Data for this review were identified by searches of Medline and references from relevant articles; several articles were identified through searches of the extensive files of the authors. Search terms were included in the Medical Subject Heading (MeSH) system and included “urinary tract infections” and “recurrence”. The search was then limited to clinical studies including “female” and “human”, and excluding “pregnancy” and “post menopause”. Only English language papers were reviewed.
ReviewPathogenesis of urinary tract infections with normal female anatomy
Section snippets
Pathogenesis
Most uncomplicated UTIs in women cannot be explained by underlying functional or anatomic abnormalities of the urinary tract, but instead seem to result from the interaction between the infecting Escherichia coli strains and the urinary tract epithelium (figure). Colonisation of the vaginal introitus with E coli seems to be one of the critical initial steps in the pathogenesis of both acute and recurrent UTI. In healthy individuals, most uropathogens originate in the rectal flora and enter the
Bacterial factors
In a prospective, community-based study of 131 episodes of recurrent UTI during 1 year, E coli was the cause of 78% of the recurrent episodes. Uropathogenic E coli have several virulence factors that increase their ability to colonise and persist in the urogenital tract.16 Binding to the urothelial surface is one factor that prevents bacterial washout by micturition and initiates bacterial invasion. This binding is mediated by the FimH adhesion located at the tip of the bacterial type 1
Voiding dysfunction
Voiding dysfunction is defined as a voiding pattern that is abnormal for age. The symptoms of voiding dysfunction include urinary urgency, frequency, and incontinence as well as infrequent voiding. Voiding disorders are common in paediatric patients who have neither neurological nor anatomic abnormalities of the urinary tract, and usually result from detrussor muscle instability. Children with detrussor instability who use various posturing manoeuvres to avoid urinary incontinence have a
Behavioural risk factors
The genital flora surrounding the urethral orifice have a strong resistance to infection from uropathogens. In normal women who never experience UTI, the main introital, vaginal, and urethral microbial flora consists of lactobacilli and staphylococci.12 Previous antibiotic use profoundly disturbs the normal vaginal microflora, reduces its adherence to vaginal epithelial cells in vivo and promotes a persistent vaginal E coli colonisation.33 Vaginal fluid from women with recurrent UTIs more
Search strategy and selection criteria
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Cited by (93)
Specific capture of Pseudomonas aeruginosa for rapid detection of antimicrobial resistance in urinary tract infections
2023, Biosensors and BioelectronicsCitation Excerpt :Complicated UTIs are among the major causes of bacteremia and are related to a high mortality rate for critically ill patients (Chan and Yuen, 2015; To et al., 2013; Wagenlehner et al., 2008). Additionally, recurrent UTIs are common among young and healthy females, although they generally possess normal urinary tracts in the anatomical and physiological regards (Finer and Landau, 2004). Toward UTIs, particularly complicated UTIs, broad-spectrum antibiotics are empirically employed against uropathogenic Gram-negative bacteria (Chan and Yuen, 2015; Flores-Mireles et al., 2015).
Influence of gender on the performance of urine dipstick and automated urinalysis in the diagnosis of urinary tract infections at the emergency department
2021, European Journal of Internal MedicineCitation Excerpt :Beside incidence, also differences in presentation and course of UTI exist between men and women. This is due to a variety of factors, like (pelvic) anatomic differences, voiding issues, and vaginal mucosa colonization [4-8]. In addition, differences in causing uropathogens exist between men and women [9].
The aberrant urethral meatus as a possible aetiological factor of recurrent post-coital urinary infections in young women
2018, Medical HypothesesCitation Excerpt :Unfortunately, scarcely any studies mention the need for thorough physical examination and anatomical evaluation; the recent recommendations of the American Academy of Family Physicians do not include regular physical examination, even in cases or recurrent UTI episodes, as it has “limited utility and is not universally recommended” [26]. Other reviews on rUTIs state that the possibility of an underlying anatomical anomaly is very low [1,16]. However it is obscure whether the urethra – vagina distance - which has never received any attention- would be considered and evaluated as an “anatomical anomaly” by most physicians.
Effect of cranberry polyphenols and metabolites on microbial activity and impact on urinary tract health
2018, Polyphenols: Prevention and Treatment of Human Disease