武功密笈

小黃藏書

  Acute urethral syndrome:

acute dysuria or frequency of less than 2 weeks’ duration,

without significant bacteriuria (ie. < 10⁵ bacteria/mL of urine)

  Urethral syndrome:

lower urinary tract symptoms that are usually of extended duration and

without recognized infectious etiologies

　

ø Possible etiologies: Hypoestrogenism Mechanical or functional urethral obstruction Traumatic insult Neurologic or psychiatric disturbance

  Mechanisms of preventing ascending UTI by the urethra:

j midurethral high-pressure zone: a mechanical barrier

k mucus-secreting periurethral glands in the posterior portion of the urethra:

trapping bacteria and secreting immunoglobulin A

  Acute urethral syndrome may represent the earliest stages of an ascending UTI

after periurethral colonization by coliform bacteria or other uropahogens.

  More recent data suggest that among women with dysuria, the demonstration of

greater than 10² uropathogens/mL of urine is the most sensitive and specific

criterion for the diagnosis of cystitis. Thus, there is a continuum of the same

disease process. It is arbitrarily designed as cystitis when associated with more

than 10⁵ bacteria/mL of urine and as acute urethral syndrome when associated

with less than 10⁵ bacteria/mL of urine.

  Escherichia coli: 41%

  Staphylococcus saprophyticus

  Chlamydia trachomatis:

- The correlation between C trachomatis and sterile pyuria is important.

  Neisseria gonorrhoeae

  3-day regimens for the treatment of uncomplicated cystitis:

　

Agents	Dose
Trimethoprim/sulfamethoxzole (Baktarâ ) (80/400)	1 double-strength tablet bid
Amoxicillin/clavulanic acid (Augmentinâ ) (250/125)	250mg tid
Norfloxacin* (Baccidalâ ) (100)	400mg bid
Ciprofloxacin* (Ciproxinâ ) (250)	500mg bid
* contraindicated in pregnancy

- Single-dose therapy is no longer recommended because of a high

frequency of E coli resistance to these agents.

- These shorter regimens have cure rates comparable with conventional 7-

to 10-day antibiotic regimens for uncomplicated cystitis. However,

clinical trials comparing 3-day regimens with longer conventional

therapy for acute urethral syndrome have not been reported.

  Chlamydial infections:

- Current therapeutic recommendations:

  Gonococcal infections:

- Recommended medication:

  Patients with acute dysuria without bacteriuria or pyuria:

- No benefit from antibiotic therapy

- Symptomatic treatment with Phenazopyridine HCl (Pyridiumâ )

  Women with recurrent UTI or with chronic dysuria not associated with infection:

- Referred for further urologic evaluation