic hypertrophy, ureterolithiasis and lower urinary tract infection. No specificity or predictive values were noted, and it is not clear at this stage whether this test is a good predictor of progression. Hyaluronic acid (HA) has multiple functions in facilitating...

Initial Evaluation And Selection Of Therapy

Surgical intervention should be considered primary therapy for those patients with refractory retention, recurrent urinary tract infection, recurrent or persistent gross hematuria, bladder stones, or renal insufficiency secondary to bladder outlet obstruction. For the remaining patients, quantitative symptom assessment with instruments such as the International Prostate Symptom Score (I-PSS) provide a standardized measurement of symptoms (16). The I-PSS includes a quality of life scale to determine the degree of bother experienced by the patient. The symptom score may be used to monitor response to therapy as well.

Clinical Features of Infections

Infections in the elderly often present in an atypical, nonclassical fashion. Furthermore, the differential diagnosis of infectious diseases in the elderly differs from the young because it is dependent on both the clinical setting and the patient's underlying functional status. For example, free living, independent, healthy elderly are prone to respiratory infections, such as bacterial pneumonia, genitourinary infections and intraabdominal infections including cholecystitis, diverticulitis, appendicitis, and intraabdominal abscesses. Institution-bound elderly are more likely to develop aspiration pneumonia, urinary tract infection, (especially if a chronic indwelling bladder catheter is present), and skin and soft-tissue infections. Infections in the elderly differ from the young also because infections in this age group are often caused by a more diverse group of pathogens compared with the young. This is best exemplified by urinary tract infection, which in the young occurs almost...

Clinical Manifestations

Urinary infection in elderly populations is usually asymptomatic (1). That is, the urine culture is positive but there are no acute local genitourinary or systemic symptoms attributable to the infection. When symptomatic infection does occur, different clinical presentations may be seen. There may be acute lower tract irritative symptoms such frequency, dysuria, urgency, or suprapubic discomfort and, particularly in elderly women, acute deterioration of continence status. Infection may also present with systemic manifestations including pyelonephritis with fever and costrovertebral angle pain and tenderness, or as fever with hematuria without other localizing findings. Fever with obstruction of a chronic indwelling catheter is also consistent with urinary infection. Bacteremic infection is most likely to occur in the setting of ureteral or urethral obstruction or mucosal trauma. A clinical diagnosis of acute symptomatic urinary infection in elderly populations is often not...

Classic Infectious Disease

The major clear-cut associations between the human polyomaviruses and classically defined infectious diseases are those of JCV with PML and BKV with hemorrhagic cystitis (Weber and Major, 1997 Arthur et al., 1988 Barbanti-Brodano et al., 1998). BKV and JCV are ubiquitous in most human populations, The pathology of PML is due to viral replication in oligodendrocytes, which are the cells in the brain that produce myelin. Numerous studies have demonstrated that the JCV promoter and enhancer contain binding sites for a variety of transcription factors that are expressed in glial cells, although only one of these appears to be truly glial cell specific (Frisque and White, 1992 Raj and Khalili, 1995). Disease is also often accompanied by rearrangements in the transcriptional control region that appear to enhance TAg expression and, subsequently, replication (Dorries, 1997, 1998 Weber and Major, 1997). The BKV promoter and enhancer have not been dissected in nearly as much detail, making the...

Complications Of Surgical Therapy

Radical vulvectomy with en bloc inguinofemoral lymph node dissection is remarkably well tolerated in spite of the extent of the surgery and the advanced age of the majority of the patients. The postoperative mortality rate is approximately 2 , usually as a result of pulmonary embolism or myocardial infarction 3,17 . Although overall survival figures are excellent with radical surgery, the short- and long-term morbidity associated with this procedure is substantial. Complications are related either to the radical vulvectomy or to the lymphadenec-tomy. Wound healing is often disturbed. Postoperative wound breakdown and infection occur with a frequency of up to 85 , often prolonging hospitalization 4 . Other early postoperative complications include urinary tract infection, seroma, phlebitis, deep venous thrombosis, and hemorrhage. Psychosexual disturbance is a major long-term problem, especially in young patients 18,19 . Edema of the lower extremities is an important late complication...

ECommon adverse effects

Hemorrhagic cystitis has been reported in one-third of patients receiving daily oral CTX, and there is a significant but lower incidence of bladder fibrosis and carcinoma. These abnormalities are caused by the CTX urinary metabolite acrolein. IV CTX is associated with a significantly lower incidence of bladder problems. Appropriate hydration, nighttime voiding, and the use of 2-mercaptoethane sulfonate can help to decrease bladder toxicity. In patients on long-term CTX, either oral or IV, monthly urinalysis is needed to monitor for hematuria. The finding of hematuria should be followed by cystoscopy. Note the development of bladder cancer can occur many years after the institution of CTX. Thus, long-term surveillance is needed.

Asymptomatic Bacteriuria

Asymptomatic bacteriuria (ABU) is defined by the presence of bacteria in the urine in a patient who does not have any symptoms (or, more generally, any clinical manifestations whatsoever) attributable to the bacteriuria, irrespective of the presence or absence of pyuria (1). At any point in time, ABU is present in a fraction of the healthy population, including males and females of all ages. However, the likelihood of ABU is greatest throughout life in females, and increases in both genders with advancing age and progressive debility (66). The spectrum of organisms causing ABU is generally similar to that of symptomatic UTI, with polymicrobial infection and certain bacterial species (e.g., enterococci, coagulase-negative staphylococci, and Gram-negative bacilli such as Providencia) encountered more frequently (66). Treatment of ABU has been recommended for patients in whom ABU is a known or strongly suspected direct contributor to adverse outcomes A (9,67). Such patients include...

Experiment 214 Identification of Enterococci

Enterococci are gram-positive cocci that form chains in culture and that, until recently, were classified in the genus Streptococcus. Because they differ in several characteristics, including the composition of their genetic material, they are now classified in a separate genus, Enterococcus. As the name implies, enterococci are found primarily in the intestinal tract, although they may be found in the upper respiratory tracts of infants and young children. Their primary role in disease is as the agents of urinary tract infection, infective endocarditis (like the viridans group streptococci), and wound infections, especially those contaminated with intestinal contents. In the laboratory, their colonies resemble somewhat those of group B streptococci. They must be differentiated from this organism because their presence at certain body sites has a different meaning. For example, enterococci isolated from a genital tract specimen of a pregnant woman near term may simply represent...

Complications Of Turp

There are several complications of TURP that are unique to the procedure. These can generally be divided into three categories intraoperative, perioperative, and long-term morbidity. Although the overall rate of complications is similar between the time periods (about 20 ), the nature of the complications differs. In the 1960s, a large percentage of complications involved systemic infections caused by pneumonia and pyelonephritis, whereas in the 1980s and 1990s, urinary retention and urinary tract infection accounted for most complications (3,20,21).

Workbook in Microbiology 7e

Normally, urine is sterile when excreted by the kidneys and stored in the urinary bladder. When it is voided, however, urine becomes contaminated by the normal flora of the urethra and other superficial urogenital membranes. The presence of bacteria in voided urine (bacteriuria), therefore, does not always indicate urinary tract infection. To confirm infection, either the numbers of organisms present or the species isolated must be shown to be significant. culating in the bloodstream from another site of infection are deposited and multiply in the kidneys to produce pyelonephritis by the hematogenous (originating from the blood) route (2) bacteria colonizing the external urogenital surfaces ascend the urethra to the bladder, causing cystitis (infection of the bladder only) or pyelonephritis by the ascending route or (3) microorganisms, usually from the urethra, find their way into the bladder on catheters or cystoscopes. fending organisms are opportunistic members of the fecal flora,...

Risk Factors For Infection In Longterm Care Residents

Infections occur commonly in residents of nursing facilities (nursing homes) as a consequence of different factors. The majority of persons residing in nursing facilities are 65 yr of age or older. Comorbid illnesses, such as obstructive uropathy, that increase with age can predispose the patient to UTI. Chronic obstructive pulmonary disease and congestive heart failure contribute to development of respiratory tract infections. Vascular insufficiency and neuropathy, frequent complications of diabetes mellitus, are associated with increased risk of skin infection. Alterations in a patient's functional status, such as impaired feeding, bathing, toileting, and mobility, can also lead to infection. Use of enteral devices to assist in feeding can promote aspiration and lead to pneumonia, whereas urethral catheters to prevent incontinence can contribute to the development of UTI. Decreased mobility and incontinence are significant risk factors for the development of pressure ulcers and...

Infection Control And Antibiotic

Clinicians should be ecologically responsible in their prescribing of antibiotics. The unnecessary use of broad-spectrum antibiotics to treat susceptible organisms should be strongly discouraged. There should be clear guidelines in place for using vancomycin in the nursing facility (e.g., MRSA, -lactam allergy, metronidazole failures in treatment of C. difficile colitis, or surgical prophylaxis in p-lactam-allergic patients). Limits to the length of antibiotic administration should also be enforced. Using third-generation cephalosporins and quinolones in LTCFs only when they are absolutely necessary in the treatment of UTIs or URI LRTIs may limit the emergence of multiresistant Gram-negative bacilli and VRE. Restricting antibiotic formularies for LTCFs has been suggested as a potential means to this end. Alerting physicians to the number of treatment courses of quinolones or advanced generation cephalosporins used can stem overprescribing. Treatment algorithms are not yet a common...

Miscellaneous Drugs

That sometimes occur due to disorders such as cystitis, prostatitis, or other affected structures such as the kidney or the urethra. Overactive bladder is estimated to affect more than 16 million individuals in the United States. Symptoms of an overactive bladder include urinary urgency, frequent urination day and night, and urge incontinence, accidental loss of urine caused by a sudden and unstoppable need to urinate. These drugs also help control the discomfort associated with irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, and endoscopic procedures. Other miscellaneous drugs are used to relieve the pain associated with irritation of the lower genitourinary tract (eg, phenazopyridine) caused by infection, trauma, surgery, and endoscopic procedures.

Preadministration Assessment

When a UTI has been diagnosed, sensitivity tests are performed to determine bacterial sensitivity to the drugs (antibiotics and urinary anti-infectives) that will control the infection. The nurse questions the patient regarding symptoms of the infection before instituting therapy. The nurse records the color and appearance of the urine. The nurse takes and records the vital signs. A urine sample for culture and sensitivity is obtained before the first dose of the drug is given.

Ongoing Assessment

Many UTIs are treated on an outpatient basis because hospitalization usually is not required. UTIs may be seen in the hospitalized or nursing home patient with an indwelling urethral catheter or a disorder such as a stone in the urinary tract. When caring for a hospitalized patient with a UTI, the nurse monitors the vital signs every 4 hours or as ordered by the primary health care provider. Any significant rise in temperature is reported to the primary health care provider because methods of reducing the fever or repeat culture and sensitivity tests may be necessary. The nurse monitors the patient's response to therapy daily. If after several days the symptoms of the UTI have not improved or if they become worse, the nurse notifies the primary health care provider as soon as possible. Periodic urinalysis and urine culture and sensitivity tests may be ordered to monitor the effects of drug therapy. When the nurse is administering any of the miscellaneous drugs, the nurse monitors the...

Nursing Diagnoses Checklist

Impaired Urinary Elimination related to urinary tract infection Using Fluids to Prevent and Treat UTIs Using Fluids to Prevent and Treat UTIs Discusses UTIs, their causes, and the need for fluids and drug therapy. The nurse advises the patient to drink at least 2000 mL or more of fluids each day unless the primary health care provider orders otherwise. Drinking extra fluids aids in the physical removal of bacteria from the genitourinary tract and is an important part of the treatment of UTIs (see Patient and Family Teaching Checklist Using Fluids to Prevent and Treat UTIs). The nurse offers fluids, preferably water, to the patient at hourly intervals. Cranberry or prune juice is usually given rather than orange juice, other citrus juices, or vegetable juices. MISCELLANEOUS URINARY DRUGS. Flavoxate is administered orally three to four times daily. The dosage may be reduced when the patient's symptoms improve. Phenazopyridine is administered after meals to prevent GI upset. This drug is...

Educating the Patient and Family

The nurse stresses the importance of increasing fluid intake to at least 2000 mL d (unless contraindicated) to help remove bacteria from the genitourinary tract (see Patient and Family Teaching Checklist Using Fluids to Prevent and Treat UTIs). In many cases, symptoms are relieved after several days of drug therapy. To ensure compliance with the prescribed drug regimen, the nurse stresses the importance of completing the full course of drug therapy even though symptoms have been relieved. A full course of therapy is necessary to ensure all bacteria have been eliminated from the urinary tract. The nurse should include the following points in a patient and family teaching plan 2 days if you are also taking an antibiotic for the treatment of a UTI. Tolterodine If you experience difficulty voiding, take the drug immediately after voiding. If dysuria persists, notify the primary health care provider.

Self Expandable Stent Prosta Coil and GianturcoZ

The ProstaCoil is 17 Fr before insertion and expands to 24-30 Fr. Yachia and associates reported on their experience in 65 patients (22). Of these, 37 had their stents removed at the time of prostatectomy. Complications were urinary tract infections in 32 patients, repositioning in 5 patients, and dysuria or perineal pain in 14 patients.

Cyclophosphamide Cytoxan

Bone marrow depression, primarily of white cell series, and predisposition to infection, both of which may be life-threatening but reversible with discontinuation of drug. Alopecia, drug-induced infertility with amenorrhea or defective spermatogenesis, hemorrhagic cystitis (in up to 25 of patients), fibrosing cystitis, carcinoma of the bladder, hematopoietic malignancies, anorexia, nausea, vomiting, and pulmonary fibrosis. Antidiuretic hormone-like activity may occur with large doses and result in hyponatremia.

Affected Organs And Cell Types In Polyomavirusassociated Disease And Persistent Virus Infection

Hemorrhagic cystitis (HC) is a serious BKV-associated complication of bone marrow transplantation (BMT) patients. Prevalence of HC varies from 10 to 68 and leads to severe hemorrhage in about 25 of bone marrow recipients (Arthur et al., 1985 Azzi et al., 1994 Bedi et al., 1995 Chan et al., 1994 Cotterill et al., 1992). Hemorrhage and viruria most likely are due to viral activation in the uroepithelium, as virus particles can be detected in exfoliated urinary cells by means of electron microscopy (Hiraoka et al., 1991). Prolonged hematuria is associated with severe morbidity and increasing viral load in urine (Azzi et al., 1999). Viruria in BMT patients was reported as early as 1975 (Reese et al., 1975). Although before transplantation only 1 of patients shed BKV (Arthur et al., 1985), increases have been reported to 22 , 48 (Arthur et al., 1988, 1989 Cotterill et al., 1992 Jin et al., 1993), 67 (Jin et al., 1995), and even 100 of patients in the post-transplant period if classic...

Entero Urinary Fistula EUF

Entero Vaginal Fistula

However, EUF has also been reported as the presenting manifestation in patients without a previous history of CD 59 . Prodromic symptoms or signs like dysuria, urinary urgency and frequency, suprapubic discomfort, microscopic or gross hematuria, are often present in early stage, indicating a status of perivesical inflammation 3, 60, 63,67 . When fistulisation has occurred, it usually manifests with pathognomonic signs like pneumaturia or faecaluria. Another specific but rare sign is the passage of urine through the rectum (urorrhea) 60, 67 . In a minority of cases, there is only a history of recurrent urinary tract infection (UTI) refractory to medical treatment, while very rarely the patient can be asymptomatic (Table 4) 65 . Pneumaturia has been reported with percentages varying from 38-94 . In the series from the Mayo Clinic it was present in 68 of patients (Table 4), but according to others 68 , this sign is evident in more than 90 of cases and, when not noticed by the patient,...

Medical Term Urine In Cavity

Foley Catheter

Cystitis UTI Urinary tract infection 44. dysuria (dis-U-re-a) _ 74. UTI _ A.A., a 48-year-old woman, was admitted to the in-patient unit from the ER with severe right flank pain unresponsive to analgesics. Her pain did not decrease with administration of 100 mg of IV meperidine. She had a 3-month history of chronic UTI. Six months ago she had been prescribed calcium supplements for low bone density. Her gynecologist warned her that calcium could be a problem for people who are stone-formers. A.A. was unaware that she might be at risk. An IV urogram showed a right staghorn calculus. The diagnosis was further confirmed by a renal ultrasound. A renal flow scan showed normal perfusion and no obstruction. Kidney function was 37 on the right and 63 on the left. While the pain became intermittent, A.A. had no hematuria, dysuria, frequency, urgency, or nocturia. Uri-nalysis revealed no albumin, glucose, bacteria, or blood there was evidence of cells, crystals, and casts. e. dysuria for 13...

Possible Mechanisms Of Activation

Transactivation may also involve herpesviruses, which can act on polyoma-virus DNA replication. Cytomegalovirus (CMV) is highly prevalent in the human population and can infect virtually any organ of its host (Sinzger and Jahn, 1996 Tevethia and Spector, 1989). Co-infection can occur in the kidney, lung, CNS, and lymphoid organs. Specifically, epithelial cells, fibroblasts, and endothelial cells are potential common host cells for BKV and CMV. Stromal cells and CD34-positive bone marrow progenitor cells might be cell types that can be co-targeted by JCV and CMV (Mendelson et al., 1996 Sinclair and Sissons, 1996). CMV infection is often activated in AIDS patients after RT, and there is a high incidence of CMV infection in patients with hemorrhagic cystitis (HC) after BMT (Childs et al., 1998). In AIDS patients no co-detection and no correlation between polyomavirus and CMV viruria was observed (Sundsfjord et al., 1994a). Similarly, the high incidence of CMV after kidney

Diseases of the genitourinary system N00N99

Excludes urinary infection (complicating) _ Cystitis Excludes prostatocystitis ( N41.3 ) N30.0 Acute cystitis Excludes irradiation cystitis ( N30.4 ) trigonitis ( N30.3 ) N30.1 Interstitial cystitis (chronic) N30.2 Other chronic cystitis N30.3 Trigonitis Urethrotrigonitis N30.4 Irradiation cystitis N30.8 Other cystitis Abscess of bladder N30.9 Cystitis, unspecified Bladder disorders in diseases classified elsewhere Tuberculous cystitis ( A18.1+ ) Urinary tract infection, site not specified

Diseases Characterized By Vaginal Discharge

Trichomoniasis is caused by the protozoan Trichomonas vaginalis. Classically, infection is associated with a thin, greenish-yellow vaginal discharge, dysparenia, vaginal irritation, and sometimes dysuria (54). On examination, a thin vaginal discharge along with punctate cervical hemorrhages (strawberry cervix) is characteristic. Men are frequently asymptomatic although trichomoniasis may cause prostatitis and epididymi-tis (54).

Clinical Aspects of the Male Reproductive System

Transurethral Incision The Prostate

Gonorrhea is caused by Neisseria gonorrhoeae, the gonococcus (GC). Infection usually centers in the urethra, causing urethritis with burning, a purulent discharge, and dysuria. Untreated, the disease can spread through the reproductive system. Gonorrhea is treated with antibiotics, but there has been rapid development of resistance to these drugs by gonococci. Vaginitis. Green, frothy discharge with itching pain on intercourse (dyspareu-nia) and painful urination (dysuria). Inflammation of the epididymis. Common causes are UTIs and STDs. Inflammation of the prostate gland. Often appears with UTI, STD, and a variety of other stresses.

An Oblique Surgical Incision Follows What Direction

C.S., a 62-year-old businessman, saw a urologist with complaints of decreased force of urine stream and ejaculation, hesitancy, and sensation of incomplete bladder emptying. He claimed he had taken prostate-health herbal supplements without any real benefit for 2 years before making the appointment. He denied dysuria, hematuria, or flank pain. He has no history of UTI, epididymitis, prostatitis, renal disease, or renal calculi. Rectal examination revealed a 50-g prostate with slight firmness in the right prostatic lobe. Bladder ultrasound showed no intravesical lesions or prostate protrusion into the bladder base. C.S. was diagnosed with benign prostatic hyperplasia with bladder neck obstruction and was scheduled for a TURP. c. dysuria, hematuria, oliguria 17. UTI

Menstrual and obstetric history

The obstetric history comprises details of all pregnancies, successful or otherwise, and any problems experienced during pregnancy, such as high blood pressure or urinary infection (Table 5.24). If a woman has never been pregnant, it may be appropriate to enquire whether this was by choice or whether difficulties in conceiving have been experienced. 'NB Remember to ask about medical disorders complicating pregnancy, Including anaemia, hypertension, diabetes mellltus. thyroid disease or urinary infection.

Diseases Characterized By Urethritis And Cervicitis

Urethritis refers to inflammation of the urethra in men or women and is manifested by dysuria, pyuria, or discharge. Discharge may range from scant and mucoid to grossly purulent. Although dysuria may suggest a urinary tract infection in females in males, urethritis is usually due to STD. The CDC criteria for diagnosis of urethritis (2) are the presence of mucopurulent or purulent discharge, Gram stain of urethral Although the symptoms and signs of gonorrhea (GC) and chlamydial infection overlap, GC is usually symptomatic, in contrast to chlamydial infection, which is often asymptomatic. In 90 of men with gonococcal urethritis, discharge occurs within 5 d of exposure (34). The discharge may be mucoid initially but becomes purulent and associated with dysuria within days. A copious, thick, green urethral discharge is more commonly associated with gonorrhea than with Chlamydia. In men, GC rarely spreads to the epididymis but may cause balantitis or penile swelling. Men with chlamydial...

Infections In The Solid Organ Transplant Recipient

In the period of > 6 mo following transplant, three clinical groups with characteristic infectious complications are seen. Approximately 60-75 of patients require minimal immunosuppression and have good graft function by this time. In these patients, common infections such as respiratory tract infections, diverticulitis, and cholecystitis may occur. However, these infections may present in an atypical manner or have more serious sequelae due to the chronic immunosuppression. From 10 to 15 of patients will have chronic recrudescent viral infections, which may lead to end-organ damage. Etiologies include papovavirus (BK, JC), which may cause urethral stricture and hemorrhagic cystitis hepatitis B or C, which may result in subacute or chronic hepatitis Epstein-Barr virus, a causative agent of post-transplant lymphoproliferative disorders CMV, which most commonly manifests as retinitis at this time adenovirus and VZV. The remaining 10-20 of patients have poor allograft function and are...

Infection Risk and Preoperative Antimicrobial Therapy

As stated previously, documented preoperative urinary tract infection must be eradicated with appropriate antimicrobial therapy. This is very important given the observation that bacteremia occurs postoperatively in 10-32 of patients without recognized preoperative bacteri-uria and occurs much more frequently in patients with infected urine (9,10). Prophylactic antibiotic administration to reduce immediate and long-term infection-related risks in patients without preoperatively documented infection has a limited effect on perioperative infections or fever, although a reduced incidence of postoperative bacteremia has been noted (9). Gorelick and associates documented demonstrable bacteria in as many as 20 of prostatectomy tissue specimens (11). As a result, antibiotics used for prophylaxis should eradicate bactericidal tissue as well as reduce levels in urine. In low-risk patients with negative preoperative urine cultures, we commonly initiate coverage about 1 h before surgery using...

Diagnostic Tests 31 Urine Culture

A positive urine culture is necessary for a microbiologic diagnosis of urinary infection. A urine specimen for culture should be obtained whenever a diagnosis of symptomatic urinary infection is considered. This specimen will not only confirm the presence of bacteriuria, but also identify the infecting organism and antimicrobial susceptibilities so antimicrobial therapy may be optimized. In every case, the urine specimen should be collected prior to the institution of antimicrobial therapy to ensure that causative organisms are isolated. An appropriate method for specimen collection that minimizes bacterial contamination must be used. For symptomatic men, a single clean-catch urine specimen is usually adequate. For men with external condom catheters used to manage incontinence, a urine specimen may be obtained immediately postvoiding from a freshly applied leg bag (1). A clean-catch specimen is preferred for women. For highly functionally impaired institutionalized women, it may not...

Clinical Aspects of the Urinary System Infections

Foley Cath Removal Female

Organisms that infect the urinary tract generally enter through the urethra and ascend toward the bladder. Although urinary tract infections (UTIs) do occur in males, they appear more commonly in females. Infection of the urinary bladder produces cystitis. The infecting organisms are usually colon bacteria carried in feces, particularly Escherichia coli. Cystitis is more common in females than in males because the female urethra is shorter than the male urethra and the opening is closer to the anus. Poor toilet habits and urinary stasis are contributing factors. In the hospital, UTIs may result from procedures involving the urinary system, especially catheterization, in which a tube is inserted into the bladder to withdraw urine (Fig. 13-5). Less frequently, UTIs originate in the blood and descend through the urinary system. An infection that involves the kidney and renal pelvis is termed pyelonephritis. As in cystitis, signs of this condition include dysuria, painful or difficult...

Long Term Complications

Long-term complications following TURP primarily include urinary tract infection, obstruction, incontinence, and erectile dysfunction, although there is debate about whether the latter is truly associated with the procedure. Interestingly, despite the use of prophylactic and perioperative antibiotics, delayed genitourinary infection is still a significant problem after TURP, accounting for nearly half of long-term complications (4 ) (21). This is probably not a result of persistent bacteriuria from the procedure but is more likely the result of some of the complications discussed below, including obstruction and incontinence.

Display 471 Common Disorders Associated With the Urinary System

Additional drugs can be used in the treatment of UTIs. Examples of these drugs include ampicillin (see Chap. 7), the cephalosporins (see Chap. 8), sulfonamides (see Chap. 6), and norfloxacin (see Chap. 10). Combination drugs are also available. The Summary Drug Table Urinary Anti-infectives gives examples of the combination drugs used for UTIs.

Perioperative Complications

Perioperative complications primarily include bleeding, urinary tract infection, and urinary retention. These occur in approx 7 of patients, sometimes extending the hospital stay by a few days or requiring discharge with an indwelling catheter (3,21). Urinary Tract Infection and Urinary Retention Recently studies have shown that urinary tract infections occur in approx 2 of patients during the postoperative period, although it had been reported to occur in as many as 60 of patients (11,21). As stated above, the use of prophylactic antibiotics during TURP is unquestioned when the patient is managed with continuous or intermittent catheter-ization because bacteriuria can be expected to occur in these situations. Recently, it has been established that all patients undergoing TURP will likely benefit from the use of prophylactic antibiotics administered preoperatively and perioperatively (14). Urinary retention has been reported to occur in approx 7 of patients after TURP (21). This can...

Thermosensitive Nitinol Stent

Marks et al. tested another nitinol prostatic stent (Horizon) in 10 patients (26). Insertion was easily done after the patients received anesthesia. Removal was easily accomplished by unraveling after the stent was cooled with iced saline. One patient required stent removal because of dysuria. Residual urine volume decreased from 189 mL to 50 mL, and PFR improved from 6.6 to 10.8 mL s.

Clinical Relevance

Clinicians have generally believed that diabetics are more susceptible to infections and that infections are generally more severe in diabetics than they are in nondiabetics. There has been a scarcity of controlled studies that have conclusively shown that certain infections are more common in diabetics as compared to nondiabetics (2). Urinary tract infection and bacteremia have also been shown to be more frequent in the diabetic (3,4). Review of the literature with regards to certain specific infections, however, strongly suggests that diabetics are clearly overrepresented in these infections (5,6). These infections are discussed in detail in this chapter. Besides all these defects in immune function, other diabetic complications that predispose to infections include peripheral and autonomic neuropathy as well as large-and small-vessel disease. These deficiencies can lead to dryness and fissuring of the skin and gangrene of extremities, in turn leading to soft-tissue and bone...

Abnormal findings

Figure 5.19 shows some common abnormalities of the scrotum. A hydrocele is a relatively common swelling due to accumulation of fluid in the tunica vaginalis, l may be unilateral or bilateral. The fluid nature of the contents should he confirmed hy transillumination. The possibility that a hydrocele may obscure a testicular tumour should not be overlooked and careful palpation of both testes is therefore necessary. Infections which affect the testis specifically (,orchitis) are mumps and syphilis. The epididymis may contain a spermatocele or other cyst. It Is prone to infection. often in association with urinary tract infection. Tills may be bacterial - usually due to coliform organisms - or

Epidemiology Of Infection In Longterm Care

In the United States, long-term care residents continue to outnumber the number of patients in the acute care setting. Infections in long-term care facilities occur at rates similar to those found in acute care hospitals ranging in incidence from 1.8-9.4 1000 patient-care days (1-4). Urinary tract infections (UTI) occur most often followed by infections of the respiratory tract, gastrointestinal tract, or soft-tissue infection. It has been estimated that 10-30 of nursing facility residents die each year, but how often infection contributes to mortality rates is not known (1). Pneumonia has been reported to result in death in 6-23 of cases, whereas bacteremia has been associated with death in 10-25 of cases (1,4). This chapter discusses the prevention and control of common infectious problems in the long-term care setting. The reader should refer to related chapters in this book for in-depth discussion of the diagnosis and treatment of specific clinical syndromes and pathogens.

Medical considerations for treatments for invasive bladder cancer in the elderly

Although several studies of extensive transurethral resection and chemotherapy in selected elderly cases have reported 50 complete and partial responses, the durability of these responses has only been for 812 months on average, with an actuarial median survival of only 10-14 months.42,43 Dose modification has often been necessary to accommodate the reduced physiological capabilities of the various organ sytems in the elderly, particularly to minimize cardiotoxicity (from adriamycin) and nephrotoxicity (from cisplatin). In one oft-quoted study, Kaufman et al. reported complete responses in 11 20 (55 ) patients with muscle-invasive disease.44 In those who were initially staged as having only superficial muscle invasion, complete response was more likely and five-year survival was 49 . In contrast, all patients with incomplete response died within three years. Moreover, overall actuarial five-year cause-specific survival was 43 . Toxicities were often significant and included leukopenia...


The extent to which prevention of urinary infection in elderly populations is feasible is unclear. The very high frequency of urinary infection is primarily due to associated comorbidity, and usually this cannot be modified. Adequate nutrition, optimal management of comorbidities, and maintenance of maximal function certainly seem reasonable recommendations, but the impact of these interventions in decreasing urinary infection is not known. For a small subset of elderly well women who are experiencing repeated episodes of acute cystitis, the use of prophylactic antibiotics, a strategy similar to younger female populations, may be effective. An alternate approach in selected postmenopausal women may be the use of topical estrogen therapy (24), although the relative efficacy of estrogen compared to antimicrobial prophylaxis remains to be determined. Studies of the impact of oral estrogen in reducing urinary infection have given conflicting results. Long-term antimicrobial prophylaxis...


Hepatic involvement with associated jaundice occurs more frequently in typhoid-endemic regions. Though rare, cystitis caused by S. Typhi can occur. Various neurological sequelae, including psychosis, ataxia, polyneuritis, and seizures, have been reported, but the exact molecular bases are


By using only the most helpful diagnostic tests, selecting the least expensive and least toxic antimicrobial regimens from among the most effective alternatives, and providing a sufficient but not excessive treatment duration in an appropriate setting, physicians can limit costs and improve clinical outcomes for patients with UTI while reducing selective pressure for antimicrobial resistance. Several departures from traditional UTI management practices are now known to be safe and cost effective, and hence can be recommended for standard use.


Painless haematuria in the aduli is usually due to a benign bladder papilloma or to renal, bladder or prostatic carcinoma. Haematuria associated with severe loin pain suggests a renal or ureteric origin, commonly due to the presence of a calculus. When haematuria is accompanied by dysuria or frequency, the source is usually in the bladder, possibly bacterial infection of the bladder wall (cystitis). Haematuria which clears rapidly during micturition is usually urethral in origin. Urinary tract Infection Urinary tract infection

Urogenital pain

Renal pain is usually due to stretching of the renal capsule or renal pelvis. A chronic dull aching discomfort in the loin and renal angle may occur in renal scarring or infection and in hydronephrosis. Intermittent pain can occur in polycystic disease from infection or spontaneous bleeding into a cyst. In acute pyelonephritis, renal pain is often accompanied by dysuria, fever and sometimes rigors. unremitting and the patient is restless, nauseated and often vomits. The pain may radiate from the renal angle and loin to the iliac fossa, the groin and into the genitalia. Once the stone reaches the bladder, it is often asymptomatic until it enters the urethra and causes dysuria. In patients with renal colic, specific questions should he asked to try to determine any underlying cause for stone formation (see Fig. 5.3). Mosi conditions causing bladder pain also cause frequency and dysuria. In males, perineal and rectal pain with associated dysuria suggest prostatic inflammation or...

Patient Population

The need for perioperative antibiotics is controversial. Urinary tract infection is a potential complication of TURP, and it can progress to bacteremia and subsequently septicemia. Urinary tract infection has been reported to occur in 6-60 of patients undergoing TURP (11). Risk factors include preoperative bacteriuria and the presence of an indwelling catheter (12). It is generally accepted that the use of perioperative antibiotics is indicated in patients at high risk for postoperative urinary tract infection, such as those indicated above. Consensus has not been reached, however, regarding the utility of this regimen in patients with sterile urine and low risk factors. Although Gibbons et al. reported that the use of prophylactic antibiotics did not prevent postoperative urinary tract infections, many other studies have come to the opposite conclusion (13). Recently, Berry and Barratt performed a metaanalysis on 32 randomized controlled trials, examining the incidence of...


Trimethoprim (Trimpex) interferes with the ability of bacteria to metabolize folinic acid, thereby exerting bac-teriostatic activity. Trimethoprim is used for UTIs that are caused by susceptible microorganisms. Trimethoprim administration may result in rash, pruritus, epigastric distress, nausea, and vomiting. When trimethoprim is combined with sulfamethoxazole (Septra), the adverse effects associated with a sulfonamide may also occur. The adverse reactions seen with other anti-infectives, such as ampicillin, the sulfonamides, and cephalosporins, are given in their appropriate chapters.


Open lesions, urinary tract infection, diarrhea extreme care should be taken in patients with cardiopulmonary involvement. G. Mechanical traction. Intermittent traction is utilized for spinal disorders, generally in conjunction with other modalities. The amount of traction prescribed depends on the area being treated and on the patient's tolerance. Its effectiveness in promoting relaxation through muscle stretching, relieving nerve compression, and relieving pain has been demonstrated. Patients receive intermittent traction two to three times per week on average for 20 minutes.


The guidelines review indicated a mean incidence of epididymitis of 2.6 in patients undergoing open prostatectomy (21). Its occurrence was equivalent for all surgical approaches. It would appear that the presence of long-term indwelling catheters, chronic urinary tract infections, and a history of epididymitis predispose patients to this problem after open prostatectomy (6,27). This same guidelines review indicated a mean incidence of urinary tract infection of 13.4 , which appears to be related to antecedent instrumentation of the urinary tract and documented preoperative infections (2,21).


Recently FDA-approved test called the T. pallidum-particle agglutination, or TP-PA, which is produced by the manufacturer of the MHA-TP). Second, in patients who have untreated syphilis for many years and are presenting with late complications, the RPR and VDRL may be negative, with only a positive treponemal serology as indication of infection. Therefore, the possibility of either false-positive or false-negative screening nontreponemal tests exists in the elderly. Finally, since the elderly have many intercurrent illnesses and are not perceived by medical providers as being sexually active or at risk for syphilis, symptoms or signs of syphilis may be mistaken for other disease states, such as a drug reaction, urinary tract infection, or benign perineal ulceration.


Columnar epithelium, which is often present on the ectocervix of adolescent girls, thus very accessible to infection. In older women, however, the columnar epithelium is located in the endocervix, where it is somewhat protected by cervical mucus. Patterns and rates of partner change also make adolescents and younger women more susceptible to Chlamydia. However, older men and women are not immune to the disease. As in men, Chlamydia can infect only the urethra in women, causing symptoms of urinary tract infection or urethral syndrome. Chattopadhyay (17) found evidence of Chlamydia in 4 of 249 culture-negative urine samples with > 50 WBC L two of these patients were 65 yr and older (17). Chlamydia should be considered as a cause for culture-negative urinary symptoms in the sexually active population.


Bacterial Uti Pathophysiology

Impaired ability to dilute and concentrate urine Incontinence predisposes to UTI Abbreviations CNS central nervous systems, LV left ventricular, CO cardiac output, VC vital capacity, TLC total lung capacity, RV residual volume, FRC functional residual capacity, PaO2 partial arterial oxygen pressure, ARDS adult respiratory distress syndrome, GFR glomerular filtration rate, UTI urinary tract infection, MODS multiple organ dysfunction syndrome, Na sodium, K potassium, Ca calcium, Mg magnesium, P phosphorus, DIC disseminated intravascular coagulation. The most common source of sepsis in older persons is the urinary tract. Urinary tract infections are discussed more completely in Chapter 10.


Bilharzial Cystitis Pathogenesis

Aberrations of chromosome 9 and 17 have been implicated in the development and progression of transitional cell carcinoma of the urinary bladder. Similar aberrations may occur in chronically inflamed and metaplastic mucosa with bilharzial cystitis and in carcinoma in situ. Bilharzial-associated bladder cancer in Egypt and sporadic cases of bladder cancer in the United States may develop through the same genetic mechanisms.


Bacterial vaginosis (BV) and candidiasis are not sexually transmitted infections, but may arise in older women because of the changes in the vaginal microflora that occur in the postmenopausal state. Because these conditions are not STDs, they are not discussed further here, but the reader is referred to the STD Treatment Guidelines for discussion on the diagnosis and treatment (10). Trichomoniasis, caused by Trichomonas vaginalis, is an STD, which in women can infect the vagina, cervix, urethra or bladder. Trichomoniasis is not a reportable disease, so accurate data on the incidence of this infection in older women are not available. Common signs due to trichomonia-sis include abnormal discharge, which is often discolored and or frothy, vaginal erythema, and punctate cervical hemorrhages. Symptoms include discharge, itching, or burning of the vagina or vulva, but occasionally women will present with predominantly urethral complaints, such as frequency, urgency, or dysuria....

Acute Pyelonephritis

Pyelonephritis connotes infection of the renal pelvis and or parenchyma, and is defined clinically by the presence of flank pain and or tenderness, usually accompanied by fever, in a patient with bacteriuria and pyuria (7). Pyelonephritis exhibits many of the same epidemiological associations as cystitis, but is approx 20-fold less common. Patients with pyelonephritis usually feel systemically ill and may have nausea and vomiting, abdominal pain, headache, and myalgias (1). Some develop bacteremia, which can precipitate septic shock and its characteristic sequelae. Treatment Regimens for UTI in Adults Acute cystitis Escherichia coli, Staphylo Male, diabetes, symptoms for > 7 d, recent UTI or antimicrobial use, childhood UTI, age > 65 yr A parenteral0 fluoroquinolone, i.v. gentamicin, i.v. ampicillin (or mezlocillin or piperacillin) plus i.v. gentamicin (preferred if Enterococcus suspected or documented), i.v. piperacillin-tazobactam, i.v. imipenem, or iv meropenem (if Enterococcus...

Indications For Turp

Cystoscopy Image Bladder Infection

Patients selected for TURP should have clinical symptoms and signs caused by bladder outlet obstruction from BPH, because this procedure is thought to work by removal of obstructing prostate tissue. Most patients (90 ) who undergo TURP do so because of the bothersome irritative and obstructive symptoms associated with BPH, termed prostatism, or more recently, lower urinary tract symptoms (LUTS) (3). Other patients, however, are treated for increased postvoid residual urine, urinary retention, urinary tract infection, hematuria, renal insufficiency, and vesical calculi. Physical examination, at minimum, should include palpation of the lower abdomen for evidence of bladder distention and digital rectal examination of the prostate. The latter should assess for prostate consistency, symmetry, and size. An estimate of prostate size, albeit inaccurate by digital examination, is important because there is a limitation to the amount of tissue that can be safely resected transurethrally....


Members of the genus Enterococcus were formerly classified with the Lancefield group D streptococci. Growth at extremes of temperature, salinity, and alkalinity as well as hydrolysis of esculin in the presence of bile characterize these organisms. More recently genetic techniques have been used to clarify the taxonomy. These facultatively anaerobic Gram-positive cocci are usually found in the gastrointestinal and biliary tracts, vagina, and male urethra. Historically not considered pathogenic in humans, enterococci now represent significant causes of nosocomial and urinary tract infections. Of the more than 12 species identified, E. faecalis and E. faecium are the most important in human infection. Because of their ability to survive harsh conditions, enterococci can persist in the environment (31,32). Adherence to host structures (cardiac valves, renal epithelial cells) facilitates the development of endocarditis and urinary tract infection. Antibiotic resistance plays a role in the...

Neurologic disease

Cytotoxic drugs are used in either severe corticosteroid-resistant disease or in the context of unacceptable steroid side effects. In patients with diffuse proliferative glomerulonephritis, cyclophosphamide has shown to retard progression of scarring in the kidney and reduce the risk for end-stage renal failure. Monthly infusions of IV pulse cyclophosphamide (0.5 to 1.0 g m2 of body surface area) preserve renal function more effectively than do corticosteroids alone, but the rate of relapse following a 6-month course is high. Most patients require extended therapy. Potential toxicities are substantial nausea and vomiting (often requiring treatment with antiemetic drugs) alopecia (reversible) ovarian failure (nearly universal in patients more than 30 years old) or azoospermia and hemorrhagic cystitis, bladder fibrosis, and bladder transitional cell or squamous carcinoma. Intermittent IV cyclophosphamide may decrease the incidence of bladder complications associated with daily oral...


Asymptomatic urinary infection in elderly populations should not be treated. Prospective, randomized, comparative trials of therapy compared with no therapy for the treatment of asymptomatic infection in institutionalized men or women have not docu mented improvements in morbidity or mortality with treatment (4,5,12). For long-term care residents with chronic incontinence and bacteriuria, antimicrobial treatment of urinary infection does not improve continence (16). Attempts to treat asymptomatic infection with antimicrobial therapy are, in fact, harmful due to increased adverse effects from medication, emergence of resistant organisms, and increased cost (4). Thus, the evidence is consistent that there are no benefits and some adverse effects with treatment of asymptomatic bacteriuria. The presence of pyuria with bacteriuria is not an indication for antimicrobial therapy, as pyuria does not differentiate symptomatic from asymptomatic infection. It follows, then, that elderly...

Tuna Complications

The appeal of minimally invasive therapies for the treatment of BPH is the ability to achieve efficacy similar to that of TURP but with significantly lower morbidity. Mortality has not been described in patients undergoing TUNA. The most common complications experienced by these patients are urinary retention, hematuria, and irritative voiding symptoms. In most cases, patients are able to void spontaneously shortly after treatment, but urinary retention has been described in 13.3-41.6 of patients (27,31-33). Most commonly, retention is transient and resolves within 1 wk. Hematuria, although common within the first days after treatment, has never been reported to require a blood transfusion. Rosario et al. reported no increased incidence of bleeding complications, even in patients receiving warfarin at the time of TUNA (34). The presumed ability of TUNA to spare the prostatic urethra from thermal injury accounts for the incidence of irritative voiding symptoms, dysuria, frequency, and...

Medical Conditions

With schizophrenia identified through records linkage methodology. Most lung diseases but only some cardiovascular diseases had elevated rate ratio values. In a study of 110 state hospital patients with schizophrenia in the United States, 38 (35 ) had one or more medical conditions (excluding extrapyramidal side effects and tardive dyskinesia) (Pary and Barton 1988). The disorders noted included diabetes, hyponatremia, thyroid disorder, urinary tract infection, bladder dysfunction, hypertension, liver disease, seizures, and visual problems, among others.

Postoperative Care

Decreased catheterization time is theoretically associated with a decreased complication rate (stricture and infection), early catheter removal does not appear to influence complications (34). When choosing a patient for early catheter removal, the physician and the patient should be cautioned that the need for recatheterization is greatest in men with diabetes and in those with a history of urinary tract distention. Interestingly, the choice of anesthesia, history of urinary tract infection, size of the prostate gland, and patient age do not significantly influence the risk for recatheterization (37).

Uric Acid Stones

Crohn Disease Skin

Clarke et al. 16 noticed that people with ileosto-my produced about 300 ml less urine in a day than the control population moreover the mean urinary pH was 5.05. At these levels, the solubility of uric acid (which has a pKa of 5.7) is almost 12 times lower 10 , and this predisposes to crystallization and formation of uric stones, even in the absence of hyperuricemia and hyperuricosuria 17 . Other circumstances like urinary tract infection, chronic ureteral obstruction, high urinary calcium and oxalate concentration, steroid use (because they increase intestinal calcium absorption), prolonged bed rest (which favours calcium mobilisation from the bones), all increase the chance of stone formation.

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