History of Genitourinary Disease

Excerpt

The severity of urinary tract infection is variable. Cystitis is an important cause of discomfort and inconvenience but is not life threatening and seldom leads to permanent damage of the urinary tract. Treatment is aimed at alleviation of symptoms. When recurrent cystitis is a problem, urinary suppression with chronic antibiotic therapy may be indicated. Pyelonephritis can lead to permanent renal scarring and dysfunction or to septicemia and death. These complications are especially likely to result when obstruction and pyohydronephrosis are present. Of uncertain significance is so-called asymptomatic bacteriuria, positive urine cultures without symptoms. It was formerly believed that this was a manifestation of chronic pyelonephritis and could lead to renal failure. In the absence of underlying structural renal disease, however, asymptomatic bacteriuria is probably not a cause of progressive renal damage. It is quite difficult to separate asymptomatic colonization of the upper tract from that of the lower tract. Techniques such as bladder washout or ureteral catheterization are definitive but invasive. Testing voided bacteria for coating by antibodies (often present with tissue infection) is noninvasive but neither adequately sensitive nor specific.

It is important to know whether a urinary tract infection is associated with a significant anatomic lesion. Treatment of a remediable lesion may prevent further episodes of infection and damage to the urinary tract from obstruction caused by the lesion. Cystitis is common in young women and probably does not warrant an anatomic investigation. Evaluation of repeated episodes has a low yield but may be indicated. Lower tract infection is rare in males with normal urinary tracts. Like upper tract infections in any patient, lower tract infection in males should be investigated with appropriate anatomic studies.