What is Urology?

Urology: Urinary & Reproductive Disease Diagnosis & Treatment

Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.

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The Recovery Timeline

The Recovery Timeline
  • 24-48 Hours: Significant symptom improvement. Dysuria lessens, urgency subsides, and fever (if present) should break.
  • 3-5 Days: Antibiotic course is typically completed. Clinical cure (resolution of all symptoms) is achieved.
  • 1-2 Weeks: Microbiological cure (elimination of bacteria) and histological healing (regeneration of the bladder mucosa and GAG layer).
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When is a "Test of Cure" (Follow-up Culture) Needed?

When is a "Test of Cure" (Follow-up Culture) Needed?

For simple, uncomplicated cystitis, if symptoms resolve, re-testing the urine is not necessary. However, a follow-up culture 1-2 weeks post-treatment is mandatory for:

  • Pregnant women (to ensure bacteriuria is cleared).
  • Patients with pyelonephritis.
  • Infections with urea-splitting bacteria (Proteus).
  • Patients with persistent or recurring symptoms.
  • Men with UTIs.
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Complications of Untreated or Resistant Cystitis

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  • Ascending Pyelonephritis: The most common complication. Bacteria ascend the ureter to the kidney pelvis and parenchyma. It can lead to renal scarring (“chronic pyelonephritis”), hypertension, and permanent renal failure.
  • Urosepsis: Bacteria enter the bloodstream via the renal veins. This triggers a systemic inflammatory response (SIRS), hypotension (Septic Shock), and multi-organ failure. Urosepsis carries a mortality rate of 20-40% if not treated rapidly.
  • Renal/Perinephric Abscess: A collection of pus within the kidney tissue or in the fat surrounding the kidney, requiring surgical drainage.
  • Emphysematous Cystitis: A rare, life-threatening necrotizing infection (usually in people with diabetes) where gas-forming bacteria (E. coli, Clostridium) ferment glucose in the tissues, creating gas bubbles in the bladder wall. Requires aggressive IV antibiotics and sometimes cystectomy.
  • Xanthogranulomatous Pyelonephritis (XGP): A chronic, destructive granulomatous process that destroys the kidney, often mimicking renal cancer.

Lifestyle and Prevention (The "Hygiene Hypothesis")

Lifestyle and Prevention (The "Hygiene Hypothesis")
  • Hydration: “Dilution is the solution to pollution.” Aim for 2.5L urine output daily. High flow washes out bacteria before they can attach.
  • Voiding Habits:
    • Timed Voiding: Void every 3-4 hours. Do not hold urine.
    • Post-Coital Voiding: Urinate immediately after sex to flush out introduced bacteria.
  • Hygiene:
    • Wipe front to back to avoid dragging fecal flora to the urethra.
    • Avoid douching and feminine hygiene sprays (they alter pH and kill good bacteria).
    • Wear breathable cotton underwear; avoid tight synthetic clothing (traps heat/moisture).
  • Constipation Management: A distended rectum compresses the bladder neck, causing retention. Treating constipation reduces the risk of UTIs, especially in children.

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FREQUENTLY ASKED QUESTIONS

How do I know if the infection has spread to my kidneys?
Warning signs of kidney involvement (Pyelonephritis) include high fever (>38°C), shaking chills, nausea/vomiting, and specifically flank pain (pain in the upper back/side, just under the ribs). If these occur, oral antibiotics may not be enough; go to the hospital immediately.

It is recommended to abstain from intercourse until symptoms have completely resolved and the antibiotic course is finished (usually 5-7 days). Sex during an active infection is painful, can further traumatize the inflamed bladder lining, and may push more bacteria into the urethra, delaying healing.

This is called “Post-Infectious Irritability.” The bladder nerves remain sensitized, and the lining takes time to heal even after the bacteria are dead. If symptoms persist for>2 weeks despite negative cultures, we evaluate for other causes such as pelvic floor spasm, yeast infection, or Interstitial Cystitis.

It is a colloquial term for cystitis precipitated by sexual activity. It does not imply a new partner or poor hygiene. It is caused by the mechanical transfer of perineal bacteria into the urethra during friction. Post-coital voiding and sometimes a single prophylactic antibiotic pill are the cures.

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