Natural UTI Infection Treatment Book

UTI Be Gone By Sherry Han

UTI Be Gone by Sherry Han is a comprehensive and simple e-book that describes how sufferers can eliminate urinary tract infection quickly and naturally. The document will demonstrate customers how you can quickly stop the discomfort brought on by UTI and how to cure it with practically no negative effects. Using antibiotics is not a good way to treat urinary tract infections since bacteria will boost resistance against antibiotics after each use. The only way to treat urinary tract infections permanently is to do that the natural and effective way. With UTI Be Gone, sufferers will know how to alleviate their problems once and for all. Sherry Han will show people how she got rid of this disease within a few weeks. Since Sherry Han released the program, she has received many positive comments from customers regarding their success.

Uti be gone Natural Urinary Tract Infection Cure Summary


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Urinary tract infections

Urinary tract infections occur in diabetic people with the same frequency as in those without diabetes, but they are sometimes exceptionally severe and may cause the renal papillae to slough, causing necrotising papillitis, or rarely emphysematous cystitis with air in the bladder wall. Infection is particularly troublesome in the rare patient with urinary retention from neurogenic bladder. Diabetic control is easily disturbed by urinary infection, as with any infection, and must be regained quickly, with insulin if necessary, while the infection is treated with antibiotics.

Therapeutic Alternatives and Developping Treatments in Refractory Urge Incontinence and Idiopathic Bladder Overactivity

The other treatments available are more invasive and often irreversible surgical procedures. Surgical therapy should only be considered when all conservative methods have failed. Endoscopic approaches have been used in urgency incontinence 162 . Overdistension of the bladder is thought to reduce bladder distension by causing degeneration of unmyelinated C afferent small sensory fibers. This technique requires anaesthesia and have some complications including hematuria, urinary retention and bladder perforation in 5 to 10 146 . Although effective in short term management, this procedure is usually temporary in symptomatic control. Bladder myectomy (autoaugmentation) has beeen proposed as an alternative to enterocystoplasty. Detrusor myectomy involves incising and removing the bladder muscle to allow bladder mucosa to form a pseudodiverticulum. Detrusor myectomy for treatment of refractory urge incontinence due to detrusor overactivity in both sexes has been reported to be successful in...

Urinary Tract Infection Uti Definition

A UTI is defined as infection of any part of the urinary tract with bacteria. It is most commonly caused by the patient's own bowel flora but can also be caused by skin organisms. UTIs are more common in women than men. Worldwide 20 of women will suffer from a UTI at some stage in their life. UTIs are classified as uncomplicated or complicated. Uncomplicated UTI - infection in a patient with no underlying renal or neurological disease. Complicated UTI - infection in men or in the presence of underlying structural, renal or neurological disease. dysuria Left untreated and in severe cases a UTI can migrate along the renal tract and the patient may develop acute pyelonephritis. Progression to pyelonephritis is associated with substantial morbidity. Patients can develop urethral obstruction, septic shock and perinephric abcess. Chronic pyelonephritis may lead to scarring and diminished renal function. As always, utilise an ABCDE approach to assessment. Airway Utilise airway adjuncts if...

Distribution and Clearance of Adenovirus from the Respiratory Tract

Adenovirus is an important respiratory pathogen affecting individuals of all ages with an annual incidence of between 5 to 10 million in the United States. Infections can occur sporadically, epidemically and nosocomially but most individuals are infected at a young age adenovirus accounts for 7 to 10 of all respiratory illnesses in infants and children 8, 9 . Although adenovirus frequently causes a mild, acute upper respiratory illness, e.g., the common cold, respiratory infections occur as a broad spectrum of distinct clinical syndromes ranging from self-limited acute pharyngitis to fatal pneumonia 10-12 , Adenovirus has also been identified an etiological factor of exacerbations in individuals with chronic obstructive lung diseases and infections can be especially problematic in immunocompromised individuals. Examples of the latter include persistent bladder infections in individuals with chemotherapy-induced neutropenia, fatal pneumonia in neonates, and exacerbation of graft...

Clinical Manifestation

Differential diagnosis includes sepsis in the early stages, and at later stages, metabolic disorders, congenital heart diseases, intraventriculus hemorrhage, and infections. Other diagnoses included omphalitis, intestinal malabsorption or volvulus, infection enterocolitis, neonatal appendicitis, spontaneous perforation, urinary infection, and Hirschsprung disease.

Bacteroides fragilis Group

Bacteroides Fragilis Group

Organisms that are capable of supplying this need Pigmented Prevotella and Porphyromonas are part of the normal oral and vaginal flora and are the predominant anaerobic gram negative bacilli isolated from respiratory infections. These include aspiration pneumonia (38), lung abscess (61), chronic otitis media (14), and chronic sinusitis (15). These organisms have been recovered also from abscesses and burns around the oral cavity (58), human bites (68), paronychia (69), urinary tract infection (70), brain abscesses (37), and osteomyelitis (71). Also, they have been isolated from patients with bacteremia associated with infections of the upper respiratory tract (11). Pigmented Prevotella and Porphyromonas play a major role in the pathogenesis of periodontal disease (72) and periodontal abscesses (73).

Relatively Common Bacterial Infections Of Aging Humans

Respiratory and Urinary Tract Infection Table 2-2 provides a list of organisms found most often in respiratory and urinary tract infections of the elderly. The most common respiratory infection is bacterial pneumonia. In about half of the community-acquired pneumonia (CAP) cases, the etiologic agent remains unidentified (2). It is estimated that 20 -30 of all CAP infections are caused by Streptococcus pneumoniae and most of the remaining cases by the other bacteria listed in Table 2-2. In the case of urinary tract infections (UTIs) in the elderly, two independent studies, separated by an interval of 12 yr, gave very similar results. One study was performed in Sweden in 1986 on a group of 1966 subjects having a mean Pathogens Found Frequently in Elderly Subjects with Respiratory or Urinary Tract Infections Pathogens Found Frequently in Elderly Subjects with Respiratory or Urinary Tract Infections

Conservative Management

All sources of infections sought and treated with appropriate IV antibiotics. If the WBC count is elevated, this should raise an index of suspicion for an underlying infection as an etiology for pseudoobstruction. A chest radiograph may aid in making a diagnosis of pneumonia in a hospitalized patient. A urine analysis will detect an underlying urinary tract infection. A diagnostic paracentesis is required in a patient with ascites and elevated WBC, fever, or peritoneal signs.

Complications Of Urinary Diversions And Their Managements

Using the intestine as a substitute for the urinary bladder can lead to significant complications. The bowel epithelium is an absorptive surface, whereas the transitional epithelium is relatively impermeable to most substances. Any urinary diversion that utilizes bowel will absorb, to some extent, urinary solutes. With the exception of stomach, the more proximal the bowel segment, the greater the reabsorption characteristics. The degree of such absorption is proportional to the duration of exposure, so that continent reservoirs increase the risk of metabolic derangements. The risk of metabolic complications from these operations also increases with decreasing renal function. Certain drugs, such as methotrexate and phenytoin, may be excreted by the kidneys and Occasionally, a segment of stomach can be used in urinary diversions, especially in the absence of other utilizable bowel segments or in patients with renal insufficiency. Instead of developing metabolic acidosis, however, the...

Why should I take drugs that have side effects

Cystitis inflammation of the bladder associated with symptoms of urinary frequency and urgency. Pyelonephritis an acute infection of the kidney associated with fever, contrasting with cystitis (a bladder infection) where fever does not occur. Thrush Compared with viral infections, bacterial infections are a more practical problem. The most commonly encountered bacterial infections complicating the use of steroids include flare-ups of bladder and kidney infections (cystitis and pyelonephritis). Less commonly, skin wounds, pneumonias, and rarer infections can be problematic.

Chemotherapy and Radiation

Currently, there is much debate about whether chemotherapy and or radiotherapy should replace surgical resection as the primary treatment modality in tumors that do not respond to antibiotic therapy (Bozzetti et al, 1993). Surgical advocates argue that resection is vital for accurate staging and histological classification, and that having an entire specimen allows the pathologist to adequately evaluate the specimen. With the advances in obtaining biopsies endo-scopically and in immunohistopathology, however, these arguments for surgery are becoming less powerful. The main arguments against nonsurgical treatment is that chemotherapy and radiotherapy can lead to necrosis of the tumor, resulting in gastric perforation or bleeding. Late complications of radiotherapy, particularly involving the abdominal and retroperitoneal viscera, are also concerns that must be considered. These complications include visceral and ureteric stricture, cystitis, enteritis, anal sphincter dysfunction, and...

Gene therapy applications in the lower urinary tract

The lower urinary tract is ideally suited for minimally invasive therapy. All of the lower urinary tract can be reached either percutaneously or through endoscopy. Using MDSCs to deliver growth factor genes, an ex viv approach, could treat such disabling and prevalent conditions as urinary incontinence, interstitial cystitis (IC), and erectile dysfunction (ED) and limit the risk of systemic side effects. Figure 2 depicts MDSC-based tissue engineering in the lower urinary tract. This section focuses on gene therapy strategies that use both viral and nonviral approaches in the lower urinary tract. 5.2. Interstitial Cystitis Interstitial cystitis (IC) is a voiding dysfunction that affects nearly a million people in the United States (48). IC is characterized by chronic pelvic pain associated with bladder symptoms of urinary frequency and urgency. A possible gene therapy approach involves the delivery of preproenkephalin to the peripheral nerves of the bladder. This method delivers low,...

Benefits Versus Toxicity And Risks Of Therapy

Chemotherapy can be divided into those of the CMF-like regimens and those of the doxoru-bicin regimens. All chemotherapies used as adjuvant treatment cause significant myelosup-pression, with leukopenia generally clinically more significant than anemia or thrombocy-topenia. In the NSABP trials of classic CMF x 6, the incidence of neutropenia less than 2,000 was 10 percent and severe infection about 1 percent.21 With AC x 4, it is 4 percent severe neutropenia and 2 percent severe infec-tion.21 With 6 months of CAF, the risk of leukopenia and infection is higher. Thrombocy-topenia is seen in less than 1 percent of patients in most regimens.21 Doxorubicin-containing regimens are more emetogenic than CMF however, the incidence of severe vomiting is rapidly dropping with the introduction of serotonin antagonists. Alopecia is nearly universal with doxorubicin and is seen in about 40 percent of CMF patients.21 Diarrhea is rarely seen with either regimens the use of serotonin antagonist...

Urological Complications

Lesions in the urinary tract may complicate surgery for ARM. Before the definitive repair, it is essential to minimize the risk of urinary tract infections caused by the rectourogenital connection, if present. This is best accomplished by establishing a completely diverting colostomy and by careful washout of the rectal pouch 8 . Infection may cause permanent damage to the kidneys, because upper urinary tract anomalies, and especially vesicoureteral reflux, are common 13-15 . Infection may occur after definitive repair and is caused in most cases by a urological anomaly, vesicoureteral reflux being the most common 15 . Urinary infections may be caused by a rectourinary fistula remnant that is too long 16 . Damage to the pelvic innervation and urethra during the dissection of rectal blind pouch may cause urinary incontinence or urethral stricture 17 . The incidence of urological injuries associated with surgery are strongly related to the experience of the surgeon 18 . A detailed...

Characteristics of staff authorised to take responsibility for the supply or administration of medicines under Patient

Clinical condition - The PGD is applicable to any patient (male or female) who has been diagnosed with genital candidiasis. Genital candidiasis is a fungal infection and is commonly caused by the species Candida albicans. In women the sites of infection may include the vulva, vagina and the urethra, and in men the most common sites include the glans, prepuce and urethra. Signs and symptoms are variable. Women may complain of a thick white vaginal discharge, pruritus, soreness, erythema, dysuria and dyspareunia. Fissuring may be apparent on the vulva. Men may present with a visible rash on the glans and they may also complain of pruritus and dysuria. Diagnosis is confirmed either clinically, microscopically (by wet and dry slide) or by culture media. Inclusion criteria - symptomatic patients who have had Candida diagnosed clinically and or microscopically, and symptomatic patients who have had Candida diagnosed on culture. Exclusion criteria - this includes female patients who have...

Primary Aquired Nasolacrimal Duct Obstruction

Interestingly, the mucous membranes of the lacrimal passage and nose reveal morphological differences between the nasolacrimal epithelial cells with microciliation only and the nasal epithelial cells with their kinociliae (Fig. 2.1) 24 . This suggests differences in susceptibility to pathogens however, it has been shown that ectopia of nasal epithelial cells is a more or less common finding in the nasolacrimal ducts 1, 27 . In addition to descending infection from the eye, ascending infection of these atopical cells during nasal inflammation could thus be the starting point of dacryostenosis. In this scenario, the nasal inflammation has long since abated when the dacryo-cystitis passes into a chronic state, causing the changes characteristic for dacryostenosis (see below).

Complications and Management


The rate of complications following LAR has been reported as high as 41 (5). Most of these are common to most major abdominal procedures and would include atelectasis, urinary tract infection, wound infection, and deep venous thrombosis. Significant complications specific to LAR include anastomotic leakage, anastomotic stricture, and imperfections of continence or bowel habit. Leakage from the anastomosis after LAR

Causes Of Aseptic Leukocyturia

A significant number of leukocytes (more than 10,000 per milliliter) is also required for the diagnosis of urinary tract infection, as it indicates urothelial inflammation. Abundant leukocyturia can originate from the vagina and thus does not necessarily indicate aseptic urinary leukocyturia 1 . Bacterial growth without leukocyturia indicates contamination at sampling. Significant leukocyturia without bacterial growth (aseptic leukocyturia) can develop from various causes, among which self-medication before urinalysis is the most common.

Clinical Application of Sacral Neuromodulation

The work-up for treatment by sacral neuromodulation must include careful assessment of past history with special emphasis on drugs influencing bladder function. A physical examination may be given to assess neurologic status, togther with a perineal examination with urodynamic investigation to assess bladder and sphincter function. To rule out any other lower urinary tract pathological conditions, urine culture can be performed to exclude urinary tract infection. Cytology and cystoscopy are helpful in ruling out carcinoma cystitis, and when indicated, imaging of the upper tract may be performed. It is recommended to perform MRI of the entire spinal cord to screen for neurologic diseases such as multiple sclerosis, a neoplasm, syringomyela, lipoma, etc. There are some specific etiologies of urinary dysfunction in children, such as neurogenic bladder (myelomeningocele, occult spinal dysraphism, sacral agenesis, tethered cord syndrome, cord lipoma, cerebral palsy), non-neurogenic bladder...

Anaerobes as Part of the Human Indigenous Microbial Flora

Images Anaerobic Bacteria

Recognizing the unique composition of the flora at certain sites is useful for predicting which organisms may be involved in an adjacent infection and can assist in the selection of empiric antimicrobial therapy. It can also be useful in determining the source and significance of microorganisms recovered from body sites. For example, bacterial endocarditis caused by Enterococcus faecalis is more often associated with urinary tract infection, while alpha hemolytic streptococcal endocarditis is more often observed in patients with poor dental hygiene and tooth extraction. Numerous studies utilized selective gut decontamination in an attempt to eradicate only the Enterobacteriaceae and preserve the anaerobes by using antimicrobials that are only effective against Enterobacteriaceae (31). The subjects of these studies were generally immunosupressed individuals and those prone to infections. The antimicrobials were either nonabsorbable (i.e., polymyxin, neomycin, bacitracin) or absorbable...

The Overactive Bladder

Oab Electrical Stimulation

The major role of cystometry in the diagnosis of overactive bladder (OAB) has recently been dissipated since overactive bladder is now taken to be a medical condition referring to the symptoms of frequency and urgency, with or without urge incontinence 2 . Thus the diagnosis of the OAB symptom complex is based upon the subjective perception of lower urinary tract dysfunction. However, as emphasized above, the OAB is a complex of symptoms that can be diagnosed as such only when there is no proven urinary tract infection or other obvious pathology.

Autonomic Function Tests

Autonomic function tests are a mandatory part of the diagnostic process and clinical follow-up in patients with MSA. Findings of severe autonomic failure early in the course of the disease make the diagnosis of MSA more likely, although the specificity in comparison to other neurodegenerative disorders is unknown in a single patient. Pathological results of autonomic function tests may account for a considerable number of symptoms in MSA patients and should prompt specific therapeutic steps to improve quality of life and prevent secondary complications like injuries owing to hypotension-induced falls or ascending urinary infections.

Antibiotic Resistance And Bacterial Variation

The importance of vancomycin resistance to the geriatrician is the common usage of that antibiotic to treat UTIs and infected pressure ulcers, which are relatively common in LTCFs (70). Vancomycin-resistant enterocci are introduced most often into LTCFs by accepting patients who have acquired resistant organisms in hospitals.

Cuscuta chinensis Lam Cuscuta japnica Choisy Fam Convolvulaceae

Cuscuta Chinensis Lam

Removes Blood Heat, relieves dysuria, counteracts toxicity, and heals sores. For acute urinary infection, and for dysuria with hematuria, it is used with Herba Lophatheri Gracilis (Dan Zhu Ye), Pulvis Talci (Hua Shi), Caulis Ake-biae (Guan Mu Tong) and Radix Rehmanniae (Sheng Di Huang).

Bacterial Interactions With Mucosal Surfaces

The attachment to host cells is required for bacterial proliferation, colony formation, invasion of host cells, or translocation across endothelial or epithelial host cell layers. Both the bacteria and the host cells may be altered as a consequence of activation of genes in both. Adherence allows the bacteria to resist host defensive processes such as mucociliary sweeping. There is a clear correlation between the ability of a pathogen to adhere to host cells and the susceptibility of the host to that pathogen. For example, among individuals who experience recurring UTIs, adherence of E. coli to epithelial cells of the subjects may be as much as five times greater than in the case of subjects who remain free of infections (31). Pathogens, including bacteria, employ a variety of mechanisms for adhering to host cells. In several, well-studied cases, known adhesion molecules are involved (32). For example, outer membrane molecules of several bacteria (Yersinia spp., Bordetella pertussis),...

Clinical Features

As the duplication cyst slowly fills with the fluid, it enlarges causing local symptoms such as tenderness, low back pain, suprapubic pain, intestinal obstruction, dysuria, dystocia, or sciatic pain. Drainage of mucus or pus from the anus or from a perianal fistula is a frequent presenting sign. Fistulae are reported to occur in approximately 20 of cystic rectal duplications and involve the perianal skin posterior to the anus or the distal canal in the midline 15 . The fistula rate of 45 in one series was based on both clinical and pathological examination, suggesting that not all communications are clinically evident 5 . A characteristic finding is a cone-shaped dimple in the midline just posterior or anterior to the anal verge. It may rarely present as a perforated ulcer 16 . No case with communication to the urinary tract has been reported, although some patients presented with urinary tract symptoms due to compression by a large duplication. Many of these patients who were...

Urinary Tract Problems

A high incidence of neurovesical dysfunction in patients with ARM has been reported by several authors 13,26,86,87 . Neurovesical dysfunction is usually congenital and often associated with lumbosacral or intraspinal abnormalities 24,87 . This is reflected by the dominance of hyperreflexic findings in cystom-etry and radiological investigations, suggesting upper motor neuron lesion. Vesicoureteral reflux in patients with ARM is commonly associated with neurovesical dysfunction, and therefore carries a high risk of recurrent urinary infection and subsequent renal damage. Urinary incontinence is related to dysplastic sacrum, urethral and bladder anomalies, and neurovesical dysfunction. Surgical damage to the bladder neck or

Darifenacin Urinary Incontinence [1518

Darifenacin demonstrates greater effect on tissues in which the predominant receptor type is M3 rather than Ml or M2. In vitro darifenacin inhibits carbachol-induced contractions with greater potency in isolated guinea-pig bladder (M3) than in guinea-pig atria (M2) or dog saphenous vein (Ml). In animal models, it shows greater selectivity for inhibition of detrusor contraction over salivation or tachycardia. The synthesis of darifenacin involves the coupling of 5-(2-bromoethyl)-2, 3-dihydrobenzofuran with as a key step. The latter intermediate is prepared from 3-(R)-hydroxypyrrolidine in a five-step sequence involving N-tosylation, Mitsunobu reaction to introduce a tosy-loxy group in the 3-position with stereochemical inversion, anionic alkylation with diphenylacetonitrile, cleavage of the N-tosyl protecting group with HBr, and conversion of the cyano group to a carboxamide. Darifenacin is supplied as a controlled release formulation, and the recommended dosage is 7.5 mg once, daily....

Why do some patients with MS become unable to urinate when they have to urinate all day and night

Treatment of bladder dysfunction is usually directed at relieving symptoms and reducing the risk of infection. Ditropan and other anticholinergic drugs are the mainstay of the treatment of urinary frequency and urgency. Unfortunately, these drugs tend to produce dryness of the mouth. Often, patients prefer to use the drugs only at night to reduce wakening and risk of incontinence. These drugs can be useful when patients with urinary frequency and urgency have to leave their homes. Urinary catheterization is sometimes necessary to achieve bladder emptying and can help prevent recurrent bladder infections and complicating kidney damage. If catheterization is recommended, it should

Urinary Tract and Genitourinary Suppurative Infections

Anaerobes have been involved in many different types of urinary tract infection (UTI). The types of infections of the urinary tract in which anaerobes have been involved include para- or periurethral cellulitis or abscess, acute and chronic urethritis, cystitis, acute and chronic prostatitis, prostatic and scrotal abscesses, periprostatic phlegmon, ureteritis, periur-eteritis, pyelitis, pyelonephritis, renal abscess, scrotal gangrene, metastatic renal infection pyonephrosis, perinephric abscess, retroperitoneal abscess, and other infections.

James M Gloor Vicente E Torres

Clinically, reflux nephropathy may cause hypertension, proteinuria, and decreased renal function when the scarring is extensive. The identification of VUR raises the theoretic possibility of preventing reflux nephropathy. The inheritance pattern of VUR clearly is suggestive of a strong genetic influence. Familial studies of VUR are consistent with autosomal dominant transmission, and linkage to the major histocom-patibility genes has been reported. Identification of infants with reflux detected on the basis of abnormalities seen on prenatal ultrasound examinations before urinary tract infection occurs may provide an opportunity for prevention of reflux nephropathy. In persons with VUR detected at the time of diagnosis of a urinary tract infection, avoidance of further infections may prevent renal injury. Nevertheless, the situation is far from clear. Most children with reflux nephropathy already have renal scars demonstrable at the time of the urinary tract infection that prompts the...


These include acute otitis media (that is related to eustachian tube dysfunction or due to the presence of nasogastric tube), aspiration pneumonia, hypoxic encephalopathy, hyponatremia due to excretion of antidiuretic hormone in response to decreased atrial filling because of venous pooling in the paralyzed infant, urinary tract infection due to indwelling bladder catheter, Clostridium difficile collitis due to colonic stasis with manifestations of toxic megacolon and necrotizing enterocolitis (47), and septicemia associated with intravascular catheters.

Figure 718

An episode of urinary tract infection (UTI) should prompt consideration of whether it involves a normal urinary tract or, alternatively, if it is a complication of an anatomic malformation. This is especially true of relapsing UTI in both genders, and this hypothesis should be systematically raised in males and in children. Recurrent cystitis in females can be explained by hymeneal scars that pull open the urethral outlet during intercourse. Although rarely, other malformations that promote recurrent female cystitis are occasionally discovered, such as urethral diverticula (arrows). Finally, it should be recalled that recurrent or chronic cystitis in an older woman can also reveal an unsuspected bladder tumor.

Figure 712

In case of urinary tract infection (UTI), distinguishing between lower and upper tract infection is classical, but the distinction is also beside the point. The real point is to determine whether infection is confined to the bladder mucosa, which is the case in simple cystitis in females, or whether it involves solid organs (ie, prostatitis or pyelonephritis). The dots in this figure symbolize the presence of bacteria and leukocytes (ie, infection) in the relevant organ. Here, infection is confined to the bladder mucosa, which can be severely inflamed and edematous. This could be reflected radiographically by mucosal wrinkling on the cystogram. In some cases inflammation is severe enough to be accompanied by bladder purpura, which induces macroscopic hematuria but is not a particular grave sign.

Figure 74

Principal pathogens of urinary tract infection (UTI). A and B, Most pathogens responsible for UTI are enterobacteriaceae with a high predominance of Escherichia coli. This is especially true of spontaneous UTI in females (cystitis and pyelonephritis). Other strains are less common, including Proteus mirabilis and more rarely gram-positive microbes. Among the latter, Staphylococcus saprophyticus deserves special mention, as this gram-positive pathogen is responsible for 5 to 15 of such primary infections, is not detected by the leukocyte esterase dipstick, and is resistant to antimicrobial agents that are active on gram-negative rods. C, Acute simple pyelonephritis is a common form of upper UTI in females and results from the encounter of a parasite and a host. In the absence of urologic abnormality, this renal infection is mostly due to uropathogenic strains of bacteria 5,6 , a majority of cases to community-acquired E. coli. The clinical picture consists of fever, chills, renal pain,...

Figure 821

Resolution of vesicoureteral reflux (VUR) detected postnatally after urinary tract infection mild to moderate VUR. The Southwest Pediatric Nephrology Study Group (SWPNSG) prospectively observed 113 patients aged 4 months to 5 years with grades I to III VUR detected after urinary tract infection. The SWPNSG reported on 59 children followed up with serial excretory urograms and voiding cys-tourethrography for 5 years. Mild (grade I and II) VUR resolved after 5 years in the ureters of 80 of these children, and in most cases within 2 to 3 years. Grade III VUR resolved in only 46 of ureters in children with VUR 20 .


Bacterial uropathogenicity plays a major role in host-pathogen interactions that lead to urinary tract infection (UTI). For Escherichia coli, these factors include flagella necessary for motility, aerobactin necessary for iron acquisition in the iron-poor environment of the urinary tract, a pore-forming hemolysin, and, above all, presence of adhesins on the bacterial fimbriae, as well as on the bacterial cell surface. (From Mobley et al. 7 with permission.)

Figure 824

Frequency of parenchymal scarring at the time of diagnosis of vesi-coureteral reflux (VUR). Many children in whom VUR is detected after a urinary tract infection already have evidence of renal parenchymal scarring. In two large prospective studies the frequency of scars seen in persons with VUR increased with VUR severity. The International Reflux Study in Children (IRSC) studied 306 children under 11 years of age with grades III to V VUR 36 . The frequency of parenchymal scarring or thinning increased from 10 in children with nonrefluxing renal units (in children with contralateral VUR) to 60 in those with severely refluxing grade V kidneys. In another large prospective study, the Birmingham Reflux Study Group (BRSG) reported renal scarring in 54 of 161 children under 14 years of age with severe VUR resulting in ureteral dilation (greater than grade 3 using the classification system adopted by the International Reflux Study in Children group) at the time reflux was detected 39 ....


The prognosis depends upon the weight of the child, age at presentation, presence of sepsis and perforation, associated congenital anomalies, and most importantly on the length of colon that has pouching. The prognosis is better in cases of incomplete CPC as cases of complete CPC suffer from recurrent watery diarrhea due to the short length of the large bowel. Window colostomy performed in the pouch also does not allow complete evacuation of the contents and is frequently associated with massive prolapse, bleeding, and recurrent urinary tract infection.

Figure 823

Resolution of grades III to V vesicoureteral reflux (VUR) detected postnatally after urinary tract infection bilateral versus unilateral VUR. Spontaneous resolution of high-grade VUR is much more likely to occur in unilateral reflux. The International Reflux Study in Children (IRSC) showed that grades III to V VUR resolved in children in whom both kidneys were affected nearly five times as often (39 ) as in those in whom VUR was bilateral (8 ). In bilateral VUR, spontaneous resolution did not occur after 2 years of observation 38 .

Figure 830

Proposed treatment of vesicoureteral reflux (VUR) in children. This algorithm provides an approach to evaluate and treat VUR in children. In VUR associated with other genitourinary anomalies, therapy for reflux should be part of a comprehensive treatment plan directed toward correcting the underlying urologic malformation. Children with mild VUR should be treated with prophylactic antibiotics, attention to perineal hygiene and regular bowel habits, surveillance urine cultures, and annual voiding cystourethrogram (VCUG). Children with recurrent urinary tract infection on this regimen should be considered for surgical correction. In children in whom VUR resolves spontaneously, a high index of suspicion for urinary tract infection should be maintained, and urine cultures should be obtained at times of febrile illness without ready clinical explanation. In persons in whom mild VUR fails to resolve after 2 to 3 years of observation, consideration should be given to voiding pattern. A...


The etiology of lower urinary tract dysfunction in ARM and cloacal anomalies is poorly understood 2-4,50,51 . However, bladder dysfunction causes significant urological morbidity in the pediatric population, resulting in renal damage from recurrent urinary tract infections and urinary incontinence, both of which can cause profound morbidity and disability 7 . Recurrent urinary tract infection may be overlooked or attributed to coexisting vesicoure-teric reflux or renal anomalies, which are prevalent in a high proportion of these children 7,27 . Consequently, detecting bladder dysfunction at an early age is essential in avoiding deterioration in renal function 5,18,24,45,46 .

Figure 829

Effectiveness of medical versus surgical treatment incidence of urinary tract infection versus pyelonephritis in severe vesicoureteral reflux (VUR). Although the incidence of urinary tract infections (UTIs) is the same in surgically and medically treated children with VUR, the severity of infection is greater in those treated medically. The International Reflux Study in Children (IRSC) (European group) studied 306 children with VUR and observed them over 5 years 155 were randomized to medical therapy, and 151 had surgical correction of their reflux. Although the incidence of UTI statistically was no different between the groups (38 in the medical group, 39 in the surgical group), children treated medically had an incidence of pyelonephritis twice as high (21 ) as those treated surgically (10 ) 41 .

Figure 818

Prenatal detection of vesicoureteral reflux (VUR). A, Ultrasonography showing mild fetal hydronephrosis. B, Postnatal voiding cystourethrogram (VCUG) showing grade 4 VUR. C, Graph showing small renal size in the same infant. Vesicoureteral reflux has been identified in neonates in whom prenatal ultra-sonography examination reveals hydronephrosis 21-28 . Normal infants do not have VUR, even when born prematurely 29,30 . The severity of reflux often is not predictable on the basis of appearance on ultrasonography 22,31 . Hydronephrosis greater than 4 mm and less than 10 mm in the anteroposterior dimension on ultrasound examination after 20 weeks' gestational age has been termed mild fetal hydronephrosis. Mild fetal hydronephrosis is associated with VUR in a significant percentage of infants 26,31 . Despite the absence of a previous urinary tract infection, many kidneys affected prenatally exhibit decreased function 22,24,32,33 . Unlike the focal parenchymal scars seen in...

Figure 822

Resolution of vesicoureteral reflux (VUR) detected postnatally after urinary tract infection at follow-up examinations over 5 years. Mild to moderate VUR spontaneously resolves in a significant percentage of children, whereas high-grade reflux resolves only rarely. The Southwest Pediatric Nephrology Study Group (SWPNSG) found that grades I and II VUR resolved in 80 of children with refluxing ureters at follow-up examinations over 5 years. In the Birmingham Reflux Study Group (BRSG), International Reflux Study in Children (IRSC), and SWPNSG investigations of high-grade VUR (grades III to V) in children, improvement in reflux severity was seen in 30 to 40 of affected ureters. Spontaneous resolution was rare and occurred in only 16 to 17 of children with refluxing ureters at follow-up examinations over 5 years 20,37,38 .

Figure 825

Development of parenchymal scarring after diagnosis of vesicoureteral reflux (VUR). Parenchymal scarring occurs after diagnosis and initiation of therapy as well. The Southwest Pediatric Nephrology Study Group (SWPNSG) followed up 59 children with mild to moderate VUR (grades I to III) diagnosed after urinary tract infection 20 . None of the children studied had parenchymal scarring on intravenous pyelography at the time of diagnosis. Parenchymal scars were seen to develop in 10 of children over the course of 5 years of follow-up examinations, including some children without documented urinary tract infections during the period of observation. In this group, renal scarring occurred nearly three times more commonly in grade 3 VUR than it did in grades 1 and 2 VUR. In the International Reflux Study in Children (IRSC) (European group), a prospective study of high-grade VUR (grades III and IV), new scars developed in 16 of 236 children after 5 years' observation 40 .

Figure 737

Urinary tract infection (UTI) in the immunocompromised host. UTI results from the encounter of a pathogen and a host. Natural defenses against UTI rest on both cellular and humoral defense mechanisms. These defense mechanisms are compromised by diabetes, pregnancy, and advanced age. Diabetic patients often harbor asymptomatic bac-teriuria and are prone to severe forms of pyelonephritis requiring immediate hospitalization and aggressive treatment in an intensive care unit.

Figure 738

Urinary tract infection (UTI) in an immunocompromised host. Pregnancy is associated with suppression of the host's immune response, in the form of reduced cytotoxic T-cell activity and reduced circulating immunoglobulin G (IgG) levels. Asymptomatic bacteriuria is common during pregnancy and represents a major risk of ascending infection complicated by acute pyelonephritis. Petersson and coworkers 12 recently demonstrated that the susceptibility of the pregnant woman to acute UTI is accompanied by reduced serum antibody activity (IgG, IgA, IgM), reduced urine antibody activity (IgG, IgA), and low interleukin 6 (IL-6) response, A-C, respectively.

Figure 1222

Urologic evaluation of transplantation recipients. Patients without signs and symptoms of bladder dysfunction generally do not need additional urologic testing. However, patients with bladder dysfunction must be evaluated to ensure that the bladder is functional after transplantation and that potential sources of urinary tract infection (UTI) are eliminated. Such patients can be screened initially with voiding cystourethrography (VCUG). (From Kasiske and coworkers 1 with permission.)

Figure 638

Infection is usually but not invariably a concomitant finding in most cases of RPN. In fact, with few exceptions, most patients with RPN ultimately develop a urinary tract infection, which represents a complication of papillary necrosis that is, the infection develops after the primary underlying disease has initiated local injury to the renal medulla, with foci of impaired blood flow and poor tubular drainage. Infection contributes significantly to the symptomatology of RPN, because fever and chills are the presenting symptoms in two thirds of patients and a positive urine culture is obtained in 70 . However, RPN is not an extension of severe pyelonephritis. In most patients with florid acute pyelonephritis, RPN does not occur.


The major causes of dehydration in children are gastrointestinal disorders and diabetic ketoacidosis. Some renal disorders (polyuric tubulopathy with urinary tract infection, polyuric chronic renal failure and diabetes insipidus) might also present in this way. Depending on the source of fluid losses and the quantities of electrolytes lost dehydration can be divided into three types


Diverticulitis is considered complicated when the disease process is associated with abscess, fistula to and adjacent an organ, stricture, or free perforation into the peritoneal cavity. As with uncomplicated disease, the best initial diagnostic test is a CT scan in any patient suspected of having complicated disease. Depending on the type of complication present, patients may present with symptoms similar to uncomplicated disease, or they may present in distress with signs of an acute abdomen. Patients with stricture formation may have few acute symptoms as the complication generally develops slowly over time. They will however likely describe a history of multiple episodes of acute diverticulitis. If stricture is suspected and the patient lacks acute symptoms, colonoscopy or a contrast study is indicated to further evaluate the diseased segment as well as the more proximal colon. Similarly, patients with fistulas to pelvic organs may have few acute symptoms but are likely to report...

Papillary Necrosis

The concern of renal specialists for urinary tract infections (UTIs) had declined with the passage of time. This trend is now being reversed, owing to new imaging techniques and to substantial progress in the understanding of host-parasite relationships, of mechanisms of bacterial uropathogenicity, and of the inflammatory reaction that contributes to renal lesions and scarring. UTIs account for more than 7 million visits to physicians' offices and well over 1 million hospital admissions in the United States annually 1 . French epidemiologic studies evaluated its annual incidence at 53,000 diagnoses per million persons per year, which represents 1.05 to 2.10 of the activity of general practitioners. In the United States, the annual number of diagnoses of pyelonephritis in females was estimated to be 250,000 2 . The incidence of UTI is higher among females, in whom it commonly occurs in an anatomically normal urinary tract. Conversely, in males and children, UTI generally reveals a...

Figure 739

Acute prostatitis as visualized sonographically. Acute prostatitis is common after urethral or bladder infection (usually by Escherichia coli or Proteus organisms). Another cause is prostate hematogenous contamination, especially by Staphylococcus. Signs and symptoms of acute prostatitis, in addition to fever, chills, and more generally the signs and symptoms of tissue invasion by infection described above, are accompanied by dysuria, pelvic pain, and septic urine. Acute prostatitis is an indication for direct ultrasound (US) examination of the prostate by endorectal probe. In this case of acute prostatitis in a young male, US examination disclosed a prostatic abscess (1) complicating acute prostatitis in the right lobe (2). Acute prostatitis is an indication for thorough radiologic imaging of the whole urinary tract, giving special attention to the urethra. Urethral stricture may favor prostate infection (see Fig. 7-20).

Figure 72

The most specific results, however, are provided by laboratory analysis, which allows precise counting of bacteria and leukocytes. Normal values for a midstream specimen are less than or equal to 105 Escherichia coli organisms and 104 leukocytes per milliliter. These classical Kass criteria, however, are not always reliable. In some cases of incipient cystitis the number of E. coli per milliliter can be lower, on the order of 102 to 104 4 . When fecal contamination has been ruled out, growth of bacteria that are not normally urethral saprophytes indicates infection. This is the case for Pseudomonas, Klebsiella, Enterobacter, Serratia, and Moraxella, among others, especially in a hospital setting or after urologic procedures.

Alkylating Agents

Mucositis, and occasional hemorrhagic cystitis. Ifosfamide, an analog of cyclophosphamide, appears to have similar efficacy, and is not entirely cross-resistant to cyclophosphamide. In addition to neutropenia, toxicity includes frequent hemorrhagic cystitis (requiring the use of a urothelial protective agent), interstitial nephritis, and temporary encephalopathy. These toxicities have limited the use of ifosfamide.


In both children and adults, such as ARM, spina bifida, sacral agenesis, exstrophy complex, postradiation cystitis, complex vesicovaginal fistulae, posterior urethral valves, prune-belly syndrome, cerebral palsy, sacrococcygeal teratoma, spinal-cord injury, perineal trauma, Hirschsprung's disease, intractable constipation, and different types of urethral failures, or in patients with perineal colostomy after rectal resection 6-19 . In the original description of Mitrofanoff and antegrade colonic enema (ACE) procedures, the conduit of choice is the appendix. In conditions in which the appendix is not available, tubular structures such as the ureter, fallopian tube, Meckel's diverticulum, and the vas deferens, or tubes created from the ileum, colon, stomach, bladder, rectus abdominis muscle, and prepuce can be used to create a Mitrofanoff channel. Ileal tubes are most commonly preferred if the appendix is not available. The use of the other organs except the ureters and bladder tubes...

Figure 1055

Adenovirus infections normally cause asymptomatic infections, coryza, or pharyngitis. Infection in the first decade of life usually protects individuals from future infection as long as the immune system is intact however, in transplant recipients, adenovirus types 11, 34, and 35 have been shown to cause interstitial pneumonia, conjunctivitis, hemorrhagic cystitis, hepatitic necrosis, interstitial nephritis and gastroenteritis, and disseminated disease.

Figure 1011

Although advanced renal disease caused by polycystic kidney disease (PKD) usually develops after childbearing, women with this condition may have hypertension or mild azotemia. Certain considerations are relevant to pregnancy. Pregnancy is associated with an increased incidence of asymptomatic bacteriuria and urinary infection that may be more severe in women with PKD. The presence of maternal hypertension has been shown to be associated with adverse pregnancy outcomes 16 . Pregnancy has been reported to be associated with increased size and number of liver cysts owing to estrogen stimulation. Women with intracranial aneurysms may be at increased risk of subarachnoid hemorrhage during labor.

Figure 1515

Indications for enteric conversion (EC). A set of complications unique to pancreas transplantation arise as a consequence of urinary diversion of graft exocrine secretions. The development of one of these complications is the most frequent cause for re-admission to the hospital after pancreas transplantation with BD. These include the following persistent gross hematuria, recurrent or chronic urinary tract infections (UTIs), urethritis, urethral stricture or disruption, urinary or pancreatic enzyme leak, graft (reflux) pancreatitis, and excessive bicarbonate loss and acidosis 18 . Surgical conversion to ED is indicated when these complications are incapacitating or refractory to conservative therapy. Except for leaks and pancreatitis, these complications are largely avoided in ED pancreas grafts. Hematuria in the immediate postoperative period is usually mild and self-limited, occasionally requiring irrigation, cytoscopic fulguration, or both. Hematuria occurring late after...

Figure 711

Appropriate antibiotics for urinary tract infections (UTI). An appropriate antibiotic for treating UTI must be bactericidal and conform to the following general specifications 1) its pharmacology must include, in case of oral administration, rapid absorption and attainment of peak serum concentrations 2) its excretion must be predominantly renal 3) it must achieve high concentrations in the renal or prostate tissue 4) it must cover the usual spectrum of enterobacteria with reasonable chance of being effective on an empirical basis. Excluding special considerations for childhood and pregnancy, several classes of antibiotics fulfill these specifications and can be used alone or in combination. The choice also depends on market availability, cost, patient tolerance, and potential for inducing emergence of resistant strains.

Figure 741

Malakoplakia (or malacoplakia), like xanthogranulo-matous pyelonephritis, is also a consequence of abnormal macrophage response to gram-negative bacteria, A. Malakoplakia occurs in association with chronic UTI 14 . In more than 20 of cases, affected persons have some evidence of immunosuppression, especially corticos-

Figure 1511

Recent retrospective studies have compared BD pancreas transplants to ED transplants. These studies have demonstrated equivalent short-term graft survival rates without increased risks of infectious complications and pancreatic enzyme leaks 1-3 . ED is associated with fewer urinary tract infections (UTIs) and no hematuria. Patients who have ED experience less dehydration and metabolic acidosis and, as a result, a reduced need for fluid resuscitation and bicarbonate supplementation 3 . Finally, in patients who have ED the Foley catheter can be removed within several days, whereas patients who have BD require prolonged drainage (up to 14 days) to permit healing of the duodenocystostomy. Consequently, with ED, patients are able to leave the hospital sooner. ED has proved to be more physiologic and results in less morbidity compared with BD. Therefore, ED is rapidly gaining popularity as the method of choice for handling graft exocrine secretions in pancreas transplantation.

Urogenital Atrophy

Because the vagina and urethra share a common embryologic origin, it is believed that estrogen deficiency causes atrophy of both structures. Atrophy of the vaginal epithelium may cause vaginal itching, dryness, and dys-pareunia, with resulting inflammation. One effect of estrogen deficiency is to cause changes in the vaginal pH, which predispose women to urinary tract infections that cause urgency, incontinence, frequency, nocturia, and dysuria. The loss of estrogen on periurethral tissues will contribute to pelvic laxity and stress incontinence. Recurrent urinary tract infections can be prevented with systemic estrogen therapy, and low-dose topical estrogen is effective in managing atrophic vaginitis. Estrogen provides relief of these symptoms and may protect against recurrent urinary tract infections.

Urinary Bladder

Answer Key Nephron

The urinary bladder is a storage organ for holding urine. The ureters enter the bladder at the ureteral orifices and the urethra exits the bladder inferiorly. These three openings make a triangular region known as the trigone at the posterior wall of the bladder. The urethra is the external tube that takes urine voided from the urinary bladder to outside the body. The urethra in the female is much shorter than in the male, which makes females more susceptible to bladder infections. The wall of the bladder consists of smooth muscle called the detrusor muscle and an inner lining of transitional epithelium. Label the features of the bladder, urethra, and associated structures and color them in.

Figure 1125

Effects of both drugs are not identical. Cyclophosphamide has a greater bone marrow toxicity, leads to amenorrhea in many patients, is teratogenic, and displays an unique urothelial toxicity (hemorrhagic cystitis and bladder carcinoma). Therefore, prospective studies comparing cyclophosphamide with azathioprine are warranted but not available. The results of the NIH trial are compared with those reported for azathioprine 57,60-62 . This analysis, carried out by Cameron 57 , does not reveal a significant difference between cyclophosphamide and azathioprine. A recent meta-analysis 63 again showed that monotherapy with prednisone was inferior to treatment with cytotoxic drugs in combination with steroids. However, as in the NIH trial and the analysis by Cameron, no differences were found between cyclophosphamide and azathio-prine in preserving renal function. AZ azathioprine AZCY combined therapy with azathioprine and cyclophosphamide IVCY intravenous pulses of cyclophosphamide POCY oral...


Autonomic function tests are a mandatory part of the diagnostic process and clinical follow-up in patients with MSA. Findings of severe autonomic failure early in the course of the disease make the diagnosis of MSA more likely, although the specificity in comparison to other neu-rodegenerative disorders is unknown in a single patient. Pathological results of autonomic function tests may account for a considerable number of symptoms in MSA patients and should prompt specific therapeutic steps to improve quality of life and prevent secondary complications like ascending urinary infections or injuries due to hypotension-induced falls.

Long Term Evaluation

All ARM patients who are diagnosed with a genitourinary malformation, spinal cord abnormality, or bladder dysfunction on initial assessment, and all cloaca patients require regular review. Patients with renal abnormalities and vesicoureteric reflux should have serial ultrasound scans to monitor their renal status. In patients suffering from urinary tract infection, whatever the etiology, a Tc-99m dimercaptosuc-cinic acid renogram is recommended to diagnose renal scarring.

The Urinary Bladder

The mucosa has a transitional epithelium, and in the relaxed bladder it has conspicuous wrinkles called rugae28 (ROO-gee). The openings of the two ureters and the urethra mark a smooth-surfaced triangular area called the trigone29 on the bladder floor. This is a common site of bladder infection (see insight 23.3). For photographs of the relationship of the bladder and urethra to other pelvic organs in both sexes, see figure A.22 (p. 51).

Figure 828

Effectiveness of medical versus surgical treatment incidence of urinary tract infections. Vesicoureteral reflux (VUR) predisposes affected persons to urinary tract infection owing to incomplete bladder emptying and urinary stasis. Medical therapy with uroprophylactic antibiotics and surgical correction of VUR have as a goal the prevention of urinary tract infection. In three prospective studies of 400 children with VUR (Southwest Pediatric Nephrology Study Group SWPNSG , International Reflux Study in Children IRSC , Birmingham Reflux Study Group BRSG ) treated either medically or surgically and who were observed over 5 years the rate of infection was similar, ranging from 21 to 39 . The rate of infection was no different between the group treated medically and that treated surgically 20,37,39 .


Urinary disturbances often appear early in the course of the disease, or are a presenting symptom (impotence common in men). Urinary incontinence (70 of MSA) or retention (30 ) may be detected by medical history, leading to more refined explorations. MSA, PSP, as well as PD patients complain of urgency, frequent voiding, or dysuria. Some describe difficulties voiding but are not aware of chronic urinary retention. Incontinence is never observed in patients with PD and rarely in late stages in PSP. In all cases, additional laboratory tests such as urodynamic tests and sphincter electromyogram (EMG) may make the association between urinary symptoms and urinary tract denervation (13). Patients with PD have less severe urinary dysfunction, by contrast with these common findings in MSA. However, sphincter EMG does not distinguish MSA from PSP.


Treatment of the condition is not simple and is often unsuccessful. Treatment may be by alteration in management techniques - for example, by delaying covering or collection until immediately after natural urination. Alternatively, urination may be stimulated by the administration of diuretics, such as frusemide or ephedrine sulphate, immediately prior to covering or collection (Voss and McKinnon, 1993). The effectiveness of such management practices in reducing the problem is disputed (Hurtgen, 1987). Urination may also be encouraged by the presence of faeces, from another stallion or a mare in oestrus, so inducing the stallion's natural territory-marking activity. Some stallions can be trained to urinate upon command, while others urinate in response to feeding, fresh bedding or exercise. As a more extreme measure, bladder catheterization has been used to evacuate urine prior to collection, but repeated use of this technique is not advised due to the risk of urethritis or cystitis...