Urinary Tract Infections

A urinary tract infection (UTI) is infection of the urinary system which mainly includes the kidneys, ureters, bladder, prostate (in men) and urethra. Urinary tract infections occur when bacteria develops in the urinary system.

Normal urine contains no bacteria (germs). Bacteria can get into the urine and the urinary tract from the skin around the rectum and genitals by traveling up the urethra into the bladder. Lower urinary tract infection or cystitis is the bacterial infection which is confined only to the bladder and the urethra.

Upper urinary tract infection or Pyelonephritis is a bacterial infection of the kidneys resulting from bacteria traveling from outside the body into the urethra to the bladder and finally to the kidneys through the ureters.

For women, the risk of having a UTI is greater than men. This is probably because of a shorter urethra, so it is easier for the bacteria to move up to the bladder.

The following risk factors increase the likelihood of having a urinary tract infection:

• Diabetes
• Advanced age
• Urinary retention (difficulty fully emptying the bladder)
• Use of urinary catheter to urinate
• Having urinary tract abnormalities that block the flow of urine
• Bowel incontinence (the loss of bowel control)
• Kidney stones
• Pregnancy
• Surgical procedures involving urinary tract

If you have cystitis or a bladder infection you may have an intense urge to pass urine, pain or burning sensation when urinating, and urine may look cloudy, bloody or have a foul smell.

If you have Pyelonephritis or kidney infection you may have fever with chills, flushed, reddened skin, pain in the back, nausea, and vomiting.

Your doctor will ask about your urinary symptoms and then may order the following tests if a UTI is suspected.

Urine Test: A sample of urine is collected and analysed in a laboratory to determine if pus, red blood cells or bacteria are present.

Ultrasound Scan: An ultrasound scan is a non-invasive, painless scan done to see whether there are any abnormalities in your urinary tract, such as a narrow ureter or a bladder stone or kidney stone.

Blood Tests: These can help assess how severe the infection is. If the doctor thinks you may have a kidney infection, then you may need to have a specialized blood test where they check to see if there are any bacteria in the blood stream.

Specialised Tests: On occasions, your doctor may need to do some specialized tests :

• CT scan: This test is often done if there is an abnormality found on an ultrasound. It gives more detailed pictures of the different parts of the urinary tract and surround structures compared to an ultrasound.
• MAG 3 study: This radiological test assess the function of each kidney and also checks to see if there are any blockage to the drainage of urine from the kidney.
• Cystopscopy: This when a small camera is placed into the bladder. It can be done under local anaesthetic.
• Retrograde pyelogram/ureterscopy: These tests are done under general anasesthic and look at the ureters and the kidneys. Sometimes, whilst doing these tests you can not only find but also treat the cause of the infection.
• Micturatingcystourethrogram (MCUG): This test is used to study the bladder and to check for Vesico-ureteral reflux. During MCUG, you are asked to lie on a bed with a urinary drainage catheter in place. A contrast agent is injected into the bladder through the catheter. An X-ray film will be taken as the contrast agent passes out of your bladder. If the X-ray film shows that the contrast agent is leaking back up the ureters to the kidneys from the bladder then Vesico-ureteral reflux is diagnosed.

Treatments:

• Antibiotics are usually used to manage urinary tract infections. Depending on the type of infection present antibiotic therapy may be given either by mouth, IV or both.
• Your doctor may also prescribe medications to relieve the burning pain and urge to urinate.
• Surgery may be needed if certain abnormlaitioes are detected on any of the tests mentioned above.