UTIs and Diabetes

People with diabetes are more vulnerable to UTIs for several reasons. First, their immune systems tend to be weaker. Second, high blood sugar can spill into the urine and encourage the growth of bacteria. Also, nerve damage related to diabetes can prevent the bladder from fully emptying. People with diabetes should talk with their doctor at the first sign of a UTI.

Treating UTIs

Prescription antibiotics will almost always cure a UTI. Your health care provider may recommend drinking lots of fluids and emptying your bladder frequently to help flush out the bacteria. Kidney infections can often be treated with oral antibiotics, too. But severe kidney infections may require hospital care, including a course of intravenous antibiotics.

Diagnosing UTIs

The first step in diagnosing a UTI is usually a simple urine test called a urinalysis. It looks for bacteria, as well as abnormal counts of white and red blood cells. The dipstick test provides quick results. Your doctor may also send your urine to a lab for culture to confirm the type of bacteria. At-home test kits can help detect a UTI, but are not 100% accurate. Be sure to go over the results and your symptoms with your doctor.

What Boosts Your Risk?

UTIs are most common in sexually active women. Other factors that may increase your risk include:

• Not drinking enough fluids
• Taking frequent baths
• Holding your urine
• Kidney stones

Urinary Tract Infections in Men

Men are much less likely than women to get UTIs. When it does happen, it's often related to another underlying medical condition, such as a kidney stone or an enlarged prostate.

How Do UTIs Begin?

Many types of bacteria live in the intestines and the genital area, but this is not true of the urinary system. In fact, urine is sterile. So when errant bacteria, such as the E. coli shown here, is accidentally introduced into the urinary system, it can start a UTI. Typically, bacteria travel up the urethra to the bladder, where an infection can take hold. Women are more susceptible than men, probably because they have shorter urethras.

UTI Complications

The main danger associated with untreated UTIs is that the infection may  spread from the bladder to one or both kidneys. When bacteria attack the  kidneys, they can cause damage that will permanently reduce kidney function. In  people who already have kidney problems, this can raise the risk of kidney  failure. There's also a small chance that the infection may enter the  bloodstream and spread to other organs.

Honeymoon Cystitis

Few things can ruin a honeymoon like a UTI. But this is so common, it has its own name -- "honeymoon cystitis." The reason is that sexual activity can push bacteria into the urethra. Of course, the problem is not confined to honeymoons. Some women get a bladder infection almost every time they have sex. Women who use a diaphragm for birth control are especially vulnerable.

UTI or Something Else?

Although burning during urination is a telltale sign of a UTI, it can  also be a symptom of certain sexually transmitted diseases (STDs.) These  include chlamydia, gonorrhea, and trichomoniasis. Simple lab tests are  available to distinguish a UTI from an STD.

When to See Your Doctor

See your doctor right away if you have signs of a urinary tract infection. A bladder infection is generally not a medical emergency -- but some people have a higher risk for complications. This includes pregnant women, the elderly, and men, as well as people with diabetes, kidney problems, or a weakened immune system.

UTI Symptoms: Bladder Infection

Most UTIs are bladder infections. Symptoms include:

• Pain or burning during urination
• The urge to urinate often
• Pain in the lower abdomen
• Urine that is cloudy or foul-smelling
• Some people may have no symptoms

What Is a Urinary Tract Infection?

What Is a Urinary Tract Infection?

About half of women will get a urinary tract infection or UTI at some point in life. It happens when germs infect the system that carries urine out of your body -- the kidneys, bladder, and the tubes that connect them. Bladder infections are common and usually not serious if treated promptly. But if the infection spreads to the kidneys, it can cause more serious illness.

Who should have it done?

Not all patients being investigated for lower urinary tract symptoms will require a full urodynamic assessment. But the studies outlined are particularly helpful when previous treatment has failed and are essential prior to surgical treatment of incontinence or bladder prolapse.

Flow-pressure study

 This is usually performed immediately after filling cystometry.
The urethral catheter is narrow enough that voiding can occur around it. The important measurement from the study is the detrusor pressure at maximum flow.
By this method, obstruction to passage of urine (high pressure, low flow) can be distinguished from a lack of tone in the detrusor muscle (low pressure, low flow).
Many women void simply by relaxing the urethral sphincter with no associated rise in detrusor muscle pressure, which can make the study difficult to interpret. Following voiding, it's usual to measure the amount of any urine left in the bladder.

Videocystourethography

In situations of particular complexity, flow-pressure studies are combined with the use of X-ray screening in order to gain additional information about the anatomy of the bladder and urethra. (Ultrasound scanning can also be used to demonstrate an abnormally low bladder neck.) 

Filling cystometry

Bladder pressure is measured because the bladder is filled to capacity with a salt solution (normal saline) at a rate of 10 to 100ml/minute, with the patient lying down.
The study is usually performed using a urinary catheter passed through the urethra into the bladder.
The catheter contains two channels. One channel is used for filling, and pressure can be recorded through the other. A 'volume versus pressure' graph, which is called a cystometrogram (CMG), is produced.
The cystometrogram is basically performed to evaluate the compliance and stability of the detrusor muscle. Eighty five per cent of all incontinence occurs in women, and three quarters of those suffer with stress incontinence (ie leakage in the absence of over activity).
Compliance is simply the elastic property of the detrusor muscles. An evaluation of compliance is an evaluation of the ability of the bladder to 'stretch' to 'normal' capacity, while maintaining low pressures.
Stability is evaluated by observing the detrusor while filling the bladder to normal capacity. The evaluation determines the presence or absence of detrusor overactivity (or instability).
Vesical pressure is the pressure that's measured inside the bladder, with a catheter that's specifically designed for pressure monitoring in the urinary tract.
This is a combination of the pressure being exerted on the bladder by the abdominal contents, the weight or pressure of any urine in the bladder and the force that the detrusor muscle is exerting on that fluid. The pressure in an empty bladder is usually called resting pressure, which changes with position.
The normal bladder resting pressures vary between 8 and 40cm of water (ie the pressure exerted at the bottom of a column of water 40cm high), depending upon the particular patient and position during study.
Abdominal pressure is measured by placing a special catheter either in the rectum or the vagina. Abdominal pressure information is significant because the bladder is contained in the floor of the abdominal cavity, and it's important to isolate pressures and activities occurring in the bladder itself.
The detrusor pressure is a subtracted pressure that's calculated by subtracting the abdominal pressure from the vesical pressure. In doing so, artefacts from abdominal straining, gas and the weight of the abdominal contents are removed from the information being processed from the catheter in the bladder, thereby representing the actual activities taking place in the bladder during the CMG.
A bladder with normal compliance will demonstrate no greater than 15cm water increase in detrusor pressure because it progresses from empty to capacity during a CMG.
When the bladder is properly positioned in the abdominal cavity, both it and the bladder neck are above the pelvic floor muscles. With aging, or after childbirth, the female pelvic floor can relax, causing the base of the bladder and the bladder neck to fall below the pelvic floor.
For a patient to remain dry, the pressures in the urethra must remain greater than the pressure in the bladder, during filling.
The average urethral closure pressure for a female is 60cmH20 and for a male it is 80cmH20.

his test determines the severity of any incontinence and objectively demonstrates the symptom.

Urine produced in the kidneys is transported to the bladder by rhythmical contractions of the ureters.
At appropriate occasions the bladder is emptied via the urethra, by contraction of the normally relaxed detrusor muscle that constitutes the wall of the urinary bladder.
The detrusor muscle's behaviour is thought to sometimes become 'unstable', leading to the lower urinary tract symptoms – such as problems with frequency, urgency and getting up at night to pass urine.
An unstable detrusor also contracts between voidings. This causes high pressures in the bladder that may be felt as urgency and give rise to urine leakage.
In men, many of these same symptoms can be caused by enlargement of the prostate gland (BPH) and urodynamic studies can help to differentiate the two causes.
For obstruction, the International Continence Society has agreed that presently the only way to objectively diagnose it or grade its severity is a urodynamic pressure-flow study.
For incontinence the issue is more complicated. There are two main types of incontinence:

1. stress urinary incontinence (SUI) that's caused by a deficiency of the closure mechanism of the bladder
2. urge incontinence that's caused by overactivity of the bladder. This overactivity can be demonstrated urodynamically by filling cystometry.

What is urodynamics?

Urodynamics is the investigation of the function of the lower urinary tract – the bladder and urethra – using physical measurements, such as urine pressure and flow rate as well as clinical assessment.
The assessment begins with a medical history and examination – which may, for example, reveal abnormalities within the lower abdomen or pelvis that are contributing to the lower urinary tract symptoms.
The patient is then given a urination (voiding) diary to be kept for three days, to document their fluid intake and output, including episodes of incontinence.

1. bladder capacity
2. the frequency of passage of urine
3. episodes of incontinence
4. getting up at night to urinate.

The diary can also outline other problems, such as excessive fluid intake.
A midstream specimen of urine is sent to the laboratory in order to exclude infection.
A pad test may be performed for women complaining of urinary incontinence. This test determines the severity of any incontinence and objectively demonstrates the symptom. The patient drinks 500ml of water and walks about performing normal everyday tasks, while wearing a pre-weighed pad.
The pad is then re-weighed and a gain of more than 1g per hour is taken to represent urinary incontinence.

Dr. Bruder

Dr. Bruder is a board certified urologist with over 25 years in practice serving New York City. He offers treatments for most urological conditions and specializes in treating erectile dysfunction and premature ejaculation. Dr. Bruder is dedicated to providing patients with the highest level of healthcare available. This is why he co-established the Luzato Medical Group, which brings his patients the combined expertise of board certified cardiologists, internists and neurologists. Dr. Bruder welcomes all patients who have problems relating to his field of medicine to make an appointment.

Dr. Bruder, MD is a board certified urologist practicing in New York City. Bruder graduated from the New York Medical College in 1982. He completed his surgical residency training at New York Medical College, final leaving the institution in 1988 as Urology Chief Resident. Since 1988, Dr. Bruder has maintained his own practice.

Recently, he co-established the Luzato Medical Group combining his urology practice with board certified cardiologists, internists and neurologists to give patients the comprehensive coverage they deserve. Additionally, Dr. Bruder retuned in 2004 to his alumarter, New York Medical College, as a Clinical Assistant Professor of Urology.

Dr. Bruder is a board certified urologist with over 25 years in practice serving New York City. He offers treatments for most urological conditions and specializes in treating erectile dysfunction and premature ejaculation. Dr. Bruder is dedicated to providing patients with the highest level of healthcare available. This is why he co-established the Luzato Medical Group, which brings his patients the combined expertise of board certified cardiologists, internists and neurologists. Dr. Bruder welcomes all patients who have problems relating to his field of medicine to make an appointment.