Urinary tract Infection

Introduction Urinary tract infection (UTI) is a common condition. The vast majority of patients suffering an episode of infection in the urogenital tract can be managed in the community and will never need to see a urologist. However, it is vital for the urologist to have an understanding of UTI. Infection can lead to considerable morbidity, especially in cases of yirulent organisms, or where the urinary tract is abnormal in structure and/or function. This chapter of The Year in Urology presents a selection of the research performed this year into UTI. Research into infection in the abnormal urinary tract is represented with a study looking at positive urine cultures in orthotopic neobladders, and another looking at the incidence of breakthrough UTIs in patients with vesico-ureteric reflux (VUR). The latter paper looks at how parenchymal change as a result of these infections may be assessed using 99-technetium dimercaptosuccinic acid renal scans. Three papers are summarized which concentrate on the male urinary tract. The first looks at the necessity for investigating UTI in men less than 45 years of age, the second at PSA levels in men with febrile UTIs, and the third at a randomized double-blind multi-centre study of levofloxacin versus ciprofloxacin in chronic bacterial prostatitis. A vaccine for UTI is a novel concept, and we look at a phase 2 study describing the use of a vaginal mucosal vaccine containing heat-killed uropathogenic bacteria as a way of managing recurrent urinary tract infection. Little data exists on the relationship between the frequency of bacterial colonization of double-J ureteric stents and stent-associated infection. The study included here concludes that such colonization plays a significant role in the pathogenesis of stent-associated infection. Two papers in this chapter look at different aspects of UTI at a cellular level — one that examines E. coli virulence factors and another that looks at P fimbria-specific B cell responses in patients with UTI. Finally, we have included a multi-centre study looking at the anti-microbial sensitivity of bacterial UTI in the UK.