SU29.3 | Urinary Tract Infections — Summary & Reflection

KEY TAKEAWAYS

Urinary tract infection runs from trivial cystitis to lethal urosepsis, and the surgical task is to triage it correctly. Classify along three axes: uncomplicated vs complicated (complicated = abnormal tract or vulnerable host — obstruction, stone, catheter, immunosuppression, pregnancy, male sex, diabetes), lower (cystitis/urethritis) vs upper (acute pyelonephritis), and the special states — recurrent UTI, asymptomatic bacteriuria, and the surgical emergencies. E. coli is commonest; Proteus (urease, alkaline urine) predisposes to struvite/staghorn stones; catheter/hospital organisms are Klebsiella, Enterococcus, Pseudomonas; Staph. saprophyticus affects young women. Investigate with dipstick → microscopy → culture (significant bacteriuria ≥10⁵ CFU/mL), bloods, and imaging (ultrasound first, CT for complicated/obstructed/abscess) to find the underlying cause. Manage with culture-guided antibiotics and sepsis resuscitation, but remember the cardinal rule: an obstructed infected system must be decompressed urgently (percutaneous nephrostomy or ureteric stent), abscesses are drained, Fournier's gangrene needs immediate debridement, and asymptomatic bacteriuria is treated only in pregnancy or before urological instrumentation. Always find and treat the underlying urological abnormality in complicated, recurrent or male infection.

REFLECT

Think back to a febrile patient you have seen with a 'urine infection', or imagine clerking one on your next on-call. Did you check the vital signs and conscious level to decide whether this was a prescription or an emergency, palpate the loins, and — in a man, especially a diabetic — actually inspect the perineum and scrotum for early Fournier's gangrene? Did you ask why this particular patient had an infection, and would you have imaged a complicated, recurrent or male UTI to look for an underlying stone or obstruction? Now picture the obstructed, septic kidney: could you explain to a junior, and to the patient's family, why the answer is a drain tonight rather than a stronger antibiotic in the morning? Reflect on how holding the single rule 'pus under pressure must be released' would change the way you respond to a UTI that is not getting better.