Treatment
Appropriate antibiotics, analgesics and rest.
Chronic Bacterial Prostatitis
It may be or not be sequel to the acute form. Common causative
organism include Klebsiella, E.Coli, Proteus etc
It may also be caused by tuberculosis and parasitic infestation
e.g schistosomiasis.
Examination is usually not rewarding.
Investigation
Are like for ABP however, unlike ABP, cystoscopy can be
perfomed (in ABP, the procedure may lead to septicaemia)
Treatment: prostatic massage twice weekly and appropriate
antibiotics
Chronic Non-bacterial Prostatitis
No organism is associated with the pathology. There is
sustained contraction of the urinary sphincter resulting
in raised prostatic urethral pressure…….
Clinical Features
Pain in the groin and lower urinary tract
Rectal examination reveals a tender prostate.
Investigation:
Micturating cystourography shows narrowing of the urethra
at the level of the external sphincter.
Treatment: bladder neck obstruction is treated and alpha-
adrenergic blockers as well as anti-inflammatory agents
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Urinary tract infection
Definition
Urinary tract infection (UTI) is the general name given to an infection of
any part of the urinary system.
The urinary system is made up of the kidneys, the ureters
(the tubes that carry urine from the kidneys to the bladder),
the bladder and the urethra. The kidneys remove waste products
from the blood to make urine, which then travels through
the ureters to the bladder, where it is stored until it
leaves the body through the urethra.
The kidneys and the ureters are known as the upper urinary
tract. An infection of this part of the urinary system
is called pyelonephritis.
The bladder and the urethra are known as the lower urinary
tract. An infection of the bladder is called cystitis,
while that of the urethra is called urethritis.
Urine is usually sterile. Urinary tract infection develops
when part of the urinary system becomes infected, usually
by bacteria. Bacteria can enter the urinary system through
the urethra, or, more rarely, though the bloodstream. Bacteria
commonly enter the urethra during sexual intercourse or
due to poor hygiene. The bacteria that cause UTI are usually
the individual's own normal intestinal organisms which
may pass from the area around the anus into the urethra
and thus into the bladder. Pylonephritis is usually caused
by the same kinds of bacteria managing to spread from the
bladder into the ureters and up to the kidneys.
The symptoms of lower urinary tract infection can include:
pain or a burning sensation during urination (dysuria),
needing to urinate frequently or urgently,
feeling that you are unable to urinate fully,
cloudy, bloody or bad-smelling urine,
pain in your lower abdomen, and
mild fever (a high temperature between 37-38.3°C or 98.6-101.0°F).
The symptoms of upper urinary tract infection can include:
any of the symptoms
of a lower urinary tract infection,
a high fever (a high temperature over 38.3°C or 101.0°F),
nausea or vomiting,
shaking or chills, and
pain in your back or side, usually on only one side.
Women are more likely to develop UTI than men. This is because in a woman the
urethra is situated closer to the anus than in a man, making it easier for
bacteria from the anus to reach the urethra. The female urethra is also much
shorter than the male urethra (which runs through the penis), so it is easier
for bacteria to reach the bladder.
You are more likely to develop a UTI if:
you have a condition that obstructs or blocks the urinary
tract, such as kidney stones,
you have a condition that prevents you from emptying your bladder fully,
you have a weakened immune system, for example because you have diabetes or
you are undergoing chemotherapy,
you are female and sexually active, as sexual intercourse can irritate the
urethra, allowing bacteria to more easily travel through the urethra into the
bladder,
you use a diaphragm for birth control,
you are male and have an enlarged prostate gland or urethral stricture
you have a foreign body inserted e.g. urinary catheter.
Sexual position: Some women may easily develop a UTI if during sexual intercourse,
their partner
enters their vagina from behind. In this position bacteria is
more likely to be pushed from around the anus forward towards the urethra.
Investigation
Urine analysis and MCS: a sample of urine will need to
be sent culture testing. This will confirm that infection
is present, identify the kind of bacteria causing the infection
and check that the antibiotic sensitivity that is appropriate
for the type of infection.
Usually in women, no further investigations would usually
be required, unless the UTI was a recurring problem. In
men and children, additional investigations may be carried
out to identify any underlying cause. An ultrasound scan
of the bladder and kidneys and/or cystoscopy may be done.
Treatment
Behaviour Modification
There are things you can do to reduce your risk of getting
a UTI:
People who are prone to getting UTIs usually find that
drinking plenty of fluids throughout the day is helpful.
At least 3litres/day is recommended.
Drink plenty of liquids, especially water. This should
help wash bacteria from the bladder and urinary tract.
Drinking cranberry juice may help to prevent cystitis.
Predisposing habits should be avoided:
Go to the toilet as soon as you feel the need to urinate,
rather than holding it in.
Wipe from front to back after going to the toilet.
Practice good hygiene wash your genitals every day and before having sex.
Empty your bladder after sex.
Medical therapy
Most UTIs can be treated with antibiotics. Generally,
an antibiotic is prescribed as soon as a UTI is diagnosed,
without waiting for the results of a urine MCS test. A
five-day course of tablets is usually given, but sometimes
a single large dose is used. Symptoms usually start to
improve within 24 hours, but the full course of antibiotics
prescribed should be taken to ensure the infection is cleared
up completely.
Occasionally, the 'culture' test result may make it necessary
to change to a different antibiotic. Pylonephritis generally
requires hospital admission, where antibiotics will be
given intraveinously. People with recurrent UTIs need to
take continuous low doses of antibiotics.
Surgery
This mode is indicated when there is a structural defect
predisposing to infection . Stones will need to be removed.
Prognosis
UTI rapidly responds to appropriate antibiotic treatment.
If left untreated however, it can eventually cause permanent
kidney damage.
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