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1、Infection of the Genitourinary Tract,Hongshu Ma Department of Urology Tianjin First Central Hospital,Urinary tract infections (UTIs) caused by pathogenic bacteria can involve any of the genital or urinary organs and eventually can spread from one site to anyor all of the others.,Definitions 1,Urinar
2、y tract infection is an inflammatory response of the urothelium to bacterial invasion that is usually associated with bacteriuria and pyuria.,Most UTIs are caused by aerobic gram-negative rods, (Escherichia coli.), gram-positive cocci (enterococci) and to a lesser extent by anaerobic bacteria.,Defin
3、itions 2,Definitions 4,Pyuria is the presence of white blood cells in the urine Bacteriuria without pyuria indicates bacterial colonization rather than infection. Pyuria without bacteriuria warrants evaluation for tuberculosis, stone, or cancer.,Classification,According to their nature history First
4、 infections/Isolated InfectionRecurrent infections Bacterial persistence Reinfections,Reinfection is recurrent infection with different bacteria from outside the urinary tract. Each infection is a new event; the urine must show no growth after the preceding infection.,Bacterial persistence refers to
5、 a recurrent urinary tract infection caused by the same bacteria from a focus within the urinary tract, such as an infection stone or the prostate.,According to Their Site of Origin,Upper urinary tract infection Lower urinary tract infection Genital system infection,Upper-tract infection,Acute pyelo
6、nephritis Chronic pyelonephritis Emphysematous pyelonephritis Renal abscess Perinephric abscess Xanthogranulomatous pyelonephritis,Lower-tract infection,Acute urethral syndrome (Women) Acute cystitis,Genital infection,Acute and chronic bacterial prostatitis. Acute and chronic epididymitis.,Pathogene
7、sis,Bacterial pathogenesis in the urinary tract depends on a number of facters, chief of which are the Bacterial Virulence Facters and the Host Susceptibility Factor,Bacterial virulence factors,Ability of adherence to urothelial cells Ability to resist bactericidal activity Ability to produce hemoly
8、sin.,Host susceptibility factors,Emptying of urine Surface mucins Urinary antibodies Urinary osmolality pH,Routes of infection,(1) Ascending infection (2) Hematogenous spread (3) Lymphatogenous spread (4) Direct extension,DIAGNOSIS,Urine Collection,Suprapubic Aspiration Urethral Catheterization Segm
9、ent Voided Urine Specimens,Urinlysis,More than 3 fresh leukocytes/High- power field,Quantitative urine culture,Colonies forming units per milliliter (cfu/ml) 100,000 cfu/ml 1000 to 10,000 cfu/ml,Location of urinary tract nfection.,Symptoms and signs Laboratory findings X-Ray findings Radionuclide im
10、aging MRI findings,Treatment strategy.,Antimicrobial drug Mdication for pain, fever, and nausea. To give fluids intravenously and orally Complicating factors (eg. Obstructive urography or infected stones),Acute Pyelonephritis,Definitions,Acute pyelonephritis is defined as inflammation of the parench
11、yma and the pelvis of the kidney causing by bacterial infection.,Etiology & Pathogenesis,Aerobic gram-negative bacteria E coli Gram-negative entric organisms Enterococci, and staphylococcus aureus Ascending infection (VUR) Hematogenous,Clinical findings 1,An abrupt onset of chill , moderate to high
12、fever Dysuria, frenquency, urgency. Abdominal pain, nausea, vomiting, and even diarrhea.,Clinical findings 2,Costovertebral angle tenderness Palpation or percussion over the costovertebral angle on the affected kidney usually causes pain. The patient sometimes has abdominal distention, tenderness, a
13、nd a quiet intestine,Dignosis 1,Laboratory findings: Leukocytosis Pyuria, Bacteriuria, Proteinuria, Hematuria Quantitative urine culture Total renal function,Dignosis 2,Imaging: Plain film Excretory urograms . Voiding cystogram CT Ultrasonography Radionuclide,Differential Diagnosis,Pancreatitis Basa
14、l pneumonia Acute-intra-abdominal disease Women pelvic inflammatory diseaseand acute prostatitis Renal abscess Perinephric abcess.,Treatment 1,Antimicrobial drugs: The appropriate intravenous treatment Oral drug Repeat urine cultures,Treatment 2,Specific measures: Any complicating factors (eg. obstr
15、uctive urography),Prostatitis,Types of protatitis,Drach (1978) (1) acute and chronic bacterial prostatitis, (2) nonbacterial prostatitis (3) prostatodynia.,NIDDK categorization and Drach classification,Diagnostic techniques,The expressed prostatic secretions (EPS) Leukocytes 10 per high-power field
16、(hpf),The 4-glass test (Stamey 1968),Acute bacterial prostatitis,Etiology & Pathogenesis,E coli 80% Enterococci 5-10% Anaerobes rarely Intraprostatic reflux of urine Invasion by rectal bacteria Hematogenous spread,Clinical features,The sudden onset of fever, chills. Low back and perineal pain. Frenquency and urgency, nocturia, dysuria Varying degrees of bladder outlet obstruction.,Digital rect
