Urine Pain: UTI

o Anatomically  Length of urethra  Presence of high pressure zones in urethra  Urethral and ureteral peristalsis  Vesicoureteral flaps  Extensive renal blood supply and flow o Mucosal defense barriers  Glycosaminoglycan layer  Antibody production  Intrinsic mucosal antimicrobial properties  Exfoliation of cells  Commensal non-pathogenic microbes in distal urogenital tract o Composition of urine  Concentration/osmolality  High urea nitrogen concentration  Organic salts  Low molecular weight carbohydrates  Tamm-Horsfall mucoprotein o Cell-mediated and humoral-mediated immunity o Frequent and complete voiding  A UTI also requires a pathogenic bacterial organism o Not all bacteria are pathogenic o For UTI, bacteria must possess 1 or more urovirulence factors for motility, adherence, invasion, production of enzymes, and production of toxins  Uropathogenic bacteria invade primarily from ascension from the lower urogenital tract