LOWER URINARY TRACT INFECTIONS

R.A.S HEMAT, MB;BCh, FRCSI, DUL.

Urethritis occurs in both men and women. Cystitis is a syndrome, may be a part of a generalised UTI, or localised only to the bladder.

Drug-induced cystitis (DIC) is a term best reserved for cases where the causal relationship has been established over time by the assessment of many patients or by rechallenging patients with the same drug. Many drugs can influence bladder function, making it vulnerable to unwanted effects of pharmaceutical agents. Drug-induced cystitis is prone to delayed recognition.
Abacterial cystitis is a spectrum of clinical situations from urethral syndrome to interstitial cystitis. Female urethral syndrome may be the female prostatitis syndrome. Chronic or late radiation cystitis produces ulcers, fibrosis, vascular stenosis, and a definite diminished capacity. As with prostatitis, the localised problem often recurs.

Mast cells in patients with interstitial cystitis (IC) have high-affinity expression of oestrogen receptors and, with a rise in oestrogen at pregnancy term, NO and cGMP production are inhibited. IC’s detrusor muscle is less sensitive to histamine.
Epididymitis is the most common of the intrascrotal infections. Epididymitis is usually unilateral and must be differentiated from testicular torsion, tumour, or trauma. Orchitis or epididymo-orchitis is the most common complication of epididymitis. Scrotal elevation and bed rest may provide symptomatic relief.

Prostatitis syndromes include, acute bacterial prostatitis, chronic bacterial prostatitis, nonbacterial prostatitis, and prostatodynia. Nonbacterial prostatitis is the most common prostatitis syndrome. Prostatodynia (PD) is a painful prostate, it is the presence of symptoms of prostatitis in the absence of any physical findings. Acute bacterial prostatitis is manifested by marked oedema and inflammation of the prostate gland. In chronic prostatitis, there is less marked and more focal inflammatory reaction than the acute disease. Organisms persist in prostatic fluid, can be the reason for reinfection after antibiotic discontinuation, in chronic prostatitis.

Prostatic abscess is uncommon condition. TRUS may show, heterogeneous areas and irregular hypoechoic areas. The majority of the abscesses start as a UTI: prostatitis, epididymitis, gonorrhoea and pyelonephritis. Unrecognised infected prostatic stones are often responsible for the failure of antibiotic therapy for CBP.

Feb, 2002

Note: The information in this article has been excerpted from the following books: urotext-ebook simplifying urology, Principles of modern urology, by Dr. R.A.S HEMAT. Permission is granted to copy and redistribute this document electronically as long as it is unmodified. This article may not be sold in any medium, including electronic, CD-ROM, or database, or published in print, without the explicit, written permission of Dr. R. A. S. Hemat.

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Dr. R.A.S HEMAT declares no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, stock holdings, gifts, or honoraria.