Brig HAROON SABIR KHAN
FCPS (Surg), FCPS (Urology)
FEBU (Europe), MHPE (RIU)
Professor of Urology

Objectives
 By the end of this presentation students will be
able to
 List upper and lower urinary tract parts
 Define Urinary tract infections
 Explain pathophysiology of UTI
 List the various factors responsible for UTI
 Diagnose 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
 Uncomplicated/Complicated
 First infection
 Recurrent infection
 Unresolved
 Persistance
 Re-infection

Prevalence
 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.

Urinary Tract Infection- Types
 Pyelonephritis
 Intrarenal abscess
 Pararenal abscess
 Cystitis
 Prostatitis
 Urethritis
Upper
Lower

Bacteria
 NON-SPECIFIC
 E-Coli
 Enterobacter
 Proteus
 Klebsiella
 Pseudomonas
 Streptococcus fecalis
 Staphylococcus aureus
 Staphylococcus epidedimidis
 SPECIFIC
 Mycobacterium tuberculosis (GUTB)
 Neisseria gonorrhoeae (Gonorrhoea)
 Teponema pallidum (Syphillis)
 Trichomonas vaginalis (Trichomoniasis)
 Trematode (Schistimiasis )
 Echionococcus granulosis (Hydatid cyst)
 Candida albicans (Fungal infection)
Gram positive
cocci
Gram negative
rods

Pathophysiology
Routs of Infection
 Ascending
 Descending
 Iatrogenic
 Hematogenous
 Lymphogenous
 Extension from neighboring organs

Pathophysiology
 Uncomplicated UTI
occurs in patients who have a normal unobstructed
urinary tract, most commom in young, sexually active
women
 Complicated UTI
a. patient is a child or a pregnant woman
b. Presence of structural or functional deformity or
obstruction
c. Underlying disease (diabetes, CKD, immunocompromised pt.)
d. Recent instrumentation or surgery of urinary tract

Clinical Manifestations
 Emphysematous Pyelonephritis
associated with production of gas in renal and
perinephric tissue specially in diabetics.
 Xanthogranulomatus Pyelonephritis
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

Classification
 Acute Pyelonephritis
 Chronic Pyelonephritis
 Xanthogranulomatus Pyelonephritis
 Emphysematous Pyelonephritis
 Pyonephrosis and perinephric abscess
 Cystitis acute/chronic
 Acute urethral syndrome
 Epididymitis and orchitis
 Per urethral abscess
 Prostatitis/Prostatic abscess
 Fournier’s Gangrene

Investigations
 Urine R/E
 Urine C/S
 CBC
 RFTs
 Ultrasound
 Plain X-Ray KUB
 CT Scan plain/contrast enhanced
 IVU
 MCUG
 Isotope Scan (DTPA, DMSA, MAG-3)

Urine Collection
 Clean-catch mid stream urine sample
 Foleys catheterization
 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

Management
 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
relatively safe

Management
 Complicated UTI
 Therapy to be individualized according to culture result
 Treat the cause
 Asymptomatic Bacteriuria to be treated in
 Pregnant women
 Patients with neurogenic bladder
 Persons undergoing urologic surgery
 Renal transplant recipients

Management
 Catheter associated UTI
 Change/ remove catheter
 7 to 14 days of antibiotics according to culture report
 Xanthogranulomatus pyelonephritis
 Nephrectomy
 Emphysematous pyelonephritis
 Early percutaneous nephrostomy followed by elective
nephrectomy

Complications
 Recurrent UTI
 Permanent Kidney damage
 Low birth weight or premature infants
 Stricture urethra/ureter
 Infertility
 Sepsis/abscess
 Shrunken urinary bladder

Genitourinary Tuberculosis
 Specific infection of Urogenital system.
 Mycobacterium tuberculosis is the main causative
organism.
 Almost secondary from pulmonary TB.
 Mainly Hematogenous spread.
 Kidney and prostate are primary organs involved,
other organs involved by secondary seeding.

Clinical Features
 Hematuria gross/ microscopic
 Sterile Pyuria
 Flank pain
 LUTS
 Epididymo-orchitis
 Hydrocele
 Discharging scrotal sinuses
 Infertility
 Low grade fever/ weight loss
 Menstrual irregularities

Investigations
 Urine R/E
 Urine C/S
 Urine for AFB (ZN Staining)
 Urine culture for AFB
 CBC
 PCR
 Ultrasound
 CT Scan (contrast enhanced)
 Cystoscopy/ biopsy

Pathogenesis

Management
 Medical treatment
Anti tubercular treatment (EHRZ, SHRZ)
(Rifampicin, Isoniazid, Ethambutol, Pyrazinamide, Streptomycin)
 Surgical treatment
I&D curettage and ATT
Removal of organ
Reconstruction surgery