Brig HAROON SABIR KHAN
FCPS (Surg), FCPS (Urology)
FEBU (Europe), MHPE (RIU)
Professor of Urology
By the end of this presentation students will be
List upper and lower urinary tract parts
Define Urinary tract infections
Explain pathophysiology of UTI
List the various factors responsible for UTI
Manage Urinary tract infection
Urinary Tract Infection
When bacteria invades Urinary tract and multiply.
Bacteriuria: Presence of bacteria in urine (symptomatic/asymptomatic)
Pyuria: presence of WBC in urine
Women are more prone to UTI due to short urethra
and anatomical position.
Almost half of all women will have at least one
episode of UTI.
Risk of UTI in women increases after menopause.
After a attack of UTI: 20-40 % will have a recurrence.
Recurrent infections are usually reinfections.
occurs in patients who have a normal unobstructed
urinary tract, most commom in young, sexually active
a. patient is a child or a pregnant woman
b. Presence of structural or functional deformity or
c. Underlying disease (diabetes, CKD, immunocompromised pt.)
d. Recent instrumentation or surgery of urinary tract
associated with production of gas in renal and
perinephric tissue specially in diabetics.
suppurative destruction of renal tissue from
chroni urinary obstruction ( staghorn calculus) or
with chronic obstruction.
• Fournier’s Gangrene
Acute fulminant necrotizing fasciitis or gangrene
affecting external genitalia or perineum
Clean-catch mid stream urine sample
Suprapubic puncture sample
If sexually transmitted disease is suspected, a urethral
swab is obtained prior to voiding
In suspected urethritis in males, first few ml of urine
sample is collected
UTI in men and non-pregnant women
7 to 14 days course of Quinolones or TMP-SMX
12 to 16 weeks course of treatment required
In STD single dose Inj. Cephalosporin followed by oral antibiotics
(Quinolone/ Cephalosporin/ Doxycycline)
UTI in pregnancy
Ampicillin, cephalosporin and nitrofurantion are considered
Therapy to be individualized according to culture result
Treat the cause
Asymptomatic Bacteriuria to be treated in
Patients with neurogenic bladder
Persons undergoing urologic surgery
Renal transplant recipients
Catheter associated UTI
Change/ remove catheter
7 to 14 days of antibiotics according to culture report
Early percutaneous nephrostomy followed by elective
Specific infection of Urogenital system.
Mycobacterium tuberculosis is the main causative
Almost secondary from pulmonary TB.
Mainly Hematogenous spread.
Kidney and prostate are primary organs involved,
other organs involved by secondary seeding.
Anti tubercular treatment (EHRZ, SHRZ)
(Rifampicin, Isoniazid, Ethambutol, Pyrazinamide, Streptomycin)
I&D curettage and ATT
Removal of organ