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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Therapeutic Philosophy: Antibiotic Stewardship

Therapeutic Philosophy: Antibiotic Stewardship

The era of prescribing antibiotics “just in case” is over. Due to the global crisis of antimicrobial resistance, Liv Hospital emphasizes Targeted Therapy. We aim to eradicate the pathogen with the narrowest-spectrum agent for the shortest effective duration, preserving the patient’s protective microbiome (gut and vagina) and preventing the emergence of “superbugs.”

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Pharmacological Management (Antibiotics)

Pharmacological Management (Antibiotics)

Treatment is empirical initially (based on local “antibiogram” resistance data) and then adjusted based on culture results.

  • First-Line Agents (Uncomplicated Cystitis):
  • Nitrofurantoin: A urinary antiseptic. It achieves high concentrations in urine but very low levels in blood/tissue. This means it effectively kills bladder bacteria while sparing the gut flora. Effective against E. coli. Dosage: 100mg BID for 5 days. Contraindicated in renal failure (GFR <30).
  • Fosfomycin: A unique phosphonic acid derivative given as a single 3-gram sachet dissolved in water. It inhibits bacterial cell wall synthesis. Ideal for compliance and effective against many ESBL organisms.
  • Pivmecillinam: A penicillin specifically effective for UTIs, widely used in Europe.
  • Trimethoprim-Sulfamethoxazole (TMP-SMX): Effective, but resistance rates are rising. Used only if local E. coli resistance rates are <20%. Standard duration: 3 days.
  • Second-Line / Restricted Agents:
  • Fluoroquinolones (Ciprofloxacin, Levofloxacin): Highly effective but associated with significant collateral damage (tendonitis, aortic aneurysm, C. difficile infection, high resistance induction). The FDA and EMA advise against using them for uncomplicated cystitis unless no other options are available. They are strictly reserved for Pyelonephritis or Prostatitis.
  • Beta-Lactams (Cephalosporins, Amoxicillin-Clavulanate): Safe (used in pregnancy) but generally have lower cure rates and faster recurrence than first-line agents due to poor vaginal penetration.
  • Treatment of Complicated/MDR UTIs:
  • Requires culture-guided therapy. May involve Carbapenems (Ertapenem IV), Aminoglycosides (Gentamicin), or newer agents like Ceftolozane-Tazobactam or Cefiderocol for highly resistant gram-negatives.
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Symptomatic and Adjunctive Therapy

Symptomatic and Adjunctive Therapy

Antibiotics kill bacteria, but symptom relief takes 24-48 hours. We treat the symptoms immediately to improve the quality of life.

  • Urinary Analgesics (Phenazopyridine): An azo dye that exerts a topical anesthetic effect on the urinary tract mucosa. It provides rapid relief from dysuria. Warning: Turns urine bright orange/red and stains contact lenses/underwear. Use for no more than 2 days to avoid masking clinical progression.
  • NSAIDs (Ibuprofen): Evidence suggests NSAIDs can provide symptomatic relief comparable to antibiotics in mild cases, reducing bladder inflammation and pain.
  • Hydration: Increasing fluid intake acts as a mechanical flush, diluting bacterial load and inflammatory cytokines.
  • Alkalinizing Agents: Citrate salts (Potassium Citrate) or Sodium Bicarbonate raise urine pH, which can soothe the burning sensation (dysuria) caused by acidic urine.
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Management of Recurrent Cystitis

Management of Recurrent Cystitis

For women with ≥ 3 infections/year, a strategic long-term plan is required.

  • Vaginal Estrogen Therapy: The gold standard for postmenopausal women. Estrogen cream/tablet/ring restores mucosal thickness, lowers vaginal pH, and repopulates the vagina with Lactobacilli, reducing UTI risk by 50-75% without systemic side effects.
  • Post-Coital Prophylaxis: A single low-dose antibiotic (e.g., Nitrofurantoin 50mg or TMP-SMX) taken immediately after sexual intercourse. Highly effective for women whose UTIs are temporally related to sex.
  • Self-Start Therapy: Highly compliant patients are given a prescription to keep at home. At the onset of symptoms, they perform a home dipstick or collect a sample, then start a 3-day course immediately. This empowers the patient.
  • Continuous Low-Dose Prophylaxis: Taking a microdose of an antibiotic daily for 6 months. Effective, but carries a high risk of breeding resistance and side effects. Used only as a last resort.
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Non-Antibiotic Prophylaxis (The "Green" Approach)

Non-Antibiotic Prophylaxis (The "Green" Approach)
  • D-Mannose: A simple sugar isomer. It acts as a molecular decoy, binding to the FimH lectin on E. coli Type 1 pili. This prevents bacteria from attaching to the bladder wall; instead, they bind to the sugar and are excreted in urine. Effective for E. coli prevention but not cure.
  • Cranberry Products (PACs): Must contain Proanthocyanidins Type A (PACs) at a dose of 36mg/day to be effective. Juice is often too diluted or too sugary. Capsules are preferred. They inhibit bacterial adhesion.
  • Probiotics: Oral or vaginal administration of Lactobacillus rhamnosus and L. reuteri to restore the protective microbiome and competitively inhibit uropathogens.
  • Immuno-Stimulants (OM-89/Uromune): Oral capsules or sublingual sprays containing lyophilized bacterial lysates (fragments of dead E. coli). They act as a mucosal vaccine, stimulating the GALT (Gut-Associated Lymphoid Tissue) to produce antibodies against uropathogens.
  • Intravesical Instillations: Direct instillation of Hyaluronic Acid and Chondroitin Sulfate into the bladder to replenish the defective GAG layer.

Biofilm Disruption

Biofilm Disruption

In chronic cases (especially with catheters or stones), bacteria form biofilms. Standard antibiotics fail because they cannot penetrate the slime matrix.

  • Strategies: Periodic catheter exchange, use of silicone catheters (resist biofilm), catheter valves (mimic voiding), and potentially novel agents like bacteriophages or enzymes that dissolve the biofilm matrix are under investigation.

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FREQUENTLY ASKED QUESTIONS

What happens if I stop taking antibiotics early?
If you stop when symptoms subside (often day 2), you kill the weak, susceptible bacteria but leave the strongest, most resistant ones alive. These “survivors” then multiply, causing a relapse that is much harder to treat because the bacteria are now resistant to the antibiotic you just took. Always complete the prescribed course.
It is strongly advised to avoid them. Caffeine and alcohol are bladder irritants; they increase detrusor instability, worsening urgency and frequency. Alcohol acts as a diuretic, leading to dehydration. Furthermore, alcohol interacts with some antibiotics (like Metronidazole or Trimethoprim), causing nausea and vomiting.

Frequent antibiotic use “scorches” your microbiome. It kills beneficial bacteria in the gut and vagina, leading to yeast infections (Candida), antibiotic-associated diarrhea (C. diff), and the emergence of multi-drug resistant “superbugs.” This is why non-antibiotic prevention (Estrogen, Mannose, Hygiene) is preferred over constant treatment.

UTIs in pregnancy are dangerous. Progesterone dilates the ureters, allowing bacteria to reach the kidneys more easily. Pyelonephritis in pregnancy can cause sepsis, kidney failure, and preterm labor. Therefore, we screen pregnant women for bacteria even if they have no symptoms (Asymptomatic Bacteriuria), treat aggressively (usually with Cephalosporins), and verify cure with follow-up cultures.

Drinking baking soda (sodium bicarbonate) mixed with water makes the urine alkaline (less acidic). This can temporarily soothe the burning sensation during urination. However, it does not kill bacteria and is not a cure. Excessive use can disrupt your body’s electrolyte balance and is dangerous for people with heart or kidney issues.

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