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Category: Urinary Infections

Is it safe for people with UTI to keep fasting during Ramadan?

Posted on by Dr. Ali Thwaini

The holy Ramadan season is upon us and we are devoted and hardcore dedicated for the long ritualistic fasting hours. To make this Ramadan season safe and healthy, urologist Dr. Ali Thwaini has a lot to share!

With long fasting hours, it is obvious that the water intake lowers to below the sufficiency levels and it is a major concern. Why?

With scorching sun, unbearable heat waves, and longer days, dehydration is a common issue accompanied by fatigue and weakness. This can ultimately lead to kidney stones and Urinary Tract Infections (UTI).

With dehydration clutching your body, dry skin and mouth, constipation, severe headache, thirst can be the resultant issues to resolve.

Kidney, Ureter or Bladder (KUB) stones and UTIs can arise in people who do not care to have at least 8 to 10 glasses of water a day. This is because, with no adequate intake of water, dilution of uric acid is not properly done and pH levels drastically reduce, leading to soaring acid levels and kidney stones start forming in your KUB.

UTIs tend to be a commonly sighted problem during fasting, especially in women.

How do you find you are afflicted with UTI?

The initial symptoms of UTIs

  • Having a burning sensation while urinating.
  • Severe pain in the lower abdomen.
  • Spotting blood in the urine.
  • Lower back pain.
  • Frequent urination accompanied by pain.

How UTIs affect your bladder can be put in simple words, it’s when there is an infestation of bacteria within the bladder. And this happens generally due to 2 main reasons:

  • Reduced intake of water, hence the bacteria are not flushed out of the bladder and hence start infesting.
  • Constipation can also result in the building up of bacteria which can resultantly affect one’s KUB.

It’s a major deduction that people with Diabetes are susceptible to bacterial, viral, and fungal diseases. Without proper medication, uncontrolled diabetes can result in chronic renal disease.

Quick remedies

  • Take special concerns to stay highly hydrated during the nonfasting hours.
  • Make sure to maintain good glycemic control with a proper diet plan and antidiabetic therapeutics.
  • Drink at least 3 liters of water a day and stick to a low carb, low protein, and less salted diet
  • Drink as much as fluids during Iftar and Suhoor in the form of fresh fruit juice to boost your immunity and nourish your body with a plethora of vitamins and minerals.
  • Skip too many cups of coffee, since it’s an infamous diuretic and can dehydrate your entire system in the blink of an eye.
  • Consume lime water with less added sugar, to boost the citrate levels of your body.
  • Intake cranberry juice is also highly recommended to keep UTIs at bay.

With a proper diet plan and a hydrated body system, the majority of UTIs can be avoided to an extent. However, it’s wise to consult a urologist, for people affected by kidney disease, kidney stones, or UTIs before fasting to keep things safe and healthy!

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Undescended Testicles: Symptoms, Diagnosis & Treatment – Dr.Ali Thwaini Urologist Dubai

Posted on by Dr. Ali Thwaini

Undescended Testicles

This is a rather common condition and is even more common in premature babies. Around one in 20 male babies is born with an undescended testicle. In about one in 70 cases, the testicle remains undescended when the child’s testicles are not in their usual place in the scrotum. Generally, only one of the testicles is affected, but on rare occasions, both testicles fail to travel to the scrotum. 

Towards the end of pregnancy, the testicles travel through a passage into the scrotum. Both testicles should be in the scrotum by the time the child is one year old.

In some children, the testicles may be in the scrotum for much of the time, but cannot be felt there because they naturally rise back into the body through fear or cold temperatures. A parent can usually find this out by putting the child in a warm bath and checking whether they can feel both testicles. If this is the case, there is no cause for concern.

Symptoms of undescended Testicles

The condition is asymptomatic for the child but the affected side cannot be felt in the scrotum. The child will not be in pain, and the undescended testicles will not interfere with any bodily function.

However, if one of the testicles becomes twisted (testicular torsion), this will be painful, either in the groin area or the abdomen, depending on the location of the testicle at the time.

Diagnosis of undescended Testicles

The mainstay of the diagnosis is by clinical examination, preferably in a warm environment in order to relax the scrofulous and allow maximum change to have a proper clinical assessment.

Aetiology

On rare occasions, the testicle does not descend due to other problems with the testicles themselves or with the male hormones. We do not know exactly why this happens, but it is not due to anything that happened.

Undescended Testicles Treatment

The method of treatment depends on the suspected cause. If the doctors suspect the testicles have not descended due to a hormone problem, they may suggest a short course of a hormone called human chorionic gonadotrophin (hCG). This is more likely to be suspected if neither testicle has descended.

If the doctor does not suspect a hormone problem, or if the testicles remain in the abdomen after the hormone treatment, the child will need a short operation under a general anesthetic called an orchidopexy.

Undescended testicles are best treated in early childhood, usually just before or around one year of age. The child’s testicles will need treatment as they do not seem to mature properly if left in the abdomen.

The amount of sperm and fertility levels seem lower in men who have had undescended testicles, and even lower if they were not treated early in childhood. This is because the testicles need to be a few degrees cooler than the rest of the body to produce sperm.

Children with undescended testicles have a higher risk of testicular cancer in the future. It is easier to check the testicles if they are in the scrotum. If the testicles remain in the abdomen or high up in the groin, this also increases the risk of testicular torsion.

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What is an orchidopexy?

This is an operation to bring the testicles down from the abdomen to their usual place in the scrotum. This is a short operation under general anaesthetic, lasting about 45 minutes. Sometimes the operation needs to be done in two stages about six months apart.

In many cases, this can be as day surgery – the child will arrive at the hospital, have the operation and be able to go on the same day. Occasionally, a child will need to stay in hospital overnight.

Penoplasty (male enhancement)


The penile enlargement procedure is seldom discussed. Men in general are private about their privates at the best of times, and when it comes to such an intimate matter, they are even more introvert.


UTI in Pregnancy Dr.Ali Thwaini Urologist Dubai

Posted on by Dr. Ali Thwaini

UTIs during pregnancy are not uncommon and increase the risk of developing pyelonephritis, which is associated with an increased risk of fetal loss, premature delivery, and low birth weight babies. Screening can reduce the risk of this.

All women should be screened for asymptomatic bacteriuria at the 1st antenatal appointment

Symptomatic bacteriuria occurs in 17-20% of pregnancies. There are pathophysiological grounds to support a link to pre-labour,

premature rupture of membranes (PROM) and pre-term labour. Untreated upper UTI in pregnancy also carries risks of morbidity and rarely mortality to the pregnant women 

Physiological changes in the pregnant woman make her more likely to suffer both asymptomatic bacteriuria (AB), and urinary infection (cystitis, pyelonephritis).

2-9% of women are bacteriuric in the first trimester. 10-30% of women with bacteriuria in the first trimester develop upper urinary tract infection in the second or third trimester

High fever, whether caused by UTI or other infection, is associated with foetal loss, at any stage in pregnancy.

Benefits of screening for asymptomatic bacteriuria:

Early screening for and treatment of asymptomatic bacteriuria in pregnancy has maternal and foetal benefits.

A Cochrane review of 14 randomized trials of asymptomatic bacteriuria in pregnant women compared the antibacterial therapy to that with placebo or no treatment. The Cochrane review showed that antibacterial therapy was significantly more likely to clear asymptomatic bacteriuria, to lower the incidence of pyelonephritis, and to reduce the rate of preterm delivery or low birth weight babies.

Screening for asymptomatic bacteriuria in pregnancy

All women should be screened once for asymptomatic bacteriuria at the

1st antenatal (booking) appointment (NICE recommendation).

Do this by sending an MSU. DO NOT USE DIPSTICKS: they are not sufficiently sensitive.

If positive result, repeat as indicated in the flow chart over the page to ensure first test is reliable , as contamination can occur.

Managing symptomatic bacteriuria

Symptomatic bacteriuria in pregnancy should be treated (see over page for guidance on antimicrobials).

Use near-patient testing with dipsticks to assess the likelihood of UTI. Send urine for culture before starting empirical therapy. Send a repeat sample 7 days after completing treatment as a test of cure.

Antimicrobials for bacteriuria in pregnancy

The choice of antibacterial and the duration of therapy depend on a number of considerations:

  1. The relative contraindications to some antimicrobials in pregnant women (always refer to the BNF)
  2. Resistance of the organisms;
  3. Adverse effect profiles (including propensity to cause C. difficile-
  4. infection).
  5. Use MSU results, when available, to guide therapy even if this entails a change of empirical therapy.
  6. Since most antimicrobials are concentrated in urine, oral therapy is sufficient in most patients

Managing incidentally-found group B streptococcus infection in urine

The antenatal care service should be informed when a group B streptococcus (GBS), Streptococcus agalactiae, is isolated in urine. Women with GBS bacteriuria identified during the current pregnancy should be offered IV antimicrobial prophylaxis during delivery .

GBS bacteriuria, is associated with a higher risk of choriamnitis and neonatal disease. However, it is currently not possible to accurately quantify these increased risks.

Women with GBS urinary tract infection during pregnancy should also receive appropriate treatment at the time of diagnosis as well as IV prophylactic antimicrobials as the time of delivery. Treatment of GBS UTI during pregnancy should be treated as per culture sensitivities. Refer to BNF for further advice on appropriate antimicrobials during pregnancy.

Urine Sampling

The specimen should be mid-stream. Cleansing with water and holding the labia apart are not essential. Use of antiseptics for cleaning the perineum is not

recommended as this can cause false negative culture results. Refrigerate specimens to prevent bacterial overgrowth.

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Interpreting a culture result:

The following usually indicates UTI in a patient with urinary symptoms. Higher counts have even higher positive predictive values:

  1. Single organisms ≥ 104 colony forming units (CFUs)/ mL
  2. Mixed growths’ indicates perineal contamination which reduces the significance of the culture. If a culture is still required, an MSU should be repeated with patient counselled on correct sampling technique
  3. Culture results should be interpreted in the light of near-patient dipstick testing.

Microscopy:

Microscopy is not available for the diagnosis of UTI except in children <3years to comply with NICE guidelines. Use near-patient testing with dipsticks to assess the likelihood of UTI, they are as sensitive and specific as microscopy for predicting the presence of infection. Urine microscopy is only performed for? glomerulonephritis, SLE, endocarditis, haematuria, casts, crystals, candiduria and Schistosomiasis and must be specifically requested with the relevant clinical details.

Treatment: please refer to the following chart:


Urinary Tract Infections (UTIs): Causes, Symptoms & Treatment

Posted on by Dr. Ali Thwaini

What is a urinary tract infection (UTI)?

Urinary tract infections(UTI) occur usually due to microbial inaction of the urinalysis tract ( that could be anywhere from kidneys, bladder, prostate- in men, and urethra) with the inflammatory response of the body.

The latter is usually manifested by various symptoms depending on the location of the infection and severity.

What are the symptoms of a urinary tract infection (UTI)?

For infections involving the urinary bladder, symptoms are:

  • painful urination and a burning sensation
  • needing to urinate frequently
  • sudden urges to empty your bladder, called urinary urgency
  • pain in your central lower abdomen, just above the pubic bone
  • blood in your urine

However, if infections affect the kidneys, the symptoms might be more pronounced, some of which are explained below:

  • pain in your sides or back that doesn’t change when you change position
  • fever and chills
  • nausea and vomiting

Certain symptoms in addition to those of a UTI could mean you have a prostate infection (prostatitis). These include:

  • fever
  • chills
  • fatigue
  • difficulty urinating or “dribbling”
  • pain in your pelvis or the area between your rectum and scrotum (perineum)

Causes of Urinary Tract Infections

Most UTIs are caused by the bacterium Escherichia coli (E. coli), which is naturally present in your body. The bacterium gets into the urinary tract through the urethra. The urethra is the tube that drains urine from your bladder.

UTIs are more common in women than in men because their urethra is shorter and the bacteria need to travel a shorter distance to reach their bladder.

At least a third of women will have one infection during their lifetime.these aren’t normally sexually transmitted , because the infection is typically from bacteria already present in the urinary tract.

UTIs in men are more common with older age, possible, because older men are more likely to develop enlargement of their prostate gland, called benign prostatic enlargement. The prostate wraps around the neck of the bladder, where the urethra connects to

the bladder. Enlargement of the prostate gland can choke off the bladder neck, making it harder for urine to flow freely. If the bladder doesn’t empty completely, bacteria that are normally flushed out with the urine might gain a foothold.

Other factors that can put you at greater risk for UTIs include the following:

  • being immobile for long periods
  • not drinking enough fluids
  • recent urinary tract surgery
  • diabetes
  • being uncircumcised
  • fecal incontinence
  • engaging in anal intercourse, which exposes the urethra to more bacteria

Diagnosis of Urinary Tract Infections

To diagnose a UTI, your doctor will examine you and ask about symptoms, including any past history of UTIs. You may be asked to provide a urine sample to check for pus and bacteria. The presence of pus strongly points to a UTI.

If your doctor suspects an enlarged prostate gland, they may do a digital rectal exam, using a gloved finger to feel your prostate gland through the wall of your rectum.

Treatment for UTIs

If you have a UTI, you will need to take antibiotic medications. Depending on the type of antibiotic your doctor prescribes, you will take the pills either once or twice a day for five to seven or more days.

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It’s also important to drink adequate fluids. You may be tempted to reduce your fluid intake if urinating is uncomfortable. Urination can help flush the bacteria from your system. Stay hydrated and urinate often while taking your antibiotics.

Many people drink cranberry juice during UTIs in hopes of clearing the infection. Lab experiments with mice showed that several substances in cranberry juice lowered bacteria count in the bladder. However, there is no strong evidence that drinking cranberry

juice during a UTI eliminates the infection or speeds recovery.

Recovering from UTIs

After starting antibiotics, you should feel better within two to three days. If your symptoms don’t clear up after taking antibiotics, see your doctor.

It’s important to finish all antibiotics prescribed, even if you’re feeling better. Stopping your antibiotics prematurely can encourage growth of bacteria resistant to common antibiotics. In effect, less than the full course of treatment kills off the

“weak” bacteria, leaving the stronger and more resistant strains.

Conclusion

Urinary tract infections(UTI) occur usually due to microbial inaction of the urinalysis tract ( that could be anywhere from kidneys, bladder, prostate- in men, and urethra) with inflammatory response of the body. Treatment for UTIs are antibiotic medications and drink adequate fluids.Dr Thwaini is a consultant urological surgeon in dubai with specialist interest in urological cancers, namely in renal cancers. He was the lead for renal cancers in the Belfast Health and Social Care Trust (Belfast City Hospital).

Lower urinary tract symptoms (LUTS)

Posted on by Dr. Ali Thwaini

Lower urinary tract symptoms (LUTS) are complaints related to altered function of the urinary tract, and these include frequency (defined as the need to pass urine very often); urgency (the need to pass urine without much warning); urge incontinence (urgency resulting in leakage of urine which you cannot control); hesitancy (not being able to pass urine immediately); poor flow ( a decrease in the force of your urinary stream; nocturia (the need to pass urine frequently at night); post-micturition dribble (urine leakage on walking away from the toilet) .

Lifestyle measures to improve Lower Urinary Tract Symptoms:

Ideally you should have a daily fluid intake of 1.5 to 2 litres. Most which should be water or squash. A good habit is to drink a glass of water before going to bed, and on getting up in the morning.

Caffeinated beverages can act as bladder irritants. If you have symptoms of frequency and urgency, you should try caffeine-free products. Drink water or fruit squash instead of caffeinated drinks (tea, coffee, chocolate, Red Bull, Lucozade or cocoa). You should reduce your caffeine intake gradually (over a fortnight or so) to prevent withdrawal symptoms.

Large volumes of fluid over a short time, especially fizzy drinks, can cause rapid filling of your bladder, frequency and urgency. You should space your drinks evenly throughout the day.

Ideally, your urine should be a light straw colour (like champagne or white wine). Very dark or strong-smelling urine is too concentrated, and suggests you should drink more. If your urine is colourless, with no smell, you may be drinking too much. During hot weather, air travel, after exercising and during illness you need to drink more.

You should avoid going to the toilet “just in case” and do not strain to empty your bladder or bowels. Good habits to adopt are:

  • allow your bladder time to empty properly – wait a few seconds, then try to empty more;
  • do not drink before you go to bed – if you are troubled by getting up to pass urine at night; and
  • only have a few sips of water at night – if you wake up needing a drink.

Bladder training:
Bladder training will probably help you by “re-educating” your bladder to hold a greater amount of urine.

It is used to treat frequency, urgency and urge incontinence due to an overactive or unstable bladder. Some people with these symptoms get into the habit of passing urine “just in case”, and the bladder can then “get used” to holding smaller volumes.

You must learn to control your bladder rather than allowing it to control you. When you feel the urge to pass urine, tell yourself that you are not going to go. Try to distract yourself for five to 15 minutes (use whatever method works best for you). If you do this every time you want to pass urine, you should find, after a week or so, that your urgency reduces.

The following week, do the same thing but now delay passing urine by a further five to 15 minutes. Your bladder will gradually learn to hold more, and your symptoms will slowly improve. Be persistent and remember that your bladder, like any other muscle in the body, may need several months’ of re-training to reach its full potential.

Pelvic floor muscle training:

  1. pelvic floor exercises can also help reduce urgency. Sitting or standing still when you get the urge, this will also help you concentrate on tightening your pelvic floor muscles.
    The pelvic floor has several functions:
    • it supports your pelvic organs and abdominal contents – especially when you are standing or exercising;
    • it supports your bladder to help stop leakage – sometimes the muscles need to work gently and sometimes (such as when you cough, sneeze or strain) they must work harder – if they are not working effectively, you may suffer from urinary incontinence; and
    • it controls wind and allows you to “hold on” with your bowels.The sphincter (valve) muscles which close your bladder neck can be damaged by prostate surgery. If this happens, your pelvic floor muscles become very important in maintaining continence. You can also contract your pelvic floor muscles after emptying your bladder to prevent post- micturition dribble.
      Other aspects:
      Avoid constipation      Urinary symptoms are often worse if you get constipated. Because the bladder and bowel are close to each other, a full bowel can affect your bladder function.
      • Eat a balanced diet – include both soluble fibre (oats, barley, berries & fruit) and insoluble fibre (roughage such as wheat-based foods, cereal, vegetables & nuts)
      • Eat regular meals
      • Empty your bowel when you feel the need – delaying may lead to constipation
      • Maintain a good fluid intake – 1.5 to 2 litres (three to four pints) per day is ideal Lose weight To reduce the load on your pelvic floor, aim for an acceptable weight for your height and build. Being overweight – having a body mass index (or BMI) over 29 – can make stress incontinence worse. There are many ways of losing weight and your GP can advise you on the best method for you. Avoid heavy lifting lifting puts an extra strain on the pelvic floor. If you do need to lift a heavy object, tighten your pelvic floor before you lift and hold it tight until you have released the load. Stop smoking Smokers are more likely to have troublesome urinary incontinence because of the strain that coughing puts on the pelvic floor. 
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Urinary incontinence is defines as involuntary loss of urine, which is a social or hygienic problem.

Posted on by Dr. Ali Thwaini

Urinary Incontinence can be divided  into several types, but the most common are:

  • Stress incontinence – leakage during periods of abdominal pressure (coughing, sneezing, lifting, straining);
  • Urge incontinence – leakage which follows an irresistible urge to pass urine;
  • Mixed incontinence – combined stress & urge incontinence;
  • Post-micturition dribble – leakage from the urethra a few minutes after passing urine (not to be confused with terminal dribbling when it is difficult to shut off the stream immediately after passing urine – usually a sign of prostatic obstruction); and
  • Giggle incontinence – tends only to occur in young girls and normally resolves as the child grows.

Facts:

  • Urinary Incontinence affects 10-15% of people.
  • 60-80% of these patients have never sought medical advice for their condition and 35% view it simply as part of the ageing process;
  • Urinary Incontinence is caused either by bladder functional disturbances and/or sphincter (valve) weakness;
  • stress incontinence is due to pelvic floor weakness for which the commonest causes include childbirth and obesity;
  • urge incontinence is caused by bladder abnormalities for which the commonest cause is an overactive bladder (OAB);
  • conservative treatment can be successful in improving most forms of incontinence; and
  • surgery is effective in incontinence if conservative measures do not work, but there is a late failure rate for all types of surgery.

Treatment of urinary incontinence:
General measures:

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Simple measures such as reducing caffeine intake, making sure that you do not drink excessivley, losing weight and carrying out pelvic floor exercises may be helpful. You should talk to your GP if you are taking drugs which cause you to make more urine (e.g. diuretics). You should stop smoking.

Urinary Incontinence

For some patients, using simple pads to catch the leakage may be sufficient. If surgery is not appropriate for any reason, inserting a catheterinto the bladder (pictured) or using intermittent self-catheterisation may resolve the incontinence.

Stress incontinence:

Non-surgical treatment

  • Weight loss – may reduce the incontinence to manageable levels without any further treatment;
  • Physiotherapy – combined with electrical stimulation or the use of vaginal cones can improve many patients with stress incontinence;
  • Oestrogen supplements – may help women with incontinence due to post-menopausal tissue atrophy; and
  • Drugs – there are now some drugs available which can temporarily improve incontinence, although they may not actually cure it.

Urethral bulking agents:

This operation involves injecting a bulking agent into the wall of your urethra (waterpipe) using a small telescope to treat symptoms of stress urinary incontinence (SUI). The bulking agent helps the urethra to make a watertight seal and to hold urine inside your bladder.

There are several different bulking agents in use. 

bladder neck suspension (colpo-suspension):

Colposuspension is the gold standard operation to treat stress incontinence. We put stitches inside the pelvis through an incision (cut) across your lower abdomen (tummy). The stitches pull up your vagina around the area of the bladder opening.

When you exercise or cough, there is downward pressure on the bladder. The stitches help to support the bladder opening when the bladder is pushed downwards, and this prevents urine leakage.

Urge incontinence:

Non-surgical treatment

Surgical treatment:

Surgery

  • Treat the underlying cause – e.g. prostate obstruction, bladder tumour, bladder stone or urethral stricture;
  • Stretching of the bladder – by overfilling with fluid at the time of telescopic inspection under general anaesthetic;
  • Botox injections – by injecting into the bladder wall using a telescope under local or general anaesthetic;
  • Sacral neuromodulation – implantation of a stimulator & electrodes into the nerves which supply the bladder;
  • Augmentation cystoplasty – enlargement of the bladder using a segment of bowel; or
  • Diversion of urine into a conduit should be regarded as a last resort when all other measures have failed.

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