Dr. Udaya Kumar, Urology Today, 09/25/12

Urinary tract infection affects millions of people and accounts for 8 million doctor visits annually.

Urinary infection occurs when bacteria enter the urinary tract and multiply causing symptoms such as painful urination, bladder pain or even blood in the urine.

Most urinary infections are confined to the bladder and lower urinary tract. However, the infection can sometimes affect the kidneys and may cause fever and chills, and left untreated, may even cause life-threatening sepsis.

Every year, 15 percent of sexually active women have at least one urinary tract infection (UTI), and up to 60 percent of all women will develop an UTI at least once in their lifetime.

Antibiotic treatment is the mainstay in the management of UTIs. However, there has been a great increase in the resistance of pathogenic bacteria to antibiotics.

Physicians usually take into account the resistance patterns of the common bacteria in the community when prescribing antibiotics before specific urine culture and sensitivity reports are available.

Cranberry juice has long been advocated as a protective agent against UTIs, but not all experts are agreed as to its efficacy. Since urinary infections occur when bacteria that enter the urinary tract attach themselves to the wall of the bladder or lining of the urinary tract, proanthocyanidins (PCAs) in cranberry reduce the risk of infections by preventing the bacterial fimbria (hair-like projections on the bacteria), from sticking to the bladder wall.

Many women find cranberry juice beneficial, and certainly it does no harm.

Several studies have demonstrated the effectiveness of cranberry juice when compared to preventive low-dose antibiotics or lactobacillus. About 8 to 10 ounces of cranberry juice a day has been shown to reduce the risk of urinary infections. However, patients should be aware of the calorie content of the juice, if they are watching their weight.

An alternative to drinking the required 8 to 10 ounces of cranberry juice is to use a cranberry supplement. If using a supplement, choose products that have been tested and verified by independent organizations, such as USP and NSF International.

Vaginal estrogens have been used to help re-establish the normal lactobacilli in the vagina in the hope that it would prevent the pathogenic E. coli.

Probiotics are oral drugs taken to change the bowel and vaginal flora. Efforts are under way to produce a vaccine against the E. coli bacteria, which is one of the most common causes of UTI in women.

Such a vaccine does not exist, however, as there are several challenges researchers face in finding the right type and the correct route of administration of the vaccine. Dr. Uehling, emeritus professor of urology at the University of Wisconsin in Madison, is in the process of testing a vaccine that can be self-administered as a vaginal suppository.

A recent study also showed that older individuals with kidney stone disease are more likely than their younger counterparts to present with urinary tract infections, or may have unusual symptoms such as atypical distribution of pain or diarrhea.

The risk of having UTI increases 1.26-fold per decade of life. Elderly patients are more likely to present with less specific symptoms, and a high degree of suspicion is essential to diagnose UTIs and stone disease in the elderly.

Please remember that drinking plenty of fluids help to flush the bacteria from the system. Water is best!

While most people should aim for six to eight glasses of fluid a day, people with kidney failure should not drink as much. When in doubt about how much fluid intake is healthy, consult your physician. 

Udaya Kumar. M.D., FRCS Urol, Dip. Urol (London), is certified by the American Board of Urology and the Board of Urology of U.K. and Ireland. He is a former professor of urology with University of Arkansas for Medical Sciences. Contact him at 3475 S. Suncoast Blvd., Homosassa, FL 34448 or 352-628-7671.