Urinary Tract Infection in Males Disease – The Healing Space Clinic

Urinary tract infection in males

DESCRIPTION

Cystitis is an infection of the lower urinary tract, usually resulting from a single gram-negative enteric bacteria. (See separate chapters for information on prostatitis, pyelonephritis, and non-gonococcal urethritis.)

System(s) affected: Renal/Urologic
Genetics: No specific genetic pattern
Incidence/Prevalence in USA: Not common
Predominant age: Increases with age. Uncommon in men under 50. 8 infections/10,000 men, ages 21-50.
Predominant sex: Male only (for this discussion)

SIGNS AND SYMPTOMS

Urinary frequency
Urinary urgency
Dysuria
Hesitancy
Slow urinary stream
Dribbling of urine
Nocturia
Suprapubic discomfort
Low back pain
Hematuria
Systemic symptoms (chills, fever) present with concomitant pyelonephritis or prostatitis

CAUSES

Escherichia coli (80% of infections)
Klebsiella
Enterobacter
Proteus
Pseudomonas
Serratia
Streptococcus faecalis and Staphylococcus

RISK FACTORS

Benign prostatic hypertrophy
Cognitive impairment
Fecal incontinence
Urinary incontinence
Anal intercourse
Recent urologic surgery, catheterization
Infection of the prostate or kidney
Urinary tract instrumentation
Immunocompromised host
Outlet obstruction

LABORATORY

Pyuria
Bacteriuria
Urine dipstick leukocyte esterase (75-90% sensitivity, 95% specificity) and nitrate (35-85% sensitivity, 70% specificity)
Urine culture - 10/high power colonies of pathogens (or counts > 100,000 bacteria/mL of urine) confirms diagnosis (Escherichia coli, Klebsiella, Pseudomonas, other agents). Lower counts can also be indicative of infection, especially in presence of pyuria.
Segmented bacteriologic localization cultures
- VB1 - collect 5–10 mL of urine of patient's initial voiding
- VB2 - sample of sterile midstream urine is obtained
- EPS - prostatic massage performed, and expressed prostatic secretion is collected from the meatus
- VB3 - patient completes voiding and 4th sample is collected
- Cultures and sensitivity collected from each specimen

Drugs that may alter lab results: Antibiotics prior to culture Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Depends on site of infection

SPECIAL TESTS

Urologic investigations necessary to rule out other disorders

IMAGING

Intravenous pyelography, cystoscopy, ultrasound

DIAGNOSTIC PROCEDURES

Careful history and physical

ASSOCIATED CONDITIONS

Acute bacterial pyelonephritis
Chronic bacterial pyelonephritis
Urethritis
Prostatitis
Prostatic hypertrophy
Prostate cancer

AGE-RELATED FACTORS

Pediatric: Usually associated with obstruction to normal flow of urine, such as vesicoureteral reflux
Geriatric: Bacteriuria is common in the elderly, appears related to functional status and is usually transient. If asymptomatic bacteriuria is noted, no treatment is needed.
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

PREVENTION/AVOIDANCE

Prompt treatment of predisposing factors
Catheter use only when necessary. If needed, use aseptic technique and closed system, with removal as soon as possible.

POSSIBLE COMPLICATIONS

Pyelonephritis
Ascending infection
Recurrent infection

EXPECTED COURSE AND PROGNOSIS

Clearing of infections with appropriate antibiotic treatment

APPROPRIATE HEALTH CARE

Outpatient, except for acute illness with toxicity or kidney failure

GENERAL MEASURES

Hydration and analgesia if required
Discontinue sexual activity until cured
Patient with indwelling catheters
- If asymptomatic bacterial colonization - no need to treat (sterilization of urine not possible and resistant organisms can take up residence)
- If symptomatic of acute infection - institute treatment

SURGICAL MEASURES

N/A

ACTIVITY

Activity as tolerated.

DIET

No special diet

PATIENT EDUCATION

For patient education materials favorably reviewed on this topic, contact: National Kidney Foundation, 30 E. 33rd Street, Suite 1100, New York, NY 10016, (212)889-2210

Clinical Investigations

ROLE OF HOMOEOPATHY

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