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URINARY TRACT INFECTIONS (UTI)

Often called cystitis which means inflammation of the bladder, urinary tract infections generally involve the bladder and rarely ascend (go upward) to involve the kidney where it is called pyelonephritis.

Symptoms

  • Frequent urination
  • Urgency (constant need to urinate)
  • Dysuria (pain when urinating)
  • Small volumes when urinating
  • Hematuria (blood in the urine)
  • Fever and/or flank/back pain

Causes and Treatments
The initial treatment for a urinary tract infection is antibiotics for 3-10 days, on average. If you have recurrent infections, treatment will depend upon the cause of the recurrent infections. There are multiple causes of UTI, depending on the age of the patient and/or their sex, with the primary causes listed below:

 
  • Sexual activity is the most common cause of recurrent urinary tract infections in the sexually active young female. Bacteria reside on the perineum (area between the rectum and vagina) and are introduced into the urethra/bladder during sexual intercourse. This type of infection is generally treated with antibiotics after sexual intercourse, and is called post coital prophylaxis.
   
 
  • Urethral diverticula develop in some women when a gland along the urethra becomes obstructed and swells. A small bulge can be felt vaginally coming from the urethra. During urination, this can fill with urine that may not empty. In addition, patients may have urinary frequency, dysuria (pain with urinating), and/or dyspareunia (pain with sexual intercourse). This condition is treated by surgical removal of the diverticula.
   
 
  • Menopause may lead to urinary tract infections because of the lack of estrogen. Local estrogen therapy restores the ability of the urethra to prevent ascent of bacteria into the urethra/bladder.
   
 
  • Stones, which can become infected and may continually infect urine in a descending (downward) way. These stones can be in the kidney, ureter or in the bladder. Stones are treated either medically or surgically depending on the composition of the stone and/or its location.
   
 
  • Retained Urine occurs if there is either an obstruction to urine flow or poor bladder contractility (weak bladder), leading to a retention of urine that can lead to a UTI. In men, obstruction may be due to urethral strictures or BPH (Benign Prostatic Hyperplasia). While rare, obstruction in women can be due to pelvic prolapse (dropped bladder or uterus) or urethral strictures. Poor bladder contractility may be due to Diabetes or neurologic conditions such as spinal cord injuries, stroke and/or Parkinson's Disease. In either case, patients may have symptoms of frequency (especially at night), straining to urinate, decreased force, and/or prolonged urination. Currently, the only treatment for retained urine due to poor bladder contractility is catheterization. These soft rubber catheters can either be used temporarily or permanently.

With patients that have retained urine because of obstruction, treatment is aimed at relieving the obstruction. Patients that have urethral strictures can have these dilated or incised. If the obstruction is due to BPH, patients may have TURP (trans-urethral resection of the prostate), TUNA (trans-urethral needle ablation of prostate), or open surgical procedures.

For a referral to a Beth Israel urologist in Manhattan or Brooklyn for urinary tract infection treatment, call our Physician Referral Service at 1-877-484-3466.

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