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The urinalysis, an inexpensive office test, is often performed unnecessarily. Improved chemical testing using reagent strips obviates the need for routine microscopy in many cases. More information is needed to make specific recommendations on the use of the routine urinalysis as a screening procedure.
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OBJECTIVES: To evaluate the current practice of the diagnostic workup in The Netherlands and the clinical relevancy of the outcome of various diagnostic procedures in young women referred for recurrent lower urinary tract infections (UTIs). METHODS: A questionnaire was sent to all urologic departments in The Netherlands (n = 104) inquiring about the diagnostic procedures used for recurrent lower UTIs. Furthermore, we performed a prospective study in 100 consecutive young female patients (18 to 40 years old) referred for evaluation of recurrent lower UTIs. All patients underwent a standardized workup: questionnaire, voiding diary, physical examination, urinalysis and culture, abdominal x-ray with ultrasound or intravenous urography, and cystoscopy. RESULTS: The response rate to the questionnaires was 92%. The standard procedures were laboratory blood tests in 56%, cystoscopy in 69%, plain abdominal x-ray in 91%, and abdominal ultrasound in 59%. Only 18% of the urologists asked every patient to make a voided urine frequency volume chart. In our group of patients, the radiologic procedures revealed only one relevant abnormality. Cystoscopy confirmed cystitis in 22 patients, but never revealed relevant findings. None of these diagnostic procedures ever contributed to the diagnosis. The 24-hour urine output was less than 1.5 L in 43 patients, which was considered insufficient. The individual self-reports of fluid intake were unreliable. CONCLUSIONS: Many Dutch urologists perform an extensive routine workup in patients referred for recurrent lower UTIs. The results of our study revealed that the yield of most diagnostic procedures in these patients is low. The focus in evaluating these patients should be directed toward the behavioral aspects. Thus, the routine workup can be restricted to a voiding diary, urinalysis, and urine culture.
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Twenty-three children with neuropathic bladder have been treated by intermittent catheterisation during the past 3 years. Twelve are now practically dry, nine are drier than before, and two have remained wet. Urinary infections have not been a major problem, but it is too soon to assess the long-term effects on the upper renal tract. Intermittent catheterisation lightens the burden for the mothers. Four children catheterise themselves and two of them are now independent.
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Although significant bacteriuria and urinary tract infection are more common in immunocompetent women than men, studies linking HIV immunosuppression with an increased risk of developing urinary infection have so far only been carried out in men. We therefore examined the relationship between bacteriuria and HIV status and CD4+cell count in a relatively homogeneous cohort of female commercial sex workers (CSW) attending a community clinic in Nairobi. Two hundred and twenty-two women were enrolled, and grouped according to HIV status and CD4 count. Group 1 were HIV seronegative (n = 52); Group 2 were HIV seropositive with CD4 + counts above 500 x 10(6)/l (n = 51); Group 3 were HIV seropositive with CD4 + counts between 201 and 500 x 10(6)/l (n = 67); Group 4 were HIV seropositive with CD4+counts below 200 x 10(6)/l (n = 52). Clinical signs and symptoms were noted and mid-stream specimens of urine obtained for culture and sensitivity. Overall 23% (50/222) had significant bacteriuria. The rates in each group respectively were 25%, 29%, 19% and 23% and there was no significant association between bacteriuria and HIV status; or between bacteriuria and level of immuno-suppression as indicated by CD4 + count. Overall 19% (30/222) of women had symptoms (frequency; dysuria; loin pain; smelly urine) or signs (fever; loin tenderness) compatible with urinary tract infection. However there was no significant association between symptoms or signs of infection and bacteriuria or HIV status. A typical range of pathogens, predominantly Enterobacteriaceae, were isolated and there were high rates of resistance to commonly used antimicrobials as well as 10% resistance to ciprofloxacin. Although high rates of significant bacteriuria can occur in highly sexually-active women, this appears unrelated to HIV infection or the level of HIV-related immunosuppression and is generally asymptomatic or clinically indistinct.
Accurate diagnosis of urinary tract infection (UTI) is possible in the emergency department. Clinical differentiation of upper tract infection (pyelonephritis) from lower tract infection (cystitis) is difficult. The consequences of untreated UTI justify treatment by the emergency physician. Many treatment schemes are available. Single-dose antibiotic therapy is the preferred treatment method for uncomplicated UTI. It reduces compliance problems, effectively cures lower UTI, and provides for early identification of patients with more complex infection. The complications of this therapy are minimal.