Mark lynch clinical lead urology cuh
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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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Mark Lynch Clinical Lead Urology CUH

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Mark lynch clinical lead urology cuh

Mark LynchClinical Lead Urology CUH

[email protected]

[email protected]

[email protected]


Mark lynch clinical lead urology cuh

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


Mark lynch clinical lead urology cuh

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


Recurrent uti management1

Recurrent UTI - management


Mark lynch clinical lead urology cuh

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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