URINARY TRACT INFECTIONS

• Urinary tract infections (UTIs) are infections of the urinary tract system (bladder, urethra, kidneys) that are generally caused by bacteria, especially E. coli. UTIs are the most common bacterial infections
• UTI can vary from asymptomatic colonization, through self-limiting, unpleasant lower tract infection to life-threatening sepsis. Women are at high risk of contracting UTIs due to a shorter urethra and the proximity of the anal and genital regions
• Clinical findings depend on which part of the urinary tract is affected. Lower UTIs manifest with dysuria, suprapubic pain, urinary urgency, and increased urinary frequency, whereas upper UTIs additionally manifest with fever and flank pain

Bacteria

• Ascending route is the commonest mode of infection, infection ascends from the urethra to the bladder
• Causative organisms: Escherichia coli (leading cause of UTI -approx. 80%), Staphylococcus saprophyticus( 2nd leading cause of UTI in sexually active women), Klebsiella pneumonia( 3rd leading cause of UTI), Proteus mirabilis, Serratia marcescens, Enterococci spp, and Pseudomonas aeruginosa , Ureaplasma urealyticum

Viruses

• Adenovirus, cytomegalovirus are commonly involved in hemorrhagic cystitis

Yeast

• rare (usually Candida species)

Other factors

• Sexual intercourse
• Honeymoon cystitis: a type of lower UTI that occurs in women after having sexual intercourse for the first time or after a prolonged period of abstinence
• Diaphragm and spermicide use 
• Catheter-associated urinary tract infection: Most common cause of nosocomial urinary tract infection 

Predisposing factors

• Abnormalities of the urinary tract 
• Females 
• Pregnancy
• Immunosuppression
• Diabetes mellitus

Symptoms indicative of Lower UTI are: 

• Dysuria
• Frequency
• Suprapubic tenderness
• Urgency
• Polyuria
• Haematuria 

Upper urinary tract infection 

• Symptoms of lower urinary tract infection
• Fever
• Flank pain
• Fatigue/malaise
• Nausea and vomiting

Urine analysis: Clean-catch midstream sample

• Pyuria: ≥ 5–10 WBC/ hpf
• Bacteriuria: abnormal number of bacteria present in a urine sample ( ≥ 106 organisms/ml)
• Positive nitrites
• Positive urease
• Haematuria and mild proteinuria

Urine culture

CT scan without contrast: recurrent UTIs, complicated UTIs, and in patients who do not respond to treatment

Ultrasound: to assess urinary obstruction

• Symptomatic UTI – Antibiotic therapy
• Asymptomatic UTI- No treatment required except in specific conditions
• General measures- drink plenty of water (3-4 liters a day)
• Prevention of re-infection – the presence of any organic pathology has to be treated

Ayurvedic Treatment

Internal medicines 

• Nirgundyadi kashaya
• Bruhatyadi kashaya
• Guduchyadi kashaya
• Saptasara kashaya
• Gokshuradi guggulu
• Chandraprabha vati
• Vilwadi gutika
• Vettumaran gutika
• Gokshura panaka
• Chandanasava
• Punarnavasava

Procedures

• Yoni kshalana - Triphala Kashaya 
• Avagaha Sweda
• Yoni Pichu - Chandanadi gana Kashaya