Chapter 45
Management of Patients with Urinary Disorders
Lower Urinary Tract Infections
- Cystitis (inflammation of the urinary bladder),
- Prostatitis (inflammation of the prostate gland), and
- Urethritis (inflammation of the urethra).
- Upper UTI; Pylonephritis (inflammation of the renal pelvis), interstitial nephritis
(inflammation of the kidney), and renal abscesses
Lower Urinary Tract Infections
- Mechanisms maintain the sterility of the bladder:
- the physical barrier of the urethra,
- urine flow,
- ureterovesical junction competence,
- various antibacterial enzymes and antibodies, and antiadherent effects mediated by the
mucosal cells of the bladder.
Risk Factors for UTI
- Inability or failure to empty the bladder completely
- Obstructed urinary flow
- Decreased natural host defenses or immunosuppression
- Instrumentation of the urinary tract (eg, catheterization, cystoscopic procedures)
- Inflammation or abrasion of the urethral mucosa
- Contributing conditions: DM, Pregnancy, neurogenic disorders, Gout, and altered
states caused by incomplete emptying of the bladder and urinary stasis
Pathophysiology
- Bacteria gain access to the bladder, attach to and colonize the epithelium of the
urinary tract to avoid being washed out with voiding, evade host defense mechanisms,
and initiate inflammation.