Diagnosis, treatment and prophylaxis of urinary tract infections – the urologist's perspective

Background:

Urinary tract infections (UTI) are a frequent clinical problem, causing significant morbidity and costs. About 30% of the patients suffer from recurrent UTI.

Definition and diagnostics:

UTI are defined as a combination of bacteriuria and clinical symptoms, thus asymptomatic bacteriuria should be treated in pregnant women only. Unnecessary antibiotic treatment leads to multidrug resistance and should therefore be avoided. Empiric antibiotic treatment is feasible, but a microbiological urine examination is helpful in uncomplicated UTI and mandatory in patients with recurrent or complicated UTI. In these groups, diagnostic measures to detect morphologic or functional abnormalities are required, including residual urine, dysfunctional voiding, stones, or foreign bodies.

Treatment:

Whereas short-term antibiotic treatment is the standard therapy for uncomplicated UTI, symptomatic treatment is a valid option. Complicated UTI require antibiotic treatment for 5 to 7 days. In patients with complicated or recurrent UTI, morphologic or functional abnormalities should be treated. If UTIs continue, prophylactic measures can be helpful. These may consist of phytotherapy (e.g. cranberries), urine acidification, immunostimulation, restoration of glycosaminoglycan layers in the bladder, or long-term low-dose antibiotic treatment. In addition, modification of the vaginal or rectal flora, improvement of defecation disorders, and lifestyle modification (e.g. drinking or toilet habits, hygiene, post-coital voiding) have proven to be helpful in reducing the number of UTI.

Conclusion:

Although there is no solitary treatment that reliably prevents UTI in all patients, several effective measures exist in conventional medicine to treat and prevent UTI.