Clinic Location & Map

#09-40 Mt Elizabeth Novena Specialist Centre
(located within Mt Elizabeth Novena Hospital)
38 Irrawaddy Road
Singapore 329563

Phone: +65 6235 1180
Fax: +65 668 41310
Emergency: +65 6535 8833
Email: drchin@ccmurology.com
 

Clinic Hours

Monday - Friday 9:00am - 5:30pm
Saturday 9:00am -12:30pm
Sunday / Public Holiday Closed

Urinary Tract Infection

picture of cystitis_of_bladder

Cystitis of the bladder showing inflamed lining

Normal urine is sterile. When bacteria get into the bladder via the urethra, it can cause infection (cystitis). Urine infection affects all age groups. The symptoms include burning sensation in the urine passage, frequent urination, bladder pain, cloudy and smelling urine and even bloody urine. Left untreated, the infection spreads to the kidneys to cause more severe infection (called pyelonephritis). When this happens, loin pain, fever, chills and even septic shock can occur.

Urinary tract infection (UTI) is more likely to occur when there is an abnormality in the urinary tract. Diabetic patients are also more likely to get UTI due to the excess sugar in their urine. Stagnant urine in the bladder due to obstruction or weak bladder muscle is another common cause.

Diagnosis

1. Urine dipstick

The dipstick test is a quick way to detect UTI and only takes a minute. The finding of both white blood cells and nitrites in the urine is highly suggestive of bacterial infection.

2. Urine culture

Confirmation of UTI is best done by obtaining a mid-stream urine specimen for culture to isolate the offending bacteria and identify the most appropriate antibiotic to give. Most laboratories can give the result by 48 hours.

3. Ultrasound

Screening ultrasound to exclude underlying causes like stone, enlarged prostate and kidney abnormalities is easily be done in the clinic [Fig 1].

Ultrasound of bladder

Fig 1. Ultrasound of the bladder showing a stone as the cause of recurrent cystitis

4. Xrays

If ultrasound reveals a stone or an abnormal-looking kidney, then contrast X-ray of the urinary tract called intravenous urogram (called IVU) is indicated [Fig 2a]. IVU is also recommended in recurrent UTI to demonstrate a duplex ureter as such an abnormality tends to allow reflux of urine up into the kidney to cause recurrent infections and ultimately, kidney damage. CT urography scan can also define abnormal urinary systems through 3-dimensional reconstruction [Fig 2b].

Left Kidney

Fig 2b. CT scan with 3-D reconstruction of an infected left kidney due to duplex system

Left Kidney

Fig 2a. IVU of an infected left kidney due to stones

5. Cystoscopy

Picture of Flexible cystoscope

Fig 3. Flexible cystoscope to visualize the bladder

Endoscopic inspection of the bladder is sometimes needed to rule out bladder disease as the cause for UTI, eg. diverticulum, enlarged prostate [Fig 3]. This is easily be done under local anaesthesia in the clinic.

Treatment

Appropriate and adequate antibiotic course is the mainstay treatment. Usually 5 days of antibiotics is adequate for uncomplicated UTI. The choice of antibiotic is best determined from the urine culture/sensitivity result. The drugs most often used to treat uncomplicated UTIs are trimethoprim/ sulfamethoxazole (Bactrim), nitrofurantoin, Augmentin and ciprofloxacin (Ciprobay). A longer course of treatment is needed for infections of the prostate, epididymis, kidney infection, diabetics and cancer patients. It is important to complete the full course of antibiotics because symptoms usually disappear before the infection is fully cleared. Pregnant woman who develop a UTI should be treated promptly, bearing in mind that only certain antibiotics are safe during pregnancy.

Drugs are available to relieve the pain during urination, eg. flavoxates (Genurin, Urispas). Urine alkalinizing agents such as citrate (Urocit K, Citravescent) can also alleviate the irritative symptoms and prevent UTI.