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Mark Lynch Clinical Lead Urology CUH

Mark Lynch Clinical Lead Urology CUH. Mlynch100@doctors.org.uk Mark.lynch@croydonhealth.nhs.uk Mark.lynch@stgeorges.nhs.uk. UTI. ADHERERNCE MECHANISMS FIMBRIAE type I – mannose sensitive, adhere to uroplakins Ia and Ib on urothelium P type – mannose insensitive

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Mark Lynch Clinical Lead Urology CUH

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  1. Mark LynchClinical Lead Urology CUH Mlynch100@doctors.org.uk Mark.lynch@croydonhealth.nhs.uk Mark.lynch@stgeorges.nhs.uk

  2. UTI • ADHERERNCE MECHANISMS • FIMBRIAE • type I – mannose sensitive, adhere to uroplakins Ia and Ib on urothelium • P type – mannose insensitive • Pap (P pili associated with pyelonephritis) – 4 proteins (F, A, G, E) • PapG is receptor component • 3 subtypes (I, II, III) • PapG subtype II associated more with pyelonephritis • PapG subtype III associated more with cystitis

  3. UTIs • UTI • Infection • Complicated or not • Recurrent • Management • Infection and stones – hand in hand

  4. UTIs or cystitis • 30% of women have at least one UTI in their lifetime • Rare in Men – investigate • Recurrent UTIs in women warrant investigation • $1.6Bn / year in US Forman B, Am J Med 2002

  5. UTIs – risk factors • Host immunity vs. Bacterial virulence • Host • Bacterial flora • Immunity and comorbidity • Stasis • Foreign body • Bacterial virulence • Fimbriae and Pili • Antimicrobial resistance

  6. UTI – excluding a cause • Complicated: • Structural or functional abnormality or underlying disease to increase infection… • DM, renal insufficiency • Urological (DxT, childhood Hx), neurological • Pregnancy, voiding dysfunction • All men

  7. UTIs – bacterial resistance • E.Coli and coliforms – 80% • Staph. Sap. – 10% • Klebsiella, Enterobacter, Proteus .. • Note foreign travel • Recent in hospital care Ronald, A Am J Med 2002

  8. Recurrent UTI - referral • UTIs that fail to respond to appropriate antibiotics. • >2 UTI in 6 months • >3 in one year • In reality – balance of risk and impact

  9. Recurrent UTI - management • History (Current, childhood, family, risk factors…smoking) • Examination – including pelvic examination • MSU, bladder diary, GFR, USS, Flexi / Cystoscopy +EUA • Pathology: Anatomical, functional, TCC, Stones

  10. Recurrent UTI - management

  11. UTIs • Very common • Confirm the infection and sensitivities • Refer complicated and/or recurrent UTIs • Beware red flags • Multi modality approach to treatment • Questions… • UTIs… • Pathways… • Anything else Urological…

  12. Renal Colic and Stones • 10% risk, 50% recurrence risk at 10 years • Risk factors include: • Geography • Diet • Anatomical • M>F • Fluid intake • Genetics (Cysteinuria)

  13. Renal Colic and Stones at CUH • Pain relief • History • Examination • Gold standard ED management • CT KUB • Early diagnosis • Early treatment • Stone clinic F/U • Access to tertiary care

  14. Renal Colic and stones at CUH • CUH • Laser lithotripsy • ESWL • Dedicated stone clinic • Seamless link with SGH • SGH • PCNL • URS (day case)

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