HOW TO TREAT URINARY TRACT INFECTION IN MALE (UTI) ?
Urinary Tract Infection in Male
Introduction
Urinary tract infections are uncommon and rare in adult males
younger than 50 years, though increases with age among adults over 50 years of
age as well as 30 times more among adult women. Urinary tract is divided into
lower and upper urinary tracts. The lower urinary tracts include bladder and
urethra while the upper tracts are the ureter, pelvic and the kidneys.
Presenting complaints; Burning sensation on micturition
Frequency
Definition
Urinary tract infection is infection of the urethra, urinary
bladder, pelvic and kidneys. Infection results into inflammation of the urethra
(Urethritis), bladder (cystitis) and kidney (pyelonephritis).
Mechanism of Transmission
The usual route of inoculation in males is with gram –
negative aerobic bacilli from the gut with e.coli, recent hospitalization, urinary
catheter, infection of the genitourinary tract typically the prostate.
Older males with benign prostate hypertrophy have incomplete
bladder emptying predisposing them to urinary tract infection on basis of
urinary stasis. Microorganisms enter into prostate via urethra, intraprostatic
reflux of urine, bacteria through prostate ducts, hematogenous and lymphatic
route from rectum.
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| URINARY TRACT INFECTION |
Causes
Causes of urinary tract infection in male are prostatitis,
epididymitis, orchitis, urethritis, cystitis, and pyelonephritis. Special
causes include the following host spinal injury, diabetes mellitus, and
immunocompromised state such as HIV/AIDS, abnormality of the urinary tracts or
transplant.
Acute / Chronic prostatitis
Acute prostatitis results from acute infection of the entire
prostate glands resulting in fever with localized pain in the perineum, while
chronic prostatitis caused by inflammatory or non- inflammatory disease as a
result dysfunctional voiding, intra prostatic reflux, chronic exposure to microorganism.
Epididymitis
Is a constellation of sign and symptom caused by infection
or inflammation of epididymis leading to acute scrotum, abscess, infarction and
infertility? Chlamydia trachomatis and Nesseria gonorrhea are the most common
pathogen implicated as cause of epididymitis in patients younger than 35 years
of age. Infection results from retrograde ascent of infected urine from the
prostatic urethra into the vas deferens to epididymis.
Orchitis
Most of the orchitis result from genitourinary infection
especially viral pathogen such as mumps, infection via blood dissemination of
tuberculosis.
Pyelonephritis (infection of the kidney)
This is the infection of the renal parenchymal (tissue) and
usually occurs in a retrograde ascending fashion from the bladder or
haematogenously. Retrograde of infected urine as a result edematous ureteral
orifice and loss of its one way valvular function leading to flow of bacteria
into the renal tissue
Cystitis
Bacterial cystitis, the commonly encounter form of the
bladder infection with sudden onset of irritative voiding symptoms (frequency, urgency,
nocturia, dysuria and suprapubic pain) and occurring by ascending of infection from
urethra. This is common in anatomic abnormality, defect in bladder emptying
mechanism and urethral catheterization.
Urethritis
Milky penile discharge secondary to Neisseria gonorrhea
resulting in periurethral micro abscess and necrotic abscess
Benign Prostate hypertrophy (Enlargement) in more than 50 years patient
Fecal or urinary incontinence
Cognitive impairment
Use of urinary catheter
Diabetes mellitus
Age older than 50 years
Lack of systemic antibiotics
Homosexual behavior with anal intercourse
Lack of circumcision
HIV/AIDS infected patient
Intercourse with infected female
Clinical Manifestation
of Urinary Tract Infection
The following are classic presentation and are 75%
predictive of urinary tract infection; dysuria, urgency and urinary frequency by day and night.
While the following are atypical symptoms of urinary tract infection, abdominal
pain (supra-pubic pain/tenderness), fever, haematuria in the absence of frequency
and dysuria, smelling urine.
The following symptoms i.e. dysuria, urgency and urinary frequency, are
related to bladder and urethral inflammation commonly called cystitis and also know as lower urinary tract infections,while
loin pain and tenderness with fever and systemic upset
suggest extension of infection to the pelvic and kidney called pyelonephritis
and are the diseases of upper urinary tracts. Acute onset of hesitancy, urinary dribbling, previous urinary
tract infection, nocturia and gross haematuria in severe case.
Co morbidities e.g. diabetic mellitus, HIV/AIDS, prolong use
of steroid and previous history of surgery such as prostatectomy implies complicated urinary tract infection. These also manifest as urinary tract infection in addition to the present disease conditions signs and symptoms.
Pain in the perineum, lower abdomen, testicle, and penis or
with ejaculation, bladder irritation, blood in the semen, cloudy urine, fever,
chills and malaise, are all suggestive of prostate disease.
Scrotal pain and swelling as well as urinary frequency,
urgency and dysuria can be seen in epididymitis and cystitis
Pyelonephritis ,infection of the kidney, see in an ill looking patient with fever,
chills, and flank pain and prostate enlargement along with delayed presentation is the
primary cause of pyelonephritis.
Flank pain/costovertebral angle tenderness following urinary
tract infection combining with pyuria and bacteriuria also signify kidney
infection.
Urethritis i.e inflammation of the urethra, with gonococcal urethritis being the most common type occurs 2-6 days after inoculation,
resulting to symptoms like dysuria, thick, milky and copious penile discharge
and pruritus.
Diagnosis
Urinalysis, urine culture and gram stain, these
investigations help to detect the culprit organism and their drug sensitivity.
Urine culture is the most appropriate test to be done while
gram stain shows diplococci organism if present
The presence of protein, nitrite, bacteria and pyuria (presence of pus cell in the urine) indicate
urinary tract infection.
A true urinary tract infection is diagnosed when 2-5 or more
white blood cells or 15 bacteria/high power field are detected on urine
analysis/urine m/c/s .
Other investigations help to rule out other causes such as
abnormality in structure of the tracts and presence of co-morbidities such as diabetes
and HIV/AIDS that can result to complicated urinary tract infection.
The investigations above are the common and simple test you
can run while the special test such as scan is left to physician to decide
Management of
Urinary Tract Infection in Male
The management of urinary tract infection is basically on
the urine microscopy, culture and sensitivity (urine M/C/S) and gives the most
appropriate and sensitivity drugs to use.
Adequate control of glucose in diabetic patient and
commencement with compliance of anti-retro viral medication in HIV/AIDS. Correction of anatomical defect by surgery if needs
arise, proper shrinkage of prostate in case of prostate enlargement or by prostatectomy
Adequate intake of water mostly during and after
treatment with average of 1-2 liters of water and treatment of both partners in case of gonococci infection.
The most common and simple medications are listed below with
medication taking for an average of 7 days;
Tab Nitrofurantoin 50mg twice daily
Tab Ciprofloxacin 500mg twice daily
Mist Spot Citrate 10mls twice daily
I prefer to make use of sensitive drugs from the cultured
urine sample especially when injections are present and in case no improvement
visits your physicians
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