Browse UTI/Pyelonephritis
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Clinical Therapeutics
Endoscopic Treatment of Primary Vesicoureteral Reflux
Foreword. This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are…
- CME
Clinical Practice
Uncomplicated Urinary Tract Infection
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 30-year-old…
- CME
- Full Text Audio
Clinical Problem-Solving
A Hidden Solution
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 51-year-old woman presented to…
- CME
Review Article
Medical Progress: Febrile Urinary Tract Infections in Children
Acute pyelonephritis is the most common serious bacterial infection in childhood; many affected children, particularly infants, have severe symptoms. Most cases are readily treated, provided diagnosis is prompt, though in some children fever may take several days to abate. Approximately 7 to 8% of…
- CME
Correspondence
Antibiotic Prophylaxis and Recurrent Urinary Tract Infection in Children
To the Editor: With regard to the article by Craig et al. (Oct. 29 issue), the rationale for prophylaxis is that prevention of recurrent urinary tract infection in children lowers the risk of sequelae of renal scarring, such as chronic or end-stage kidney disease. However, there has been a…
- Free Full Text
Editorial
Antimicrobial Prophylaxis for Urinary Tract Infection in Children
Approximately one third of children who have a urinary tract infection — the most frequent serious bacterial infection in young febrile children — have vesicoureteral reflux, a congenital condition in which the urine flow is retrograde from the bladder toward the kidneys during micturition.…
Original Article
Antibiotic Prophylaxis and Recurrent Urinary Tract Infection in Children
Urinary tract infection is a very common illness in children, affecting 2% of boys and 8% of girls by the age of 7 years. Urinary tract infection is associated with long-term morbidity, with renal damage reported in about 5% of affected children. The observation that urinary tract infection and…
- Free Full Text
This study from four Australian centers examined whether low-dose, continuous oral antibiotic therapy would prevent urinary tract infection in children (under the age of 18 years) who had already had one or more microbiologically proven urinary tract infections. Long-term, low-dose trimethoprim–sulfamethoxazole was associated with a modest decrease in the number of urinary tract infections in predisposed children.
Original Article
Burch Colposuspension versus Fascial Sling to Reduce Urinary Stress Incontinence
Urinary incontinence affects an estimated 15 to 50% of women,, resulting in a significant medical, social, and economic burden. In 1995 dollars, the annual direct costs of incontinence in the United States were estimated to be more than $16 billion. Among women with incontinence, 50 to 80% are…
- Free Full Text
This multicenter, randomized clinical trial compared two surgical procedures — the Burch colposuspension and the autologous fascial pubovaginal sling — in women with urinary stress incontinence. Success rates (in terms of overall urinary-incontinence measures and stress-incontinence measures specifically) were higher at 2 years for the sling group, but this group also had greater morbidity. These findings inform decision making with respect to surgical treatment of stress incontinence and underscore the importance of surgical randomized trials.
Correspondence
Medical Mystery: Abnormal Abdominal Radiograph — The Answer
To the Editor: The medical mystery in the December 7, 2006, issue involved a 50-year-old woman who presented to the emergency department with obtundation and hypotension. An abdominal radiograph showed gas throughout the right kidney (Figure 1A). Computed tomography (CT) of the abdomen revealed…
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Clinical Practice
Chronic Prostatitis and the Chronic Pelvic Pain Syndrome
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 38-year-old…
A 38-year-old man reports pelvic pain, dysuria, and urinary urgency for the past 4 weeks. He has had several similar episodes over the past 2 years; urine cultures were not performed. He is sexually active and reports frequent discomfort after ejaculation. He is otherwise healthy and takes no medication. He has no fever, chills, or flank pain. How should he be evaluated and treated?
Urethral catheterization may be indicated for diagnostic or therapeutic purposes: to decompress the bladder in patients with urinary retention, to permit irrigation to remove blood and clots from the urinary bladder, to obtain sterile urine for diagnostic purposes, to measure urinary output in critically ill patients or during surgical procedures, or to measure the residual urinary volume after voiding. This procedural video demonstrates how to perform male urethral catheterization.
Clinical Problem-Solving
Ring around the Diagnosis
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 71-year-old retired…
Original Article
Risk of Myocardial Infarction and Stroke after Acute Infection or Vaccination
Systemic inflammation and infections accelerate atherogenesis in animals, and circulating markers of inflammation, such as C-reactive protein, predict the risk of vascular events in humans. However, systemic inflammation is not a constant but varies in response to infections or to other…
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In this large study based on data from the United Kingdom General Practice Research Database, rates of myocardial infarction and stroke increased sharply during the first three days after the diagnosis of an acute respiratory syndrome. The rates increased to a lesser degree after acute urinary tract infections. By contrast, there was no increase in risk after influenza, tetanus, or pneumococcal vaccination.
Clinical Practice
Acute Uncomplicated Urinary Tract Infection in Women
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 28-year-old…
A 28-year-old woman telephones her physician to report dysuria and urinary urgency during the preceding three days. She has had several previous urinary tract infections, including three during the past year. She is otherwise healthy, takes no medications, and is sexually active, using spermicide-coated condoms for contraception. She does not have fever, chills, vaginal discharge, or flank pain. How should she be evaluated and treated?
