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Mark Lynch Clinical Lead Urology CUH. [email protected] [email protected] [email protected] UTI. ADHERERNCE MECHANISMS FIMBRIAE type I – mannose sensitive, adhere to uroplakins Ia and Ib on urothelium P type – mannose insensitive

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Presentation Transcript
slide2
UTI
  • ADHERERNCE MECHANISMS
    • FIMBRIAE
    • type I – mannose sensitive, adhere to uroplakins Ia and Ib on urothelium
    • P type – mannose insensitive
    • Pap (P pili associated with pyelonephritis) – 4 proteins (F, A, G, E)
    • PapG is receptor component
      • 3 subtypes (I, II, III)
      • PapG subtype II associated more with pyelonephritis
      • PapG subtype III associated more with cystitis
slide3
UTIs
  • UTI
  • Infection
  • Complicated or not
  • Recurrent
  • Management
  • Infection and stones – hand in hand
utis or cystitis
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
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
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
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
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
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
slide12
UTIs
  • 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
Renal Colic and Stones
  • 10% risk, 50% recurrence risk at 10 years
  • Risk factors include:
    • Geography
    • Diet
    • Anatomical
    • M>F
    • Fluid intake
    • Genetics (Cysteinuria)
renal colic and stones at cuh
Renal Colic and Stones at CUH
  • Pain relief
  • History
  • Examination
  • Gold standard ED management
    • CT KUB
    • Early diagnosis
    • Early treatment
    • Stone clinic F/U
    • Access to tertiary care
renal colic and stones at cuh1
Renal Colic and stones at CUH
  • CUH
    • Laser lithotripsy
    • ESWL
    • Dedicated stone clinic
    • Seamless link with SGH
  • SGH
    • PCNL
    • URS (day case)
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