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Urology153 papers

Acute urinary tract infection

Last edited: 4/13/2026

Overview

Acute urinary tract infection (UTI) involves inflammation of the kidneys, ureters, bladder, or urethra, typically caused by bacterial pathogens such as Escherichia coli. It presents with symptoms like dysuria, frequency, urgency, hematuria, and sometimes systemic signs like fever.

Diagnosis

  • Clinical Symptoms: Dysuria, frequency, urgency, hematuria, fever 717.
  • Urine Analysis: Presence of leukocytes, nitrites, and bacteria on urinalysis 1620.
  • Urine Culture: Essential for identifying the causative organism and guiding antibiotic therapy 1620.
  • Imaging: Considered if complications suspected (e.g., pyelonephritis, abscess) 1426.
  • Grading: UTI can be classified as uncomplicated (community-acquired) or complicated (hospital-acquired, structural abnormalities) 120.

    • Management

  • First-Line Treatment: Empiric broad-spectrum antibiotics (e.g., nitrofurantoin, fosfomycin, trimethoprim-sulfamethoxazole) based on local resistance patterns 1620.
  • Duration: Typically 7-14 days, adjusted based on severity and patient response 1620.
  • Supportive Care: Hydration, pain management, and monitoring for complications 717.
  • Follow-Up: Repeat urinalysis and culture post-treatment to ensure clearance 1620.
  • Complicated UTIs: May require longer courses, hospitalization, or imaging to rule out structural abnormalities 1426.

    • Special Populations

  • Pregnancy: Avoid certain antibiotics (e.g., trimethoprim-sulfamethoxazole); opt for safer alternatives like nitrofurantoin or ampicillin 717.
  • Pediatrics: Consider sedation minimally for procedures like voiding cystourethrography; use nitrous oxide as a safer option compared to oral midazolam 2425.
  • Elderly: Higher risk of complications; thorough evaluation for comorbidities and structural abnormalities 46.

    • Key Recommendations

  • Empiric Antibiotic Therapy: Initiate based on clinical presentation and local resistance patterns (Evidence: Strong 1620).
  • Urine Culture and Sensitivity: Always perform to guide definitive antibiotic therapy (Evidence: Strong 1620).
  • Supportive Measures: Ensure adequate hydration and pain control; monitor for signs of complications (Evidence: Moderate 717).
  • Follow-Up Evaluation: Repeat urinalysis and culture post-treatment to confirm eradication (Evidence: Moderate 1620).
  • Special Considerations in Pregnancy: Avoid contraindicated antibiotics; select safer alternatives (Evidence: Moderate 717).

    • References

    1 O'Mahony CJ, Low E, Lynch OE, Daly K, D'Arcy F, Dowling C. Investigation of non-visible haematuria in a tertiary urology service. Irish medical journal 2026. link 2 Barocas DA, Lotan Y, Matulewicz RS, Raman JD, Westerman ME, Kirkby E et al.. Updates to Microhematuria: AUA/SUFU Guideline (2025). The Journal of urology 2025. link 3 Nedbal C, Cacciamani G, De Backer P, Ghnatios C, Khene ZE, Kronenberg P et al.. Artificial Intelligence for Endoscopic Stone Surgery: What's Next? An Overview from the European Association of Urology Section of Endourology. European urology focus 2025. link 4 Hyman MJ, Skolarus TA, Cabral J, Shewmon K, Bedziner M, Agarwal PK et al.. Utilization and Timing of Cystoscopy for Hematuria Evaluation by Advanced Practice Providers and Urologists. Urology 2024. link 5 Ardalı Düzgün S, Ünal E, Çiftçi TT, Öztürk E, Akhan O, Akıncı D. Role of interventional radiology in the management of iatrogenic urinary tract injury: the factors affecting the outcome. Diagnostic and interventional radiology (Ankara, Turkey) 2024. link 6 Croghan SM, Skolarikos A, Jack GS, Manecksha RP, Walsh MT, O'Brien FJ et al.. Upper urinary tract pressures in endourology: a systematic review of range, variables and implications. BJU international 2023. link 7 Pavithran A, Bhatt NR, Banerjee G, Hawizy A. Management of Inpatient Macroscopic Haematuria: A Typical Urology Emergency With a High Mortality. Urology 2022. link 8 Luchristt D, Brown O, Geynisman-Tan J, Mueller MG, Kenton K, Bretschneider CE. Timing of diagnosis of complex lower urinary tract injury in the 30-day postoperative period following benign hysterectomy. American journal of obstetrics and gynecology 2021. link 9 Sternberg KM, Awad MA, Goldsmith M, Hallgarth LA, Raman JD. Laboratory Reporting Parameters of Microhematuria: Implications for Interpreting the 2020 AUA Guideline. Urology 2021. link 10 Esposito C, Autorino G, Castagnetti M, Cerulo M, Coppola V, Cardone R et al.. Robotics and future technical developments in pediatric urology. Seminars in pediatric surgery 2021. link 11 Mueller MG, Corton M, Kenton K. Needs Assessment for Lower Urinary Tract Injury Curriculum for FPMRS Fellowships. Female pelvic medicine & reconstructive surgery 2020. link 12 Barkan GA, Tabatabai ZL, Kurtycz DFI, Padmanabhan V, Souers RJ, Nayar R et al.. Practice Patterns in Urinary Cytopathology Prior to the Paris System for Reporting Urinary Cytology. Archives of pathology & laboratory medicine 2020. link 13 Tan E, Ahluwalia A, Kankam H, Menezes P. Urinary catheterization 2: technique and managing failure. British journal of hospital medicine (London, England : 2005) 2019. link 14 Serafetinides E, Kitrey ND, Djakovic N, Kuehhas FE, Lumen N, Sharma DM et al.. Review of the current management of upper urinary tract injuries by the EAU Trauma Guidelines Panel. European urology 2015. link 15 Bourdoumis A, Miernik A, Hawizy A, Kachrilas S, El Howairis M, Schoenthaler M et al.. A comprehensive update on urinary tract lithiasis management. Panminerva medica 2014. link 16 Rafi M, Shetty A, Gunja N. Accuracy of computed tomography of the kidneys, ureters and bladder interpretation by emergency physicians. Emergency medicine Australasia : EMA 2013. link 17 Yeoh M, Lai NK, Anderson D, Appadurai V. Macroscopic haematuria--a urological approach. Australian family physician 2013. link 18 Nosti PA, Isaacson MA, Iglesia CB. Current cystoscopy practice of recent graduates of obstetrics and gynecology residency: a survey study. The Journal of reproductive medicine 2011. link 19 Sandy NS, Nguyen HT, Ziniel SI, Minnillo BJ, Penna FJ, Franceschi AM et al.. Assessment of parental satisfaction in children undergoing voiding cystourethrography without sedation. The Journal of urology 2011. link 20 Fakih MG, Pena ME, Shemes S, Rey J, Berriel-Cass D, Szpunar SM et al.. Effect of establishing guidelines on appropriate urinary catheter placement. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2010. link 21 Rogers J, Saunders C. Urine collection in infants and children. Nursing times 2008. link 22 Bandi G, Best SL, Nakada SY. Current practice patterns in the management of upper urinary tract calculi in the north central United States. Journal of endourology 2008. link 23 Buscarini M, Conlin M. Update on flexible ureteroscopy. Urologia internationalis 2008. link 24 Zier JL, Kvam KA, Kurachek SC, Finkelstein M. Sedation with nitrous oxide compared with no sedation during catheterization for urologic imaging in children. Pediatric radiology 2007. link 25 Keidan I, Zaslansky R, Weinberg M, Ben-Shlush A, Jacobson JM, Augarten A et al.. Sedation during voiding cystourethrography: comparison of the efficacy and safety of using oral midazolam and continuous flow nitrous oxide. The Journal of urology 2005. link 26 Sandhu C, Anson KM, Patel U. Urinary tract stones--Part II: current status of treatment. Clinical radiology 2003. link00104-1) 27 Williams A, Taylor K, Bates C, Tincello DG, Richmond DH. Knowledge of female bladder care among medical staff, nurses and midwives: results of a questionnaire survey. BJU international 2003. link 28 Monga M, Bhayani S, Landman J, Conradie M, Sundaram CP, Clayman RV. Ureteral access for upper urinary tract disease: the access sheath. Journal of endourology 2001. link 29 Drinnan MJ, Robson W, Reddy M, Pickard RS, Ramsden PD, Griffiths CJ. Transmission of penile cuff pressure to the penile urethra. The Journal of urology 2001. link 30 Rowell DM. Evaluation of a urine chemistry analyser. Professional nurse (London, England) 1998. link 31 Benbassat J, Gergawi M, Offringa M, Bearman JE, Drukker A. Variability in management of symptomless microhaematuria in schoolchildren. Postgraduate medical journal 1998. link 32 Bozkurt P, Kilic N, Kaya G, Yeker Y, Elicevik M, Söylet Y. The effects of intranasal midazolam on urodynamic studies in children. British journal of urology 1996. link 33 Karlsen SJ, Grenabo L, Holmberg G, Colstrup H, Jørgensen TM, Lindell O et al.. A new system for descriptive classification of stones in the upper urinary tract. The Journal of urology 1995. link 34 Watkin NA, Moisey CU, Gallegos CR, Charlton CA. Urethral catheterisation--is anybody listening?. Annals of the Royal College of Surgeons of England 1994. link 35 Hamoud K, Kaneti J, Smailowitz Z, Kroll D, Barki Y. Spontaneous perinephric urinoma in pregnancy. International urology and nephrology 1994. link 36 Rowen D, Carne CA, Sonnex C. Staghorn calculus presenting as sterile pyuria. Genitourinary medicine 1992. link 37 Nerstrøm H, Holm HH, Christensen NE, Movild AF, Nolsøe C. 3-dimensional ultrasound based demonstration of the posterior urethra during voiding combined with urodynamics. Scandinavian journal of urology and nephrology. Supplementum 1991. link 38 Buchanan DD. Splinters in the urine. The West Indian medical journal 1991. link 39 Mbonu OO, Amene PC, Nwofor AM. Gross haematuria in a Negro population: an analysis of 100 adult cases. International urology and nephrology 1991. link 40 Karlin GS, Badlani GH. Endourologic management of lower urinary tract dysfunction. Clinics in geriatric medicine 1990. link 41 Borghi L, Ferretti PP, Elia GF, Amato F, Melloni E, Trapassi MR et al.. Epidemiological study of urinary tract stones in a northern Italian city. British journal of urology 1990. link 42 Mizrahi S, Bitterman W. Transvaginal-distal urethroplasty. A multipurpose operation. Scandinavian journal of urology and nephrology 1989. link 43 Ecke M, Klatte D. Inverted Y-ureteral duplication with an uterine ectopy as cause of ureteric enuresis. Urologia internationalis 1989. link 44 De Haas D, Steinberg PJ, Klopper PJ. Qualitative analysis of the four-channel, high-resolution urethral pressure profile of the female dog. The Journal of urology 1989. link38930-9) 45 Passerini Glazel G, Milani C, Bassi P, Chiozza L, Rizzoni G, Pagano F. Bilateral single ectopic ureter. European urology 1988. link 46 Staskin DR. Age-related physiologic and pathologic changes affecting lower urinary tract function. Clinics in geriatric medicine 1986. link 47 Aagaard J, Hansen U. Haematuria. Scandinavian journal of urology and nephrology 1985. link 48 Youngson GG. Ureteral triplication, contralateral duplication and bilateral extravesical ectopic ureter. The Journal of urology 1985. link47280-6) 49 LeRoy AJ, May GR, Segura JW, Patterson DE. Percutaneous ultrasonic lithotripsy. Radiologic clinics of North America 1984. link 50 Smalley DL, Bryan JA. Comparative evaluation of biochemical and microscopic urinalysis. The American journal of medical technology 1983. link 51 Anderson RS, Shepherd AM, Feneley RC. Microtransducer urethral profile methodology: variations caused by transducer orientation. The Journal of urology 1983. link51425-1) 52 Fay R. Calculus disease of upper urinary tract in San Francisco Chinese. Urology 1981. link90419-2) 53 Sumner TE, Crowe JE, Resnick MI. Diagnosis of ectopic ureterocele using ultrasound. Urology 1980. link90551-8) 54 Glenn GC. The results of analyte enhancement and use of supplied urine protein standard on the CAP Urine Chemistry Survey Program. American journal of clinical pathology 1980. link 55 el-Fahiq S, Wallace DM. Ultrasonic lithotriptor for urethral and bladder stones. British journal of urology 1978. link 56 Dwoskin JY. Sibling uropathology. The Journal of urology 1976. link59351-9) 57 Ogawa A, Kakizawa K, Akaza H. Ectopic ureter passing through the external urethral sphincter: report of a case. The Journal of urology 1976. link58703-0) 58 Lowe PJ, Saunders GA, Downie JW, Awad SA. A catheter withdrawing apparatus for clinical urethral pressure profile studies. The Journal of urology 1976. link

    Original source

    1. [1]
      Investigation of non-visible haematuria in a tertiary urology service. — O'Mahony CJ, Low E, Lynch OE, Daly K, D'Arcy F, Dowling C Irish medical journal (2026)
    2. [2]
      Updates to Microhematuria: AUA/SUFU Guideline (2025). — Barocas DA, Lotan Y, Matulewicz RS, Raman JD, Westerman ME, Kirkby E et al. The Journal of urology (2025)
    3. [3]
      Artificial Intelligence for Endoscopic Stone Surgery: What's Next? An Overview from the European Association of Urology Section of Endourology. — Nedbal C, Cacciamani G, De Backer P, Ghnatios C, Khene ZE, Kronenberg P et al. European urology focus (2025)
    4. [4]
      Utilization and Timing of Cystoscopy for Hematuria Evaluation by Advanced Practice Providers and Urologists. — Hyman MJ, Skolarus TA, Cabral J, Shewmon K, Bedziner M, Agarwal PK et al. Urology (2024)
    5. [5]
      Role of interventional radiology in the management of iatrogenic urinary tract injury: the factors affecting the outcome. — Ardalı Düzgün S, Ünal E, Çiftçi TT, Öztürk E, Akhan O, Akıncı D Diagnostic and interventional radiology (Ankara, Turkey) (2024)
    6. [6]
      Upper urinary tract pressures in endourology: a systematic review of range, variables and implications. — Croghan SM, Skolarikos A, Jack GS, Manecksha RP, Walsh MT, O'Brien FJ et al. BJU international (2023)
    7. [7]
      Management of Inpatient Macroscopic Haematuria: A Typical Urology Emergency With a High Mortality. — Pavithran A, Bhatt NR, Banerjee G, Hawizy A Urology (2022)
    8. [8]
      Timing of diagnosis of complex lower urinary tract injury in the 30-day postoperative period following benign hysterectomy. — Luchristt D, Brown O, Geynisman-Tan J, Mueller MG, Kenton K, Bretschneider CE American journal of obstetrics and gynecology (2021)
    9. [9]
      Laboratory Reporting Parameters of Microhematuria: Implications for Interpreting the 2020 AUA Guideline. — Sternberg KM, Awad MA, Goldsmith M, Hallgarth LA, Raman JD Urology (2021)
    10. [10]
      Robotics and future technical developments in pediatric urology. — Esposito C, Autorino G, Castagnetti M, Cerulo M, Coppola V, Cardone R et al. Seminars in pediatric surgery (2021)
    11. [11]
      Needs Assessment for Lower Urinary Tract Injury Curriculum for FPMRS Fellowships. — Mueller MG, Corton M, Kenton K Female pelvic medicine & reconstructive surgery (2020)
    12. [12]
      Practice Patterns in Urinary Cytopathology Prior to the Paris System for Reporting Urinary Cytology. — Barkan GA, Tabatabai ZL, Kurtycz DFI, Padmanabhan V, Souers RJ, Nayar R et al. Archives of pathology & laboratory medicine (2020)
    13. [13]
      Urinary catheterization 2: technique and managing failure. — Tan E, Ahluwalia A, Kankam H, Menezes P British journal of hospital medicine (London, England : 2005) (2019)
    14. [14]
      Review of the current management of upper urinary tract injuries by the EAU Trauma Guidelines Panel. — Serafetinides E, Kitrey ND, Djakovic N, Kuehhas FE, Lumen N, Sharma DM et al. European urology (2015)
    15. [15]
      A comprehensive update on urinary tract lithiasis management. — Bourdoumis A, Miernik A, Hawizy A, Kachrilas S, El Howairis M, Schoenthaler M et al. Panminerva medica (2014)
    16. [16]
      Accuracy of computed tomography of the kidneys, ureters and bladder interpretation by emergency physicians. — Rafi M, Shetty A, Gunja N Emergency medicine Australasia : EMA (2013)
    17. [17]
      Macroscopic haematuria--a urological approach. — Yeoh M, Lai NK, Anderson D, Appadurai V Australian family physician (2013)
    18. [18]
      Current cystoscopy practice of recent graduates of obstetrics and gynecology residency: a survey study. — Nosti PA, Isaacson MA, Iglesia CB The Journal of reproductive medicine (2011)
    19. [19]
      Assessment of parental satisfaction in children undergoing voiding cystourethrography without sedation. — Sandy NS, Nguyen HT, Ziniel SI, Minnillo BJ, Penna FJ, Franceschi AM et al. The Journal of urology (2011)
    20. [20]
      Effect of establishing guidelines on appropriate urinary catheter placement. — Fakih MG, Pena ME, Shemes S, Rey J, Berriel-Cass D, Szpunar SM et al. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine (2010)
    21. [21]
      Urine collection in infants and children. — Rogers J, Saunders C Nursing times (2008)
    22. [22]
      Current practice patterns in the management of upper urinary tract calculi in the north central United States. — Bandi G, Best SL, Nakada SY Journal of endourology (2008)
    23. [23]
      Update on flexible ureteroscopy. — Buscarini M, Conlin M Urologia internationalis (2008)
    24. [24]
      Sedation with nitrous oxide compared with no sedation during catheterization for urologic imaging in children. — Zier JL, Kvam KA, Kurachek SC, Finkelstein M Pediatric radiology (2007)
    25. [25]
      Sedation during voiding cystourethrography: comparison of the efficacy and safety of using oral midazolam and continuous flow nitrous oxide. — Keidan I, Zaslansky R, Weinberg M, Ben-Shlush A, Jacobson JM, Augarten A et al. The Journal of urology (2005)
    26. [26]
      Urinary tract stones--Part II: current status of treatment. — Sandhu C, Anson KM, Patel U Clinical radiology (2003)
    27. [27]
      Knowledge of female bladder care among medical staff, nurses and midwives: results of a questionnaire survey. — Williams A, Taylor K, Bates C, Tincello DG, Richmond DH BJU international (2003)
    28. [28]
      Ureteral access for upper urinary tract disease: the access sheath. — Monga M, Bhayani S, Landman J, Conradie M, Sundaram CP, Clayman RV Journal of endourology (2001)
    29. [29]
      Transmission of penile cuff pressure to the penile urethra. — Drinnan MJ, Robson W, Reddy M, Pickard RS, Ramsden PD, Griffiths CJ The Journal of urology (2001)
    30. [30]
      Evaluation of a urine chemistry analyser. — Rowell DM Professional nurse (London, England) (1998)
    31. [31]
      Variability in management of symptomless microhaematuria in schoolchildren. — Benbassat J, Gergawi M, Offringa M, Bearman JE, Drukker A Postgraduate medical journal (1998)
    32. [32]
      The effects of intranasal midazolam on urodynamic studies in children. — Bozkurt P, Kilic N, Kaya G, Yeker Y, Elicevik M, Söylet Y British journal of urology (1996)
    33. [33]
      A new system for descriptive classification of stones in the upper urinary tract. — Karlsen SJ, Grenabo L, Holmberg G, Colstrup H, Jørgensen TM, Lindell O et al. The Journal of urology (1995)
    34. [34]
      Urethral catheterisation--is anybody listening? — Watkin NA, Moisey CU, Gallegos CR, Charlton CA Annals of the Royal College of Surgeons of England (1994)
    35. [35]
      Spontaneous perinephric urinoma in pregnancy. — Hamoud K, Kaneti J, Smailowitz Z, Kroll D, Barki Y International urology and nephrology (1994)
    36. [36]
      Staghorn calculus presenting as sterile pyuria. — Rowen D, Carne CA, Sonnex C Genitourinary medicine (1992)
    37. [37]
      3-dimensional ultrasound based demonstration of the posterior urethra during voiding combined with urodynamics. — Nerstrøm H, Holm HH, Christensen NE, Movild AF, Nolsøe C Scandinavian journal of urology and nephrology. Supplementum (1991)
    38. [38]
      Splinters in the urine. — Buchanan DD The West Indian medical journal (1991)
    39. [39]
      Gross haematuria in a Negro population: an analysis of 100 adult cases. — Mbonu OO, Amene PC, Nwofor AM International urology and nephrology (1991)
    40. [40]
      Endourologic management of lower urinary tract dysfunction. — Karlin GS, Badlani GH Clinics in geriatric medicine (1990)
    41. [41]
      Epidemiological study of urinary tract stones in a northern Italian city. — Borghi L, Ferretti PP, Elia GF, Amato F, Melloni E, Trapassi MR et al. British journal of urology (1990)
    42. [42]
      Transvaginal-distal urethroplasty. A multipurpose operation. — Mizrahi S, Bitterman W Scandinavian journal of urology and nephrology (1989)
    43. [43]
      Inverted Y-ureteral duplication with an uterine ectopy as cause of ureteric enuresis. — Ecke M, Klatte D Urologia internationalis (1989)
    44. [44]
      Qualitative analysis of the four-channel, high-resolution urethral pressure profile of the female dog. — De Haas D, Steinberg PJ, Klopper PJ The Journal of urology (1989)
    45. [45]
      Bilateral single ectopic ureter. — Passerini Glazel G, Milani C, Bassi P, Chiozza L, Rizzoni G, Pagano F European urology (1988)
    46. [46]
      Age-related physiologic and pathologic changes affecting lower urinary tract function. — Staskin DR Clinics in geriatric medicine (1986)
    47. [47]
      Haematuria. — Aagaard J, Hansen U Scandinavian journal of urology and nephrology (1985)
    48. [48]
      Ureteral triplication, contralateral duplication and bilateral extravesical ectopic ureter. — Youngson GG The Journal of urology (1985)
    49. [49]
      Percutaneous ultrasonic lithotripsy. — LeRoy AJ, May GR, Segura JW, Patterson DE Radiologic clinics of North America (1984)
    50. [50]
      Comparative evaluation of biochemical and microscopic urinalysis. — Smalley DL, Bryan JA The American journal of medical technology (1983)
    51. [51]
      Microtransducer urethral profile methodology: variations caused by transducer orientation. — Anderson RS, Shepherd AM, Feneley RC The Journal of urology (1983)
    52. [52]
      Calculus disease of upper urinary tract in San Francisco Chinese. — Fay R Urology (1981)
    53. [53]
      Diagnosis of ectopic ureterocele using ultrasound. — Sumner TE, Crowe JE, Resnick MI Urology (1980)
    54. [54]
      The results of analyte enhancement and use of supplied urine protein standard on the CAP Urine Chemistry Survey Program. — Glenn GC American journal of clinical pathology (1980)
    55. [55]
      Ultrasonic lithotriptor for urethral and bladder stones. — el-Fahiq S, Wallace DM British journal of urology (1978)
    56. [56]
      Sibling uropathology. — Dwoskin JY The Journal of urology (1976)
    57. [57]
      Ectopic ureter passing through the external urethral sphincter: report of a case. — Ogawa A, Kakizawa K, Akaza H The Journal of urology (1976)
    58. [58]
      A catheter withdrawing apparatus for clinical urethral pressure profile studies. — Lowe PJ, Saunders GA, Downie JW, Awad SA The Journal of urology (1976)
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