obstruction that blocks or narrows the URETHRA
such as a bladder stone (UROLITHIASIS), URETHRITISor
URETHRAL STRICTURE, BENIGN PROSTATIC HYPERPLASIA
(BPH) orPROSTATITISin men, CYSTOCELE(sagging of
the bladder) or UTERINE PROLAPSEin women, and
rarely a tumor. As well, STROKE, SPINAL CORD INJURY,
orTRAUMATIC BRAIN INJURY (TBI) can damage the
nerves that control urination. The diagnostic path
may include urinalysis and CYSTOSCOPYor ULTRA-
SOUNDto evaluate the urethra and bladder. Treat-
ment targets the underlying cause and may
include BLADDER CATHETERIZATION to empty the
bladder of urine, either as an emergency proce-
dure for acute urinary retention or on a routine
basis for chronic urinary retention. Often, the
underlying cause is treatable and the urinary
retention resolves.
See also URINARY FREQUENCY; URINARY URGENCY.
urinary urgency The overwhelming sensation of
the need to urinate. Urinary urgency, also called
overactive BLADDER, can cause a person to urinate
dozens of times each day. Though a common
symptom of conditions such as CYSTITISand URI-
NARY TRACT INFECTION(UTI), especially when urinary
urgency occurs in combination with URINARY FRE-
QUENCY, urinary urgency may indicate a blockage
in the urinary tract or result from neurologic con-
ditions or injuries. Urinary urgency may also
result in URINARY INCONTINENCE(inability to hold the
URINE), even when the amount of urine in the
bladder is small. Other common causes include
DIABETES, PREGNANCYin women and BENIGN PROSTA-
TIC HYPERPLASIA(BPH) in men. The diagnostic path
begins with an assessment of any symptoms that
accompany the urinary urgency, urinalysis, and
perhaps procedures such as CYSTOSCOPYand pelvic
ULTRASOUNDto examine the bladder and URETHRA.
Treatment targets any identified underlying cause.
The doctor may prescribe medications such as
tolterodine or oxybutynin to slow the bladder’s
response.
See also NEUROGENIC BLADDER; URINARY RETENTION.
urinary tract infection (UTI) A bacterial INFEC-
TIONof the BLADDERand URETHRA. The most com-
mon bacterial culprit is Escherichia coli, which is
normally present in the gastrointestinal tract.
Other BACTERIAmay also cause UTI. Typically UTI,
commonly called bladder infection, refers to infec-
tion that remains in the bladder and urethra. UTI
may be acute (come on suddenly) or chronic
(occur repeatedly over time). Untreated or under-
treated UTI can spread into the KIDNEYS(NEPHRITIS),
causing significant illness and the potential for
permanent damage to the delicate tubules and
glomeruli of the nephrons.Symptoms and Diagnostic Path
Symptoms of acute UTI tend to be more intense
than symptoms of chronic UTI, though either can
be highly uncomfortable. The general symptoms
of UTI include- DYSURIA(burning with URINATION)
- URINARY FREQUENCYandURINARY URGENCY
- HEMATURIA(bloody URINE)
- cloudy, foul-smelling urine
- aching or discomfort in the lower pelvis or
lower back
Urinalysis shows the presence of bacteria in
most UTIs, confirming the diagnosis. Urinalysis
does not identify the kind of bacteria, however.
The doctor may choose to obtain a urine sample
via BLADDER CATHETERIZATION(to avoid contamina-
tion by bacteria normally on the SKIN’s surface)
and culture it in the laboratory to determine the
kind of bacteria present. A urine culture is espe-
cially helpful in chronic UTI or when symptoms
fail to respond to initial treatment. A urologist
may recommend additional diagnostic procedures
for chronic UTI to determine the underlying rea-
sons for the frequency or persistence of infection.Treatment Options and Outlook
ANTIBIOTIC MEDICATIONSare the standard treatment
for UTI. The antibiotic and length of treatment
depend on the bacteria causing the infection. Most
UTIs in women respond to a 3-day course of the
antibiotic TMP-SMX or an antibiotic in the fluoro-
quinolone family such as ciprofloxacin. Women
who cannot take either of these antibiotics may
instead take an antibiotic in the tetracycline family
(tetracycline or doxycycline) or the cephalosporin
family (such as cefaclor). Men take the same
antibiotics though often require a longer course,urinary tract infection (UTI) 225