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Urinary tract infectious disease — Clinical Guidelines

Overview

Urinary tract infections (UTIs) encompass infections affecting any part of the urinary system, including the kidneys, bladder, ureters, and urethra, often caused by bacteria such as Escherichia coli. 20

Diagnosis

Key Diagnostic Criteria: Presence of dysuria, frequency, urgency, hematuria, and suprapubic pain.

Recommended Tests: Urinalysis (leukocyte esterase, nitrites), urine culture, and sensitivity testing.

Grading: Classification into uncomplicated vs. complicated UTIs based on patient factors and clinical presentation. 20

Management

First-Line Treatments:

- Antibiotics: Fluoroquinolones (e.g., ciprofloxacin), beta-lactams (e.g., ceftriaxone), or trimethoprim-sulfamethoxazole for uncomplicated UTIs. 1 - Duration: Typically 7-14 days depending on severity and site of infection.

Adjunctive Treatments:

- Supportive Care: Increased fluid intake, pain management. - Follow-Up: Repeat urinalysis and culture post-treatment to ensure clearance. 20

Special Populations

Elderly: Higher risk of complicated UTIs and comorbidities affecting treatment choices. 4

Non-English Speaking Patients: Potential barriers to timely removal of ureteral stents, increasing risk of complications. 4

Comorbidities: Presence of diabetes or renal impairment may necessitate adjusted antibiotic therapy and monitoring. 20

Key Recommendations

Use urinalysis and urine culture for accurate diagnosis and guiding antibiotic therapy (Evidence: Strong 20).

Consider patient-specific factors (e.g., age, comorbidities) when selecting antibiotic prophylaxis or treatment (Evidence: Moderate 4).

Ensure timely removal of ureteral stents to prevent complications, especially in vulnerable populations (Evidence: Moderate 4).

Provide supportive care including adequate hydration and pain management alongside antimicrobial treatment (Evidence: Expert opinion).

References

1 Gavi F, Ragonese M, Fettucciari D, Sighinolfi MC, Turri F, Panio E et al.. Antibiotic prophylaxis in stone surgery: a systematic review of the literature. World journal of urology 2025. link 2 Han JS, Grimsby GM, Grunewald N, Bresler L. Advancing the Future of Urology: Initial Experience and Program Design of an Innovative Incubation and Mentorship Program. Urology practice 2025. link 3 Deng X, Chen Y, Zhai Q, Song L, Du C, Tan W. Fluid absorption during flexible ureteroscopy with intelligent control of renal pelvic pressure: a randomized controlled trial. World journal of urology 2024. link 4 Kothari P, Du C, Aalami Harandi A, Hwang K, Griffith S, Kim J. Barriers to Healthcare: Non-English Speaking and Elderly Patients More Likely to Have Retained Ureteral Stents. Urology 2024. link 5 Pellegrino C, Koo K, North AC, Badalato GM, Badlani G, Fang R et al.. An Analysis of American Urological Association Census Trends: Earlier Planned Retirement and Practice Pattern Changes May Exacerbate the Urology Workforce Shortage. Urology 2024. link 6 Xue J, Yang Q. Clinical application of a special postoperative position cushion for patients after percutaneous nephrolithotomy: a randomized trial. Annals of palliative medicine 2021. link 7 Janssen K, Deng K, Majerus SJA, Lin DL, Hanzlicek B, Butler RS et al.. Transurethral versus suprapubic catheterization to test urethral function in rats. Scientific reports 2021. link 8 Nam CS, Daignault-Newton S, Kraft KH, Herrel LA. Projected US Urology Workforce per Capita, 2020-2060. JAMA network open 2021. link 9 Nam CS, Daignault-Newton S, Herrel LA, Kraft KH. The Future is Female: Urology Workforce Projection From 2020 to 2060. Urology 2021. link 10 Zhong X, Wang P, Feng J, Hu W, Huang C. Novel Transparent Urinary Tract Simulator Improves Teaching of Urological Operation Skills at a Single Institution. Urologia internationalis 2015. link 11 Kreshover JE, Dickstein RJ, Rowe C, Babayan RK, Wang DS. Predictors for negative ureteroscopy in the management of upper urinary tract stone disease. Urology 2011. link 12 Kruck S, Anastasiadis AG, Gakis G, Walcher U, Hennenlotter J, Merseburger AS et al.. Flow matters: irrigation flow differs in flexible ureteroscopes of the newest generation. Urological research 2011. link 13 Andonian S, Okeke Z, Smith AD. Digital ureteroscopy: the next step. Journal of endourology 2008. link 14 John B, Ghani KR, Patel U, Anson K. Resin polymer and corrosion casting of the porcine pelvi-calyceal system: a useful model for investigating new imaging and endoscopic techniques of the upper urinary tract. Urological research 2008. link 15 Fuselier HA, Prats L, Fontenot C, Gauthier A. Comparison of mobile lithotripters at one institution: healthtronics lithotron, Dornier MFL-5000, and Dornier Doli. Journal of endourology 1999. link 16 Bagi P, Thind P, Nordsten M. Passive urethral resistance to dilation in healthy women: an experimental simulation of urine ingression in the resting urethra. Neurourology and urodynamics 1995. link 17 Angeletti LR, Cavarra B. Critical and historical approach to Theophilus' De Urinis. Urine as blood's percolation made by the kidney and uroscopy in the middle ages. American journal of nephrology 1994. link 18 Castañeda F, Hernández-Graulau JM, Castañeda-Zúñiga WR. Interventional radiology of the lower urinary tract and its relationship to surgical treatment. Cardiovascular and interventional radiology 1991. link 19 Eshghi M, Addonizio JC. Same-session endourological removal of upper and impacted lower urinary tract stones with the aid of prone flexible cystoscopy. The Journal of urology 1987. link43018-7) 20 Benejam R, Narayana AS. Urinalysis: the physician's responsibility. American family physician 1985. link 21 Levin HS. Operating room consultation by the pathologist. The Urologic clinics of North America 1985. link 22 Fujita K. Urinary alanine aminopeptidase activity in various urinary tract diseases. Hinyokika kiyo. Acta urologica Japonica 1984. link 23 Banner MP, Pollack HM. Fluoroscopically guided percutaneous extraction of upper urinary tract calculi. Radiologic clinics of North America 1984. link 24 Kerlan RK, Kahn RI, Ring EJ. Percutaneous renal and ureteral stone removal. Urologic radiology 1984. link 25 Hocman G, Baláz V. Determination of proteins in unconcentrated normal human urine. Biochemistry and experimental biology 1977. link 26 Fowler JE. Retroperitoneal struvite calculus causing persistent bacteriuria. The Journal of urology 1977. link58230-0)

Urinary tract infectious disease