Tuesday, April 23, 2024

A Guide to Good Urinary Health

On 24 Feb, 2024, Seniors Today hosted their weekly Health Live Webinar with Dr Pankaj Maheshwari, a Senior Urologist at Fortis Hospital Mulund, who spoke on and answered questions about UTI and other Urinary Concerns in Seniors.

About Dr Pankaj Maheshwari

Dr Pankaj Maheshwari is Senior Consultant at Fortis Hospital Mulund. An MBBS and MS from GMC Nagpur, and a DNB and MCH in Urology from Grant Medical College, Mumbai in 1995 with eminent teachers like Dr Percy Chibber and Dr Madhav Kamat. He is also an FRCS from Glasgow.

He is a pioneer in the use of Holmium laser in India and trained in holmium laser prostatectomy with Dr Peter Gilling, NZ. He established the Holmium laser in 1998.

He has to his credit 75 Publications in national and international journals with an RG score of 31.42 (56 in indexed journals).

He is Co-editor of ‘Atlas of Endourology’ & USI’s Clinical Urology.

He has authored 10 chapters in different urology books.

He is a recipient of the Societe Internationale Urology Traveling Fellowship in 1999. He is a member of editorial board of Indian Journal of Urology and on review panel of more than 20 national and international urology journals.

He is a recipient of the Best Reviewer Award for J Endourol & IJU. He is Hon Treasurer of the Urology Society of India (2023-25). He is Ex-Treasurer of the West Zone Chapter of USI and is a Past-President of Lions International.

Urinary tract infection is one of the most common causes for patients coming to the hospital. It is the most common infection people suffer from.

Urinary tract infections can affect anyone at any point of time, since the time of their birth. It is more common in boys below the age of 5 years. Beyond that age, it is more common in girls and women.

There are certain bacterias which are normally present in our body and they are called commensals. These are helpful bacteria in the intestines which help with the process of digestion, they are also present in the urinary tract, vagina- and help in preventing aggressive infections.

But, if your immune system is not very strong, or if you are not consuming adequate amounts of water, or presence of any other disease which is causing an obstruction in the urinary tract- this can lead to the proliferation of the existing bacteria or it can also be due to entry of other bacterias and their growth which can lead to symptomatic urinary tract infections.

If your routine urine investigation shows presence of bacteria, it is not a cause for concern, since the bacteria present are commensals. Thus, every patient with a report showing presence of bacteria in their urine does not need to be treated for a urinary tract infection. Unless the individual is symptomatic or has immunocompromised status.

Urinary tract infections are more common in women for the following reasons:

  • Anatomic: urinary and vaginal passage are very close and the rectal passage is just behind. There is infection around the rectal passage, it is possible that the infection from there comes forward and enters the vaginal passage and from the vaginal passage it can further travel forward and enter the urinary passage.

Once in the urinary passage, the bacteria tend to rise up in the urethra, the urethral tube in women is short.

  • Sexual: sexual encounters can cause infection in the vaginal passage which can then enter the urinary passage.

Thus, urinary tract infections in women either start in the rectal or the vaginal area and then gain access to the urinary passage.

Urinary tract infection in men is not very common. If a male patient presents with a urinary tract infection, it is considered as a case of complicated urinary tract infection and it requires detailed evaluation and investigation.

A female patient with urinary tract infection is more common and is hence not treated as a case of complicated infection, due to the above mentioned reasons. And can thus be treated either symptomatically or with oral antibiotics and does not warrant a detailed evaluation.

However, if the female patient presents with a urinary tract infection 2 or more times in a period of 6 months or more than 3 in a year, then it is considered as a case of complicated urinary tract infection and requires a thorough and detailed evaluation.

This infection from the bladder can also travel up to the kidney. In kidneys, another source of infection can be blood borne infections wherein infection from anywhere in the body has reached the kidney.

Urinary tract infection is a broad term and can be further classified based on the site of infection.

  • Kidneys: Pyelonephritis
  • Urinary bladder: Cystitis
  • Outflow tubing (urethra): Urethritis

Cystitis is more common.

Pyelonephritis is rare and severe.

Patients with cystitis will have the following symptoms/ complains:

  • Increased frequency of urination
  • Inability to hold urine
  • During during micturition
  • Painful micturition
  • Lower abdominal pain
  • Fever

Patients with pyelonephritis will have the following symptoms/ complains:

  • Flank pain
  • Associated symptoms such as nausea and vomiting
  • Fever

These patients may not have burning/ painful micturition due to the higher foci of infection.

Urinary tract infections are also more common in the senior age group. The causes for it are different for males and females.

In females:

  • Hormonal changes post menopause leading to the fall in the levels of oestrogen, leading to an acidic pH of the vagina and acidic pH tends to be medium for growth of bacteria.
  • Age related vaginitis, allowing the possibility of it entering the urinary tract

In males:

  • Obstruction of the urinary tract. The commonest of all is due to the prostate gland

In patients with diabetes, which is an immunocompromised state, thus, urinary tract infections are more severe in diabetic patients.

Once you have been diagnosed with a urinary tract infection, here’s what you do:

  • Clinical assessment by a doctor
  • Detailed evaluation

Depending on the severity of the infection, your physician will treat you with the necessary antibiotics, and treatment of any cause for obstructions.

When you’re asked to get your urine investigations, it is commonly thought that a morning/ first sample is required, however that is not true. Morning samples are only needed for the diagnosis of some specific conditions such as tuberculosis.

You do not need a morning sample, but you do need a fresh sample.

Ensure the following things:

  • Go to the lab yourself and give a fresh sample
  • Give it to the lab technician/ handler himself, avoid transportation of the sample as it might take time or the sample may not be preserved
  • In men, before giving the sample, the foreskin should be retracted and the penis cleaned with soapy water. Pass 50-60ml of urine and then collect 10ml. The initial and terminal urine should not be collected in the bottle. (Mid stream sample)
  • In females, the vagina needs to be opened with 2 fingers, washed with water. Pass 50-60ml of urine and then collect 10ml. The initial and terminal urine should not be collected in the bottle. (Mid stream sample)
Dr Noor Gill
Dr Noor Gill, MBBS, deciphers the space between heartbeats, figuratively and literally. Powered by frequent long naps and caffeine, she believes that “knowledge without giving back to society is meaningless” and works to make caring cool again.

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