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Yeah, yeah, yeah. Okay. Yeah. More helpful than Allah. Look, if right, so we're live now, so I'm just gonna give it a few more minutes, 10 minutes, and then we'll start. Yeah. No. Yes. Yeah, Yeah. Well, okay, everyone. I'm just gonna give it another couple of minutes to let one join, and then we can go ahead and start in two minutes. Right? So good evening, everyone on both ankles. You for joining us to be in our first session off the mind. A bleep urology. Siris. So the urology series is basically going to be running over the next three months. So we'll be having a regular session every Thursday for the next 12 weeks. And starting at eight PM, it's weak. And now, although it's called the urology Siris, it's not exactly just for people who want to go into, you know, urology or people who are currently working in urology. And the aim of our Siris actually is to target anyone from medical student to a doctor too. And, you know, juniors, nurses pas, who could deal with patients in the hospital setting on Do, um, you know, might face issues related to urology. That they don't necessarily feel very confident dealing with. So the a move our course at the moment is going to be trying to give you a boost and your confidence in dealing with urologist situations. And hopefully, um, you know, giving you that feel that you've done everything for a patient before you decide to pick up the phone and contact the urology registrar. So today's topic is going to be covering UTI urinary tract infections and urosepsis from urologists. Perspective on Do. Um Well, okay on. So if we go the next slide, So before we start, I just like to give a quick message out for one of our sponsors. So this is COPD me that basically, um, and online portfolio platform for your professional development. They have a really nice interface, like a dragon. Drop one, too. It's quite useful you can find on your android or your apple phone. So it's quite good for anyone who is registered with the TMC with the enemy see, or any other health care professionals. So without further ado, I'll hand over to you, Doctor Tom. Hello. So sorry. Hi, everyone. My name is set on hands. As you see I'm smiling now, but I usually don't smile on a cold. So I'm a urology. Seem course surgical to be here in the UK, walking toward the hospital on Been trusted in urology. So hopefully this lecture really be helpful for all of you. Uh, so we're gonna try this in this lecture to hopefully cover most of the topics relate to your in fact infection. So basically, what we're trying to aim is to help you to reach a diagnosis on, to pick up the different times off UTI is what to like. What request as investigations and how you treat them on. Also, would you follow them up? And at the end, hopefully, we're gonna have, like, a quick case discussion on a couple of questions. So you're in, you're in if you're in fact infections. So if we look at the anatomy off the urine tract system, we can divide it into two main categories and, uh, for your a tract infections, which is basically the kidney infection or what we call the point of fried us, and we have the lawyer tract infections basically any infection affecting the bladder, the urethra or the prostate and those are cystitis, your your fighters and prostatitis. So a quick reminder off what are the like, the majority of the symptoms for someone who has a urine tract infection? What what they would be presenting to us. So first of all, we'll have, like a dysuria, basically don't know what's What's the cereal, just like painful urination. Also, a majority of the people will have an increase in the frequency of going to do so. Basically, we would go more often, and also sometimes they will notice a change in the color of the urine itself. Sometimes it's there is a blood. That's what we call the material. Sometimes it's just like cloudy urine. Onda also will have some other symptoms. Systemic symptoms such as fever, feeling unwell may be having some nose your vomiting as well. Um, usually those two symptoms, as we're going to discuss that, are on the usually present with buying a fighter's associating also with another fan pain on either the side or both of the side effects a severe case. So when someone's will present it off with those symptoms, of course, we're gonna go ahead and do a physical examination on what we are expecting from this physical exam. Usually it might be there is nothing asymptomatic, but the majority of the cases We will have symptoms, and those symptoms are some of the patients present with what we call the cost. Of course, the vertebra angle tenderness, which is basically mean There's a tenderness in the flank, and that's usually a red flag for final fighters. Sometimes, if we have a law urine tract infection they can present with urethra discharge, and usually those are associated with either your throats or sometimes for starters as well. Uh, also, if we managed to do a digital digital rectal examination on if someone is presenting with, like with the finding there is like a prostate tenderness or maybe swelling or it's like very, very, very painful. That may indicate that that person has a prostatitis. So love wise usually start with the basic ones, which is a urine analysis, just a single. You end up on there and it can tell you a lot of things. So basically, if you have a positive for Lupus trays, which is like, just and some productive, those start off UTI patient and I trade positive. Usually, who's will have a high suspicious indication for a UTI are also the prison support cell, white blood cell count and, ah, blood cell count as well the cultures and the UTI. So a positive cultures mean that we have more than 100,000 off bacteria in the urine itself, on the most the most common pathogen. And those infections, such as cystitis, for starters up on Fridays are the number one is equalize. Number two is staphylococcus Suffro phytic assists. And also we have another organism. So, such at the 40 years marbles and capsella, they can't goes uti. And also the anterior caucus. All of those. They march a little bit off antibiotic choice, but we're gonna We're gonna discuss this for their own with what specific antibiotic you should get If we suspect the earth, your your fighters, you do. It is like part of the part off a sexually transmitted disease. We should usually think about either chlamydia or my Okay, uh, so we're going to start with the cystitis, So cystitis kind of divided into on uncomplicated, which is simple cystitis. Or we could have a complicated cystitis, which means, like the patient present with other symptoms, and they're like a little bit to be more sick than just a normal, a normal uterine patient and also some patient who presents with a kind of cystitis. Ah, the uncomplicated cystitis. Usually that they like the patient of the group of patients who will be presenting toe us usually are healthy adult women. Anyone like made are above the age of 12. They're not pregnant on this is very important because if it's pregnant, we need to think about other causes they would present or a knee or two. They're GP having no symptoms like that. You won't find any fever or nausea or vomiting, like the severe symptoms they would have. Dipstick urine will will show that they might have some glucose trees, a positive or positive for my trades opposite for white blood cell count. So the treatment you Julian, it's trimethoprim. But for the treatment section here, I think you should follow. Every one of us should follow the guidelines for our local trusts, so the trimethoprim is widely used on. There's another agent, which is nitrofurantoin, but usually you should follow the local guideline for your local fast when you prescribe antibiotic going to get cystitis means special present with symptoms, but there wouldn't be have another additional Centrums. The group of patient We're thinking about complicated cystitis. Any other females with comorbid medical history or conditions, pregnant ones as well. Number two main patients. Patients who have enduring catheters or patients who are hospitalized or they may present with very severe symptoms like they're systemically. And one. The diagnosis also will be made according to the urinalysis, and we're gonna have. We're gonna ask for urine culture as well so we can isolate the pathogen, which causing this problem so we can start them with a wide spectrum antibiotic. Then we'll, when we have the urine culture result we can. It's changed that antibiotic toward the specific antigen or to the treatment. We usually start with floor Carpathians because usually they have a wide spectrum. Then, after we get the results of the culture, we can change it according to the to the pathogen, the treatment course. Usually it's between 7 to 14 days, but also that depends on the patient itself and number two, sometimes with difficulty. Asian was not responding early on. They might have require it for the more course of antibiotic up to four weeks. Yeah, so especially things we need to be aware of when someone has a catheter in. So basically someone has the catheter and any place in situ we need to get rid of that catheter. Assume it's possible because it's a foreign body. There's a lot of colonization going on around it on. That would be the source of the infection. So, first of all, you need to remove the catheter. If the patient is catheter dependent, then take the catheter out. Take their own culture on the urine. Analysis is treat the patient and put Insert a new for Skeletor and make sure that patient this system It could be well as well. Another common thing with the catheter itself that we have some time different organism, which we don't usually see in most of the patient, which is conditioner. So for if if we have, you can do that in the urine. If the patient is symptomatic that you have to treat with an e fungal infection, you do that the choice will be fluconazole or if they have any. If they're not responding, you can go for, um, for for tennis. Um, but if the patient is a symptomatic, you do. You can consider it as just a simple cyst sides and don't treat it as well. It's usually between the patient. We don't treat any blood vessels on. For those who usually present to us with recurrent cystitis, we need to think out of the box because if they presented for more than a couple of as episodes of cystitis, you need to think about. Maybe they have some anatomical variation or they have some anatomical abnormality on. For that, we need to run a and for the check up. For those and usually allergic, a referral will be a property this'll stage. Yeah, so the most severe case in your in fact and fiction inspire fighters, which is infection of the kidney itself. On those patient usually like when you when you look at them at bay and you can easy to pick them up because they're really very, very severe, they're very poorly. They are present to you not only with the urinary symptoms they would present also, with constitutional symptoms, the patient will be presenting with fever, high grade fever, feeling sick, vomiting. They have severe headache. They're very They're like they look very sick and also most of them. If they present lay, there would be very septic as well, which I mean LeBron pressure tachycardia On this five age of the patient, they will look very sick. Yeah, So the appropriate thing to do at this stage is to check your urine analysis as usual, take take your and also send it for the lab for culturals and do the routine bloods. It's a clinical diagnosis most. Most of the time. You don't need to record to do any imaging unless the patient is not responding to the initial treatment, and usually the require longer course of antibiotic. And, as we said, usually, start with white spectrum antibiotic until you have a definitive pathogen. Then you can switch that antibiotic according to your hospital guidelines. What So what can go wrong with by Fridays? First of all, you can have what we call a prolific or in a lapses, and that's just a common accumulation off the past. Within the kidney itself, usually you need they need IV antibiotic, and if they're not responding way, we will have, like a ultrasound imaging or city guarded drainage for those. And sometimes if someone has a big storm in the urine tract system, that might cause what you call it like a urine Stasis on that would cause an infection, and that would cause multiple episodes of infection. So anyway, to treat the infection, you need to treat the underlying cause itself on. That would be the mobile of that with those stones. Also impatient with the was immune compromise, such as like diabetic, patient or patient. On cirrho, they usually present with very bad, find a friend just as well. So symptoms off prostatitis, which is another common you're on a tract infection. So the thing about the prostatitis you need to think about the anatomy of the proceeds that the process located down, down, like in the green area. So basically the patient will be presented with, with the perennial pain and tenderness on also the pain and the tender. It's not typical for a urine tract infection, so you do they have in the lower abdomen and the premium also the testes itself in the Penis and people Also they were. They will tell you that they have a severe pain while exact while while injecting ejaculated as well. And also they might see some blood in it as well on those fish. And usually they have, like a big prostate as well, from from the history it's if you can tell that they will, they will have high temperature. They will have the Syria's well. They would feel fatigued. Most of the time. They will have three near being on doing his crowd cloudy on. As we said earlier on, if on the ejaculation said, Sometimes there's a button mixed with the semen as well. What you should do. You should do a full examination on make sure that to examine the prostate itself on when you examine the prostate, you will notice that it's tender and the patient will be screaming from pain. So how would you do that? You'll do a urinalysis and urine culture, but also make make sure that you try to stimulate the prostate itself and try to take a a semen from the discharge. Because when you stimulate a prostate itself, that would be like a fluid coming out from the From the front message the pains from the urethra. Make sure that you send it to the lab so you can take a definitive diagnosis for that pathogen or to the treatment you started. Wide spectrum Antibiotic UTI. They're very, very sensitive to floor, floor or Korean, but also you need to check with your local trust guidelines, and usually they need a loan. They're on antibiotic long corresponded by the could go up to six weeks. Risk factor for those patients on protected sexual, Uh, course dehydration. Sometimes trauma on. But sometimes, if if they're not, if they're not doing a lot of ejaculation or their sexual abstinence as well, there will be like Stacy is, and that would be a good a good place for you to look, to grow as well. Birthright. It's it's it's considered to be part of the sexual transmitted disease as well. So the major to organism that cause your arthritis are the chlamydia. And that may Syria area, usually patient with female, they would present a like symptomatically without any any symptoms. But they can present with just symptoms off UTI, which can be the Syria, the shorter from that from message, and they will have some pelvic inflammatory disease as well, like they will feel not nothing themselves. Elphick base Also, the diagnosis is should be taking your analysis, taking your culture just to actually that matter. And you have to want to make sure that you do a pelvic exam as well, when we need to send those either urethra so back in the short to the lab, just to make sure that we have a definitive pathogen. The thing about the chlamydia, usually you can pick it up from the urine culture itself. So if you don't pick it up, that should be a like a hen to you that you need to think about chlamydia and the new guidelines. Now every every patient is listening 25 years old, they should be screened for chlamydia because they have a lot of complication. One of these complications Bioness as well. The treatment usually is single those off and doxycycline. But as I said, you need to double check with your local trust. A nice in a good area, usually another another positive for your arthritis. Similar presentation to chlamydia. The treatment differs a little bit. We have a wide range of treatment. You can use the secretary zone. You could use the several proximity of fluxes, but also you need to make sure that you send it to the lab and also if if you have someone who is presented with an infection off and I see that you need to treat it also for chlamydia because there's a high chance that part of them they present with the same time. So we have here like a quite case discussion. I thought it would be nice. Just discuss it with with you. So basically, a 43 year old woman who has a diabetic, who she should have a diabetic presented today, any department complaining off chills, nausea and no back pain for the past two days. So basically here we can tell like it's a female. That's number one. She has a risk factor, which is diabetics. You're basically she's, um, you're compromised. She came into or any with it. Chills, nausea, low back pain, which is suspicious A little bit for UTI Elian. That week, the patient give a history that she had also increasing the urinary frequency and in Syria, so she had some urinary symptoms as well. You know that you might have UTI. I went to urgent people's captain time frame for her for a couple of days. But despite the antibiotic use, she's still complained off nausea and vomiting and their symptoms got worse. The past medical history for that patient. As we said, it's not about that yet, but multiple. You're attractive fiction in the past, and also there was no history of any sexually transmitted disease or anybody saw this short. When she came in, she waas really and, well, she was uncomfortable. Her vitals showed that her temperature was around 39.5. She was taking cardiac with a heart rate of 105 on a BP of 106 which is quite low for someone who is 43 fit and weight. When we examine the patient, the patient had a drawing mucous membrane, which basically means that the patient is dehydrated. She's slightly becoming more and more septic. She also started to have our own examination. She had suprapubic tenderness as well, and also the most important thing that she had the right flank tenderness and right course, effective all angles, indifference. So from the history, just get it to you. I think we need to think about one thing now, once a year thing, which is fine. A Friday. So that should be on the top of your the French of diagnosis at this moment. So we started with the basic work up for basically we have taken some urinalysis is they're anuses confirmed. There's by your area. There's also hematuria and bacteria. We taken some blood, some urine samples as well. A. Send it to the lab just in sure that we're gonna do a urine culture so we can start on the right antibiotic. That patient required admission because she wasn't she had to do a course of antibiotic. We did not do anything to her. She's septic. At the moment. She's in severe pain, so basically she needs an admission for IV fluids and IV antibiotic and also for pain controls as well. The following day, the culture showed that she had the chronic, the broads. So we started here on IV antibiotic that covered the car negative thoughts and after 72 hours off hydration IV antibiotic, the patient assistance to have to still feeling the 12th and still feeling septic. So basically, here at the moment, you need to think about not only buying a Fridays, we need to think about the complication pile of Fridays, and at this point we can start asking for some images because, as we said, find a franchise is a clinical diagnosis. But if the patient is not responding to the antibiotic or to the management were given, we need to think out of the box. So this patient had had we changed antibiotic for this patient we had were question cities. Count for this patient on the CT scan showed that you had a bone Fridays complicated by a renal absence. And as you can see that what? That's the ultrasound. And that was the CT scan and this patient, if she's not responded. IV antibiotics. You were required to go for a drainage, but likely for this patient. She ended up responding very well to the antibiotic. Sorry, So what we need to think about So we need to diagnose and think about any patient who presents with with the really attractive fiction or urinary symptom to think they might have a urine tract infection on. The best thing to do is to recognize them early and to start their treatment as early as possible because if they're not treated, they can develop some complication. And those complications are very bad. And that case is one of those complications. And number two, Yeah, not everyone will respond to a certain antibiotic. That's why we need to do the urine. We need to take a urine culture. So actually that single pathogen and try to tackle that pathogen with what sensitivity? And then number three. Keep in mind that equalized the most common cause of those UTI so and also the other course. There's other courses, as we discussed earlier on. And also don't forget about the chlamydia and the nice, especially in any sexual active male or female. Now everyone lived 25. She needs to be screened for chlamydia because it's it's very severe, can cause a lot of complication, such as pelvic inflammatory Disease is an infertility. So we have here a couple of questions. Hopefully, those couple of question that just be like to the point on. Hopefully they will help you guys. So what did the most common cause of your UTI in other minutes? Adult males chorea do you want like like there's any pool or anything or just, uh, S o uh, everyone can feel free to pop your answers in the checkbooks. So quite a few people saying See, for Foley's catheter. So the most common cause for it's benign prostatic hyperplasia that the most common cause off you tell you another man's for his catheter is is a common cause. But the major causes the benign prostatic hyperplasia because, as we said, benign prostatic hyperplasia we call is what we call like an outfielder struck shin for the urine, and that will make it very good a place for your and tea bacteria to grow in the urine for a scatter couldn't be a cause, but for this catheters, but the second most common cause after that benign prostatic hyperplasia. Other courses could be contributed courses on anatomical causes, and we need to think about those. If the patient is not responding or presented to us with A with a recurrent episodes of UTI, I hope that was clear for your eyes. The second question I should be a quick one, and he's the one straight forward one. The most common again is in causing UTI, so I'm getting a lot of easy for this question. What? You should be the answer. Yeah. So equalize the most common cause for uti Onda. Uh, that was that. Hopefully, it was like to the point precise. I didn't want to make, like, a long slides. I know it's quite safe in the night as well, so hopefully, like, you get most of the things you like. You wanted to know about Duty II, And how would you treat it on dime? Happy to answer any questions if you have any. Thank you very much, Doc. Just the time from very helpful session. And so probably concludes, Anyone have any questions? They like to pop on to chat box and we can discuss thumb. Okay, so it doesn't seem like there's any questions at the moment. If you to Shitzu, ask a question of the moment and you can always feel free to send us an email. Um, with your question and we'll be hooked Toe house, right? Could you Yep. So basically most important thing is we really appreciate your feedback. So the only way that we're gonna be able to work on improving our sessions and making sure that we deliver our sessions based on what you want to learn and the way that you want to learn it is through your feedback. So please go ahead and use the QR code. I'm also gonna pop the feedback form a zoo link in the chat box just now. And once you feel that reform, you will get your attendant certificate as well. So please go ahead and do that. And as I said before, if you have any questions, email address is just below. And please be sure to join us for a next session on acute urinary retention to thank you very much on giving. What did you think you could? He has a good thank you very much. Thank you.