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    Urinary Tract Infection (UTI)

  • What is urinary tract infection (UTI)?
  • Classification of UTI
  • How is UTI diagnosed? How to have the process of its diagnosis done correctly for right care?
  • What kinds of UTI patients require a comprehensive evaluation?
  • Common difficulty and confusion in diagnosing and treating UTI
  • What are the modifiable or correctable causes for UTI?
  • Key points of life reality

    This article is to answer some often-asked questions about UTI for general public, not to exhaust its
    "everything" for professionals and academicians, so to help the affected to ease unwanted and
    unnecessary UTI-related anxiety, to improve its treatment efficiency, according to Dr. Lin's lifelong study
    and practice in medicine, especially urology.  

    What is urinary tract infection (UTI)?
    UTI is a vague term that denotes some infective agents invading some where inside urinary tract, that is,
    kidneys, ureters, bladder, and urethra.

    For females, urethra is a 4-5 cm tubes; for males, it consists of prostate urethra and membranous urethra
    which are equivalent to the urethra of females plus a long tube called bulbous urethra, which is the fixed
    part of urethra called bulbous urethra, which is between the part behind scrotum(sac) and distal to
    prostate urethra, and the mobile part called pendulous urethra which is inside the penis.

    Classification of UTI
    To help understand, communicate, and treat UTI, its classification is designed by anatomical involvement
    and clinical complexity as follows:
    By anatomical involvement, it is classified as upper or lower UTI:
    1. lower UTI denotes only involve bladder and urethra, and chiefly presents with irritative voiding
       symptoms such as increased urinary frequency, urgency, bladder pain, painful urination, not emptying
       bladder well, etc. + occasionally fever and chill particularly in someone being unable to empty bladder;

    2. upper UTI chiefly denotes UTI clinically involving kidneys and ureters, and clinically manifests pain in
       the middle of the back, usually one-sided and constant, and more likely has fever and chill with general
       sickness and exhaustion than the lower UTI because of involving the kidney tissue.

    For treatment, upper UTI needs taking the selected antibiotics longer-usually 2 weeks or longer, and
    lower UTI, about 3-5 days unless having a poorly emptying bladder or in men with bacterial prostatitis,
    which will require a longer use of selected antibiotics as selected with urine culture from properly
    collected fresh urine.

    By clinical complexity and implication, it is classified as uncomplicated or complicated UTI:
    This differentiation can be done easily by reviewing the information as described in the next section-
    How is UTI diagnosed?...
    1. Most of UTI are uncomplicated as those in most of sexually active females, who can be treated
    empirically by taking antibiotics for 3-5 days.
    2. Complicated UTI occurs in some who are suspected to involve upper urinary tract-kidneys and ureters,
    and those who may have obstruction from various causes like stone, tumor, or inborn defect, somewhere
    along urinary tract. The commonly affected are males and females with upper UTI, and they need to take
    antibiotics for 7-14 days or even longer under professional discretion and follow-Up so to provide timely
    modification so to attest: Doctors have never cured anything for anyone, but, at most and at best, merely
    modify something for someone to some degree with or without drugs and or procedures at reasonable
    time in reasonable way to reasonable patients.

    How is UTI diagnosed? How to have the process of its diagnosis done correctly
    for right care?
    Most of cases with UTI are diagnosed with urinalysis and urine culture from properly collected fresh urine
    when they are evaluated for unbearable change in how they void such as going to pee "too" often-
    frequency-and/or in a hurry-urgency, leaking urine, burning painful urination, slow urine flow, pushing to
    pee, not emptying bladder, or being unable to pee at all.

    If unbearable voiding change is the first-time life event, make sure to be evaluated and diagnosed
    correctly if any possible before taking antibiotics under assuming you get UTI.

    The recommended standard for right diagnosis comprises a comprehensive effort to review the specifics,
    relevance, and sequence of events of all symptoms and to properly interpret the findings of properly
    conducted physical examination and timely and correctly done urine or blood tests. Such effort will surely
    and most likely reach a right diagnosis so to initiate right treatment. How to have these related things for
    good care done correctly? Follow the instructions as described in What Should We Do at Feeling Sick?

    Through such a comprehensive effort, doctors can tell if the UTI is uncomplicated or complicated as well
    as upper or lower urinary tract infection.

    For those with known history of recurrent UTI, at times, some of them could be empirically treated after a
    brief screening triage to assure nothing serious; such approach should be done under a cooperative
    effort between patients and the attending doctors, but still with caution and timely directly or indirect follow-
    up so to avoid later finger-pointing blame each other if the outcome of assumed care fails to meet
    expectation.

    What kinds of UTI patients require a comprehensive evaluation?
    As mentioned above, a comprehensive evaluation should be provided to those who are clinically
    suspected to have upper and / or complicated UTI.

    Common difficulty and confusion in diagnosing and treating UTI
    The anatomy and physiology of urinary and genital tracts are near and overlapping. Hence, to a great
    degree, the symptoms of UTI and STD may be not only overlapping, fusing, and confusing; so are the
    interpretation of the findings of physical examination and laboratory testing as well as acquirement of
    urine specimen for urinalysis and culture. However, the approach to a systemic and comprehensive
    evaluation as described in What We Should Do When We Feel Sick? can overcome such inherent
    difficulty; so, peruse this articles and others in the selected category of What to do at Feeling Sick? in the
    HOME page of www.ForMeFirst.com.

    Keep these in mind, you can take precaution in collecting specifics, relevance, and sequence of events of
    all symptoms and in obtaining urine specimen so to ask, interact, and work closer and better with the
    attending doctor to reach best possible diagnosis for most reasonable treatment, care, and counseling at
    possibly having UTI at present and in the future.

    What are the modifiable or correctable causes for UTI?
    1. Obstruction, inability to empty bladder, from inborn or acquired causes by accidental traumatic or
       surgical injury to local regional tissues or nerves, positioning, or even drug side effects;
    2. Instrumentation and procedures with catheter insertion leading the pact;
    3. Urinary stones in the ureters especially in those with severe ureteral obstruction, recurrent UTI and
       diabetus mellitus, etc.;
    4. Fistula between bowel and bladder like those from colonic diverticulitis, chronic bowel inflammatory
       disease, after prostate procedures, or from malignancy.

    Steps and Options of Care for UTI - new or recurrent
    1. Realize, understand, and accept the facts of life reality and disease through counseling;
    2. Keep up healthy lifestyle without overindulgence and obsession;
    3. Take on behavioral modification with necessary and realistic adjustment according to personal   
       mental and physical capacity so to optimize personal defense immunity
    4. Use medications-antibiotics and/or symptoms-releieing  and /or voiding-improving agents as
       needed and as tolerated.
       a. Antibiotics from empirical selection like nitorgurantoins, trimethoprin/sulfamethoxazole (Bactrim
           or Septra) or laboratory selection according to urine culture and sensitivity. If effective,
           UTI-related urinary irritative symptoms should be drastically improved in 1-3 days and normal
           voiding will return in 5-10 days. If not improved as expected, reassess for bettering diagnosis by
           ruling out IC (interstitial cystitis) or CPPS (chronic pelvic painful syndrome) and /or bacterial
           sensitivity.
      b. Drugs to improve urine flow by relaxing urinary sphincter, which can be used for males or females:
           Chiefly, alpha-blockers are used, such as alfuzosin (Uroxatrol), doxazosin (Cardura), tamsulosin
           (Flomax), terazosin (Hytrin), etc. If working, it may improve urine flow in 1-3 days.
           Key side effects: dizziness from postural hypotension.
      c. Drugs to improve urine flow by shrinking the size of prostate, of course only for males: Examples
           are finasteride (Proscar) and dutasteride (Avodart). If working, urine flow may be improved in 1-3
           months. Key side effect: Impair erection.
      d. Drugs to ease painful urination: Phenozopyridine is the most common agent in use. And the drugs to
           ease bladder instability, bladder spam: Examples: oxybutynin (Diropan, Ditropan XLor Urotrol),
           tolterodine (Detrol, Detrol LA),  fesoterodine (Toviaz), Trospium, Darifenacin (Enablex), solifenacin
           (Vesicare), mirabegron (Myrbetriq), etc. Key side effect: dry mouth, constipation, etc.
      e. Drugs for long-term prevention with continual or intermittent use under self-testing and self-treating
           regimen: Ntrofurantoin or trimethoprin/sulfamethoxazole or cranberry extract or urine-acidifying agents
           or even periodic bladder antibiotic instillation.

    Key points of life reality
    - Doctors have never cured anything for anyone, but just modify something for someone to some
      degree at reasonable time in reasonable way to reasonable patients with or without drugs and / or
      procedures.

    - No magic in life and medicine; if any, that is to apply current available knowledge, skill, technology,
      drugs, common sense, and wisdom at reasonable time in reasonable way to reasonable patients to
      allow the body to undergo its best possible self-healing process so to optimize functional    
      improvement and recovery with its own residual strength.

    To stress the above understanding, go to the self-explanatory selection of What to Do at Feeling Sick?
    and Basics of Life Reality and Self-Care on HOME page of www.ForMeFirst.com.


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    Note:
    The article below contains the information which well concurs with mine as what I have often elaborated to
    and discussed with my patients who have been treated repeatedly elsewhere before coming to see me; it
    worths to read.

    http://formefirst.com/eNewsletter06.htmlRegarding the Diagnosis and Treatment
    of Urinary Tract Infections - Click to link:    . It is worthwhile to read!
                             by Lucas Schulz, PHARMD; Robert J. Hoffman, MD; Jeffrey Pothof, MD; Barry Fox, MD
                             from J Emerg Med. 2016;51(1):25-30. from The Journal of Emergency Medicine
                            
    Copyright is preserved. Copying is prohibited without author's permission.
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