Urinary tract calculi
S Asbury, A Mishra, KM Mokbel, M Fishman Jonathan in Principles of Operative Surgery, 2017
This chapter discusses the different types of urinary tract calculi, diagnosis for ureteric colic and the initial management of urinary tract calculi. It provides the relative contraindications to performing an intravenous urogram (IVU). Renal colic is intensely painful. Therefore adequate analgesia should be administered immediately. Relief is normally obtained with parenteral opiates and NSAIDs, and rehydration with oral and intravenous fluids should be commenced. A urine sample should be tested for haematuria and pyuria. Serum electrolytes should be tested to assess renal function, and a white cell count should be measured. A plain kidney, ureter and bladder (KUB) X-ray should be taken. Around 90% of renal tract stones are radio-opaque and should be visualised on this film. IVU can then be performed to confirm the diagnosis, determine the degree and level of obstruction, and verify the presence of the contralateral kidney.
Inflammation and Infection
Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple in Basic Urological Sciences, 2021
Urinary Tract Infections (UTI) - inflammatory response of urothelium to micro-organism invasion, usually associated with bacteriuria and pyuria. Uropathogenic Escherichia coli (UPEC) is the main cause for both uncomplicated and complicated UTIs. Uropathogens can avoid bladder host defences and multiply and ascend to the kidneys. At high concentrations, lyses host cells which allow uropathogens to cross the epithelial barrier and gain access to host iron stores that are necessary for growth. Hydrolysis of urea to carbon dioxide and ammonia. The host deploys constitutive and induced innate defence mechanisms which interfere with colonization. Urine - high osmolality and acid pH discourages bacterial growth. Micturition - flushes away infected, apoptosed BECs and non-adherent microbes. ‘The presence of bacteria in urine in the absence of clinical symptoms normally associated with an UTI’.
Special Urine Tests
Alfred H. Free, Helen M. Free in Urinalysis in Clinical Laboratory Practice, 1975
There are many determinations which are performed on urines which do not readily fit into any particular classification. Many of these have a present or potential practical utility in clinical laboratory practice. This chapter describes several determinations as typical representative tests. The aminoaciduria accompanying the many variations of Fanconi's syndrome is well known, as is the specific aminoaciduria of cystinuria. Hydroxyproline is derived from proline and is an important amino acid constituent of collagen. The presence of hydroxylysine in urine was reported by Estes and Golaszewski. The milky appearance of the specimen may lead to false interpretation as pyuria or lipiduria. Pneumaturia is defined by Schreiner as the passage of gas bubbles in the urine. It can result from vesicovaginal fistula or vesicoentric fistula as a congenital anomaly in infants or as a result of a neoplasm or infection.
Asymptomatic group B streptococcal bacteriuria among pregnant women in Saudi Arabia
Published in British Journal of Biomedical Science, 2015
This study aims to determine the asymptomatic bacteriuria in pregnancy due to GBS and its antimicrobial sensitivity pattern for planning strategy for the management of these cases and also to determine the relationship between asymptomatic bacteriuria and pyuria. A total of 3863 consecutive urine specimens were collected from 3863 pregnant women with asymptomatic bacteriuria attending the obstetrics and gynaecology department of our hospital over a period of two years. Specimens were processed using standard microbiological procedures. All the subjects were evaluated for bacteriuria. The prevalence of asymptomatic bacteriuria due to group B streptococci (GBS) was 82/3863 (2.1%) among pregnant women in Saudi Arabia. Among these, 69/82 patients (84.2%) had clinical and microbiological features consistent with cystitis, versus 13/82 (15.8%) for pyelonephritis. About 51.2% (42/82) of the patients who had urine analysis performed had positive results based on positive urinary leucocyte esterase and pyuria. Disc-diffusion analysis of all 82 GBS isolates showed that they were highly susceptible to Augmentin and linezolid. Screening for bacteriuria in pregnancy and proper treatment must be considered as an essential part of antenatal care in this community. To prevent asymptomatic bacteriuria complications, all pregnant women should be screened at the first antenatal visit. A negative test for pyuria is not a reliable indicator of the absence of asymptomatic bacteriuria in pregnant women. Further, ongoing surveillance and evaluation of outcomes in pregnancies complicated by GBS bacteriuria is required to optimise maternal and newborn care.
Evaluation of the risk factors associated with the development of post-transurethral resection of the prostate persistent bacteriuria
Published in Arab Journal of Urology, 2017
Tarek Osman, Karim Omar ElSaeed, Hassan A. Youssef, Mohamed Shabayek, Ahmed Emam, Mohammed Saad Hussein
Objectives:To determine the preoperative, intraoperative and postoperative risk factors that influence the development of persistent post-transurethral resection of the prostate (TURP) urinary tract infection (UTI) defined as pyuria and/or bacteriuria remaining for 3 weeks after surgery. Patients and methods:This is a prospective study including 100 patients scheduled for TURP. Urine analysis and culture was performed immediately after catheter removal, then at 1 and 3 weeks postoperatively, and the results were correlated to various preoperative, intraoperative and postoperative potential risk factors to detect any significant relation to persistent UTI. Results:There was a statistically significant relationship between bacteriuria and the following risk factors: old age, past history of diabetes mellitus, large prostatic size, positive preoperative urine analysis and culture, preoperative catheter use, previous urological interventions, large size of sheath, long duration of operation, postoperative catheter events and postoperative manual wash. Conclusions:Many risk factors have been found to contribute to the development of post-TURP UTI and avoiding these factors can enhance recovery of patients undergoing TURP.
The uncertainties of the diagnosis and treatment of a suspected urinary tract infection in elderly hospitalized patients
Published in Expert Review of Anti-infective Therapy, 2018
Introduction: The diagnostic criteria for a urinary tract infection (UTI) and proper treatment of elderly patients hospitalized with nonspecific symptoms is uncertain. Areas covered: A nonsystematic literature review of the variable approaches in diagnosing and treating hospitalized elderly patients with a suspected UTI. Expert commentary: Bacteriuria and/or pyuria cannot confirm the diagnosis of a UTI because of the high prevalence in the elderly regardless of presentation so urine cultures are not indicated in those hospitalized for diseases outside the urinary tract. The microscopic urinalysis is imprecise and inaccurate, and lowers the sensitivity in detecting a bacteremic UTI if used to confirm a positive dipstick test result. There is some evidence that cancelling urine cultures in the absence of a positive dipstick (negative leukocyte esterase and nitrite) is safe and prevents unnecessary antibiotic therapy. Urinary catheterization to obtain a urine sample is common in the elderly and it is unclear if changes in antibiotic therapy based on culture results outweighs the risks of the procedure. In hospitalized elderly patients without septic shock, it is unclear when it is safe to withhold antibiotic therapy, and when patients with criteria used to define severe sepsis need immediate treatment with broad-spectrum antibiotics.
Related Knowledge Centers
- Bacteriuria
- Leukocytes
- Pus
- Urinary Tract
- Urine
- Tuberculosis
- Urinary Tract Infections