Mark Lynch
Clinical Lead Urology CUH
Mlynch100@doctors.org.uk
Mark.lynch@croydonhealth.nhs.uk
Mark.lynch@stgeorges.nhs.uk
UTI
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ADHERERNCE MECHANISMS
• FIMBRIAE
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type I – mannose sensitive, adhere to
uroplakins Ia and Ib on urothelium
• P type – mannose insensitive
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Pap (P pili associated with
pyelonephritis) – 4 proteins (F, A, G, E)
• PapG is receptor component
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3 subtypes (I, II, III)
PapG subtype II associated more with
pyelonephritis
PapG subtype III associated more with cystitis
UTIs
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UTI
Infection
Complicated or not
Recurrent
Management
• Infection and stones – hand in hand
UTIs or cystitis
• 30% of women have at least one UTI in their
lifetime
• Rare in Men – investigate
• Recurrent UTIs in women warrant
investigation
• $1.6Bn / year in US
Forman B, Am J Med 2002
UTIs – risk factors
• Host immunity vs. Bacterial virulence
• Host
– Bacterial flora
– Immunity and comorbidity
– Stasis
– Foreign body
• Bacterial virulence
– Fimbriae and Pili
– Antimicrobial resistance
UTI – excluding a cause
• Complicated:
– Structural or functional
abnormality or underlying disease
to increase infection…
• DM, renal insufficiency
• Urological (DxT, childhood Hx),
neurological
• Pregnancy, voiding dysfunction
– All men
UTIs – bacterial resistance
• E.Coli and coliforms – 80%
• Staph. Sap. – 10%
• Klebsiella, Enterobacter, Proteus ..
– Note foreign travel
– Recent in hospital care
Ronald, A Am J Med 2002
Recurrent UTI - referral
• UTIs that fail to respond to appropriate
antibiotics.
• >2 UTI in 6 months
• >3 in one year
• In reality – balance of risk and impact
Recurrent UTI - management
• History (Current, childhood,
family, risk factors…smoking)
• Examination – including
pelvic examination
• MSU, bladder diary, GFR,
USS, Flexi / Cystoscopy +EUA
• Pathology: Anatomical,
functional, TCC, Stones
Recurrent UTI - management
UTIs
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Very common
Confirm the infection and sensitivities
Refer complicated and/or recurrent UTIs
Beware red flags
Multi modality approach to treatment
• Questions…
• UTIs…
• Pathways…
• Anything else Urological…
Renal Colic and Stones
• 10% risk, 50%
recurrence risk at 10
years
• Risk factors include:
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Geography
Diet
Anatomical
M>F
Fluid intake
Genetics (Cysteinuria)
Renal Colic and Stones at CUH
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Pain relief
History
Examination
Gold standard ED
management
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CT KUB
Early diagnosis
Early treatment
Stone clinic F/U
Access to tertiary care
Renal Colic and stones at CUH
• CUH
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Laser lithotripsy
ESWL
Dedicated stone clinic
Seamless link with SGH
• SGH
– PCNL
– URS (day case)