URINARY TRACT DISEASES Infections of the Urinary Tract

The aim of treatment of infections of the urinary tract is not only to procure symptomatic relief of the acute attack, but also to prevent recurrences and to preserve renal function. Infections are sometimes associated with a structural abnormality which may be amenable to surgery. Investigation is required to detect these abnormalities. It is not difficult to relieve symptoms in the typical attack of acute cystitis, and in fact these often disappear within a few days even if no antimicrobial agent is given. Since in these cases bacteriuria may persist after the symptoms have gone it is important that cure should be confirmed bacteriologically. Patients who have had an attack of acute symptomatic urinary tract infection are very likely to get a recurrence. Bacteriuria recurs within six months in half, and by the end of 18 months in three-quarters of patients. Though relapses due to the same organism mostly occur within three months, reinfections due to a new organism are acquired at a slower rate, mostly within eighteen months. In the case of recurrences of infections with Escherichia coli it is possible to distinguish relapses from reinfections only if sero-typing is used. Differentiation between relapse and reinfection is helpful in localizing the infection since 80%/, of relapses are associated with upper tract bacteriuria, while 70%V, of reinfections occur in patients with bladder bacteriuria. Of those with bacteriuric