By Chris Dawson, Hugh Whitfield
Urological difficulties surround quite a lot of either distressing and probably existence threatening stipulations and the variety of normal perform displays is starting to be quickly as a result of expanding age of the inhabitants. either trustworthy and accomplished, the second one variation of the ABC of Urology presents a completely up to date and revised consultant to the speciality which highlights the hot advances during this sector. Concentrating particularly at the remedy and prognosis of the commonest stipulations, the emphasis is on shared care, the place the talents of the first care workforce are utilized in conjunction with clinic referral.This concise, well-illustrated and hugely useful textual content will give you the excellent reference for basic practitioners and perform nurses, in addition to junior medical professionals dealing with health facility referrals.
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Extra info for ABC of Urology (ABC Series)
Protective glycoprotein layers that cover the urothelium are broken down, promoting colonisation of the exposed deeper layers. Patients susceptible to urinary tract infection also have increased carriage of adhesive bacteria in the large intestine, perineum, introitus, and prepuce. Features of urinary tract infections ● ● ● ● ● ● ● Urinary tract infection is common, particularly in women Urinary tract infection may be less common in men because the extra urethral length prevents bacterial colonisation of the bladder Cystitis produces symptoms of frequency, urgency, dysuria, and suprapubic pain Local symptoms may be absent, particularly in elderly people, who may present only with increasing confusion Urine often has an offensive odour Underlying functional or anatomic disorders must be excluded Ascending infection causes pyelonephritis, which typically presents with fever, loin pain, and malaise Risk factors for complicated urinary tract infection Male sex Old age ● Febrile urinary tract infection ● Symptoms for Ͼ 7 days ● Haematuria ● History of stone disease ● Recent hospitalisation ● ● ● Common urinary bacterial pathogens Klebsiella spp Providencia spp ● Citrobacter spp ● Serratia spp ● Enterococcus faecalis ● ● ● ● Escherichia coli Staphylococcus saprophyticus ● Streptococcus faecalis ● Proteus spp ● Pseudomonas spp Urinary tract infection symptoms Management of urinary tract infection in women Urinary tract infection is extremely common in women, as the short urethral length permits easy bacterial colonisation of the bladder.
A plain x ray of the kidneys, ureters, and bladder and a renal ultrasound examination will exclude upper tract abnormalities including stones. An ultrasound of the bladder combined with uroflowmetry will detect a residual volume and show the flow rate profile. A tight urethral meatus in women can result in poor bladder drainage and urinary infection. When obstructive symptoms predominate, a cystoscopy and urethral dilatation may improve flow and prevent further infection. Midstream urine samples ● ● ● True urinary tract infections, rather than contaminations, are present with Ͼ 105 bacterial forming colonies/ml of midstream urine Many patients with infective urinary symptoms have lower counts Presence of more than one type of organism suggests contamination Antibiotic sensitivity testing ● ● ● This is becoming increasingly important as the number of resistant organisms increases If bacteria present on urine culture are not sensitive to the antibiotic initially prescribed, an alternative needs to be prescribed Local knowledge of the bacterial uropathogens and their sensitivity is crucial to minimising the likelihood of prescribing an ineffective antibiotic Categories of women with cystitis symptoms according to bacterial presence ● ● ● Bacteria always present in urine Bacteria sometimes present in urine Bacteria never present in urine Treatment Uncomplicated urinary tract infections usually respond to a course of three days of oral antibiotics.
An exception can be made in young women with a proved urinary tract infection, but these patients should also be referred for investigation if the haematuria persists despite treatment of the infection. Macroscopic haematuria has a risk of 20–25% of cancer (bladder, renal, and prostatic) and the risk of detecting similar cancers in patients with microscopic haematuria is around 4%. Occasionally, bladder cancer presents with infection or is found incidentally on ultrasound. Investigation of microscopic haematuria is controversial, but currently the recommendation is that persistent evidence of haematuria on microscopy or dipstick testing in patients older than 40 years should be referred for investigation.