Bacterial cystitis is impossible to cure with its presence due to?
bladder inflammation
What is bacterial cystitis
common condition. inflammatory response of the lining of the bladder (urothelium) to bacterial invasion. characterised by frequent urination and burning sensation (dysuria) on voiding.
What is interstitial cystitis?
rare condition
What is no common with bacterial and interstitial cystisis
incontinence
Patient will general complain of pelvic pain and not
bladder pain
what occurs in a patient with pyuria?
bacteria attacks the urothelium, cytokines are produced and white blood cells appear in the urine to fight the infection. pus cells are counted per litre of urine to define pyuria
What is Sterile pyuria
absent pus cells of obvious bacteria. most common sterile pyuria is chlamydia urethritis. (chlamydia cells are not found in urine). Other sterile pyuria include bladder cancer, tuberculosis, bladder stones and schistosomiasis (parasitic worms/ malaria).
What is Bacteruria ?
presence of bacteria in the urine.
what are the markers for symptomatic women
>108 colony forming units per litre of urine. recent changes by the European association of urology typical symptoms of cystitis should be reduced to >105 colony forming units per urine litre.
NOT commonly used by Australasia microbiologists= KNOW THIS!!!!
what colony forming unit?
microbiology department, urine is placed on an agar plate, set at 37 degrees C for 24 hours and the amount of colonies determine the amount of bacterial organisms present in urine.
recurrent proven bacterial cystitis is defined as
3 proven infections within 12 months
originally was 3 infections in 5 years > studies provided insight that 25% of women who have a proven bacterial cystitis have a recurrent infection within 6 months
is a urine dipstick a sufficient measurement of associated urogynaecological issues?
NO
what does a urine dipstick look for with a urinalysis?
abnormal levels of nitrates, leukocytes and proteinuria
what is a cystocele?
weakened muscles and tissues around bladder wall allowing the falling in to the vaginal canal causing trapped urine increasing the risk of urinary tract infections and recurrency.
what does intercourse spread into the urethra of a women posing potential problems
Flora from the perineum into the urethra
what is atrophic vaginitis and how can it be treated?
thinning, drying and inflammation of the vaginal walls due to less estrogen production. topical vaginal oestrogen cream can be used to thicken the lining of urethral wall to increase the mucosal seal.
why are three urine containers given to patient at the first symptoms of cystitis?
because women lead busy lives and if we as clinicians can capture the first microbiological evidence of bacterial cystitis the correct antibiotics can be administered before the bacterial is embedded deep into the wall of the bladder
how to explain how to get a midstream urine sample
ask the patient to sit forward on the toilet, spread their labia, clean the area with wet tissue of soap and water, Ask the patient to void a few drops to remove any contamination from the urethra meatus, the next void needs to be caught in the urine container.
what should be asked of patient with recurrent bacterial cystitis?
poor stream / feeling of incomplete emptying / post void dribbling / any recent incontinence surgery eg: TVT (tension-free vaginal tape)
isolated UTIs - what is usually prescribed for these patients?
5 days of macrodantoin 100mg QID. effective for e-coli, klebsiella, enerobaccter and streptococci if urine pH is normal (pH 5.5-5.6)
(not suitable for pseudomonas)
recurrent UTIs - best practice
using topical vaginal estrogen creams (ovestin) applied digitally to the peri-urethral area and to the introitus gives better results, in terms of mucosal thickening of the urethra and prevention of ascending bacteria.
types of vaginal oestriol creasm
vagifem - applicator usage (tablet form)
Ovestin - applied by digital (cream)
what is the kilmartin regime?
the use of table salt as a way of killing bacterial infections. Used to wash the perineum at the onset of dyuria. The use of bicarbonate soda drinks to alkalinise the urine to reduce pain.
what is hipprex (methamine hippurate) and what should it be used in conjunction with
used if the pH of urine is acidic - <pH 5.5. it should be given with vitamin c atleast 1gm BD to lower urine pH.
Cranberry most important ingredient
proanthocyanidin (PAC)
how much cranberry juice is required and how does it work
1500ml of juice a day. it assists inhibiting the adhesion of fimbria to e-coli receptor to the uroepithelial cells.