Consultant Urologist at the University College Hospital, Ibadan, Prof Linus Okeke, explains causes of urinary tract infections, diagnostic and preventive measures, in this interview with TOBI AWORINDE

What are urinary tract infections?

The urinary tract is the passage where waste product filtered in the urine is passed to the exterior. This tract includes the kidneys, ureters, bladder and urethra. When microorganisms such as bacteria, get into any or all of these tracts, it is termed urinary tract infection, colloquially called ‘toilet disease’.

What are the causes of urinary tract infections?

The urinary tract should be free of all disease-causing germs but when organisms find their way into the urinary tract, they cause urinary tract infections. These organisms are mostly bacteria, but other organisms like viruses, fungi and parasites can also cause this infection.

What other factors increase the risk of getting a urinary tract infection?

Age is a major determinant. The extremes of age are more predisposed. The female gender is more predisposed to UTI for some reasons, such as the short length of the urethra, the close proximity of the tract to the anus and vagina, pregnancy, sexual and behavioural practices, such as wiping from the back towards the front after defecation among females. Other factors that increase the incidence of UTI include sexual intercourse, especially with a new or multiple sexual partners; structural abnormalities (congenital or acquired) in the urinary tract, a previous infection in the urinary tract, poor hygiene, particularly in children who are potty-training; coexisting immune suppressive infections, such as diabetes, HIV, etc.; and presence of a foreign body in the urine tract, such as a urethral catheter. Alcohol and caffeine intake have also been implicated among other factors.

What are the signs of a urinary tract infection?

The signs could include a sudden strong desire to urinate, pain or a burning feeling when urinating, frequent urination, usually of a small quantity; lower abdominal cramps or pains, cloudy or bloody tinged urine, foul smelling urine, back pain, fever and/or chills, nausea or vomiting. In children, where it may be difficult to communicate, the presence of irritability, crying on urination, occurrence of new day or night wetting in a previously dry child, with any of the previously listed symptoms, should be a pointer to a UTI. The elderly may present with bizarre presentations such as hallucinations, restlessness, social withdrawal, agitation and confusion.

How does one diagnose UTIs?

If any of the above listed symptoms are observed, kindly visit a doctor, who will further evaluate and perform some necessary investigations to confirm the disease. A list of some of the investigations includes a urinalysis, urine microscopy culture and sensitivity, abdominopelvic ultrasonography, urethra-cystoscopy, retrograde urethrogram, micturating cystourethrogram, intravenous pyelogram, urodynamics, etc., each as may be found necessary in each case.

How are UTIs treated?

Most urinary tract infections are treated with antimicrobial medication. These medications work by killing the germs that cause the infection. The duration of treatment depends on the tract affected and the nature of the germ. In more severe cases, the patient is admitted for care.

The Punch