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UTI• ADHERERNCE MECHANISMS
• FIMBRIAE
• type I – mannose sensitive, adhere to uroplakins Ia and Ib on urothelium
• P type – mannose insensitive
• Pap (P pili associated with pyelonephritis) – 4 proteins (F, A, G, E)
• PapG is receptor component• 3 subtypes (I, II, III)• PapG subtype II associated more with
pyelonephritis• PapG subtype III associated more with cystitis
UTIs
• UTI• Infection• Complicated or not• Recurrent• Management
• Infection and stones – hand in hand
UTIs or cystitis
• 30% of women have at least one UTI in their lifetime
• Rare in Men – investigate• Recurrent UTIs in women warrant
investigation• $1.6Bn / year in US
Forman B, Am J Med 2002
UTIs – risk factors
• Host immunity vs. Bacterial virulence• Host– Bacterial flora– Immunity and comorbidity– Stasis– Foreign body
• Bacterial virulence– Fimbriae and Pili– Antimicrobial resistance
UTI – excluding a cause
• Complicated:– Structural or functional
abnormality or underlying disease to increase infection…• DM, renal insufficiency• Urological (DxT, childhood Hx),
neurological• Pregnancy, voiding dysfunction
– All men
UTIs – bacterial resistance
• E.Coli and coliforms – 80%• Staph. Sap. – 10%• Klebsiella, Enterobacter, Proteus ..– Note foreign travel– Recent in hospital care
Ronald, A Am J Med 2002
Recurrent UTI - referral
• UTIs that fail to respond to appropriate antibiotics.
• >2 UTI in 6 months• >3 in one year• In reality – balance of risk and impact
Recurrent UTI - management
• History (Current, childhood, family, risk factors…smoking)
• Examination – including pelvic examination
• MSU, bladder diary, GFR, USS, Flexi / Cystoscopy +EUA
• Pathology: Anatomical, functional, TCC, Stones
Recurrent UTI - management
UTIs• Very common• Confirm the infection and sensitivities• Refer complicated and/or recurrent UTIs• Beware red flags• Multi modality approach to treatment
• Questions…• UTIs…• Pathways…• Anything else Urological…
Renal Colic and Stones
• 10% risk, 50% recurrence risk at 10 years
• Risk factors include:– Geography– Diet– Anatomical– M>F– Fluid intake– Genetics (Cysteinuria)
Renal Colic and Stones at CUH
• Pain relief• History• Examination• Gold standard ED
management– CT KUB– Early diagnosis– Early treatment– Stone clinic F/U– Access to tertiary care
Renal Colic and stones at CUH
• CUH – Laser lithotripsy– ESWL– Dedicated stone clinic– Seamless link with SGH
• SGH– PCNL– URS (day case)
