NR 507 Week 4 Assignment; Urinary System Pathologies; Common Diseases and Disorders

Urinary Tract Infections Urinary tract infections (UTI) are commonly seen in clinical practice. Bacteria from the gut can invade the urinary epithelium to cause inflammation and infection anywhere along the urinary tract such as the urethra, bladder, ureter, or kidney. Some individuals are predisposed to developing a UTI. It is more common for women to develop a UTI especially when pregnant, sexually active, during post-menopause with estrogen-deficiency and when being treated with antibiotics where the normal bacteria flora is diminished. Although less common, men may develop a lower UTI. An upper UTI is less common in men due to the longer urethra and ureter structures that make it more difficult for bacteria to reach the kidney. An indwelling urinary catheter can also contribute the development of a UTI. Finally, individuals who experience urinary obstruction, diabetes or neurogenic bladder are also at risk for developing a UTI. A UTI can be discussed in terms of its severity. It can be complicated or uncomplicated. It can also be discussed according to its location, where it can occur anywhere along the urinary tract (upper vs. lower tract disorders). It is under these categories that UTI will be discussed. Finally, common organisms that cause UTI are covered. This information is essential as the NP is responsible for identifying the organism so that appropriate treatment can be initiated. The diagram below compares the male and female urinary tracts. Note that the female has a shorter urethra which predisposes her to an increased risk of infection than the male. UTI Risk Factors There are several risk factors that predispose individuals to the development of a UTI. For women, pregnancy is a risk factor. During pregnancy, progesterone relaxes smooth muscle that causes stasis of urine, allowing the bacteria to colonize. Also, the female ureter is shorter and allows for the entrance of bacteria into the urethra. Post-menopausal women are also at risk for developing a UTI. The lack of estrogen results in vaginal and urethral dryness that promotes an environment for bacteria to grow. Sexual intercourse also contributes to the development of a UTI where bacteria can be easily introduced into the urethra. If spermicides are used during sexual intercourse, this also puts the woman at risk for a UTI. Indwelling urinary catheterization is also a major cause of a UTI, especially in females. The catheter itself can introduce infections directly into the bladder. The bacteria will colonize in the bladder and initiate an immune response. The neutrophils enter the area to further promote inflammation. Fibrinogen accumulates on the catheter which provides an ideal environment for the attachment of uropathogens that express fibrinogen-binding proteins. After the initial attachment to the fibrinogen-binding proteins on the catheter, the bacteria multiply to form biofils. This results in epithelial damage to the urinary tract that leads to a kidney infection. Lower vs. Upper Tract Disorders A UTI can be discussed in terms of its location. Note that a UTI can occur anywhere along the urinary tract and can be associated with