Urology
Urinary Tract Infection
요로감염
Bacterial infection of the lower or upper urinary tract
- How common
- Women lifetime 50%, annual 11%
- Typical age
- Sexually active women and elderly
What is it?
Enteric bacteria (E. coli) ascend the urethra to colonize bladder/kidney.
Commonly affected: Urethra, bladder, (if ascending) ureter/kidney
How it develops
- Periurethral colonizationE. coli colonizes periurethral mucosa
- Urethral ascentP-fimbriae mediate adhesion and ascent
- Bladder invasionInvades urothelium, forms biofilm
- Inflammatory responseNeutrophil influx → dysuria, frequency, hematuria
Symptoms
- DysuriaBurning sensation on urination
- FrequencyFrequent small voids
- UrgencySudden compelling urge
- HematuriaGross hematuria in 20–30%
- Suprapubic painLower abdominal tenderness
How it is examined
- UrinalysisLeukocytes, nitrites, hematuria
- Urine cultureFor recurrent/complicated UTI
- Physical examCVA tenderness rules out pyelonephritis
Imaging
Simple UTI needs no imaging; renal US for recurrent/complicated.
- Clinical diagnosis
- Urinalysis confirms
CT urography to evaluate obstruction/stones in complicated UTI.
- Obstruction
- Stone evaluation
Non-surgical care
- NitrofurantoinFirst-line simple cystitis (100 mg bid x 5 days)
- TMP-SMXTMP-SMX DS bid x 3 days (resistance <20%)
- Fosfomycin3 g single-dose
- CiprofloxacinComplicated UTI; 250-500 mg bid x 7 days
- Hydration & hygiene>2 L/day water; wipe front-to-back
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Recurrent UTI with suspected anatomic abnormality
Procedures that may be discussed
- Cystoscopy
- Ureteroscopy (stone/anatomy)
- VUR surgical correction
Outlook
Cure rate 95% with antibiotics; 25% recur within 6 months.