Acute Urinary Tract Infection In Patients With Underlying Benign Prostatic Hyperplasia And Prostate Cancer
Musliu Adetola Tolani, Aisha Suleiman, Mudi Awaisu, Muhammad Mukhtar Abdulaziz, Ahmad Tijjani Lawal, Ahmad Bello
Corresponding author: Musliu Adetola Tolani, Division of Urology, Department of Surgery, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
Received: 20 Nov 2019 Accepted: 25 Jun 2020 09 Jul 2020
Keywords: Benign prostatic hyperplasia, catheter-associated infections, prostate cancer, urinary tract infection
©Musliu Adetola Tolani et al. Pan African Medical Journal . This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Musliu Adetola Tolani et al. Acute urinary tract infection in patients with underlying benign prostatic hyperplasia and prostate cancer. Pan African Medical Journal. 2020 36:169.
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Risk Factors Of A Urinary Tract Infection
Aside from age, there are additional factors that put men at a greater risk for developing a UTI including:
- Not being circumcised
- An enlarged prostate
- Urinary bladder catheter placement can disrupt the normal flow of urine, which help wash away the microbes. A urinary bladder catheter is usually used for various medical conditions to facilitate urine outflow
- Blockages in the urinary tract, such as caused by kidney stones, which impair the flow of urine
- Poorly controlled diabetes
Does An Enlarged Prostate Gland Put Men At Risk Of Urinary Tract Infections
A urinary tract infection is usually caused by the bacteria E. coli finding their way into the urethra, but it can also be the result of stagnant urine left sitting in the bladder allowing bacteria normally found in the urinary tract to multiply. It is possible for an enlarged prostate to obstruct the complete emptying of a males bladder, thus adding to his chances of getting a UTI.
However, it is also possible for a urinary tract infection to cause prostatitis a temporary swelling and inflammation of the prostate. The two share most of the same symptoms which may confuse the sufferer even more, especially if he has both issues simultaneously.
An enlarged prostate is not the same as prostatitis. Benign prostatic hyperplasia , also referred to as an enlarged prostate, is a common result of aging rather than an illness. A mans prostate is located near the bladder, and his urethra passes through the middle of it. A prostate keeps growing throughout a mans life, but it isnt quite clear why it often enlarges after the man is older. One third of males have an enlarged prostate by their sixties, and one half by their eighties. It is thought to be an imbalance in hormones.
Since the urethra is centered in the prostate, an enlarged prostate can easily cause difficulties.
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Side Effects From Hormone Therapy
Hormone therapy for prostate cancer, known as androgen deprivation therapy , suppresses production of testosterone. ADT can cause several side effects. These include fatigue, hot flashes, decreased bone density, ED, depressed mood, decreased sex drive, weight gain, heart risks, breast growth and cognitive decline.
The severity and length of side effects depend on how long treatment lasts. “If a man has only six months of treatment, their level of testosterone rises again, and they’ll go back to feeling like themselves,” Calvaresi said.
Often, mood changes in men on ADT are caused by other side effects such as weight gain and hot flashes. “If we can manage those other side effects, then often that improves mood,” she said. Following a healthy diet and exercising regularly often helps to decrease fatigue, prevent weight gain and improve overall mood. Before beginning hormone therapy, you should discuss the effects of ADT with your doctor, and talk about how you can change your exercise and eating habits to help head off side effects before they occur.
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- The prostate gland is a male reproductive organ that produces fluids to feed and protect sperm cells.
- Many men experience urinary changes as they age. In many cases, these changes do not need specific treatment.
- When urinary changes cause problems, they can be treated successfully by lifestyle changes, medication, surgery or a combination of the three.
- For problems such as blood in the urine, pain on urination, inability to urinate or uncontrollable urine flow, see your doctor promptly.
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Continuous Irrigation Of The Bladder After Prostatectomy
Prostatectomy is one of the most common surgical procedures performed in the prostate. It can be suprapubic prostatectomy or transurethral resection. It is a common procedure in cases of prostate cancer and benign prostatic hyperplasia.
You might need CBI in this case and other surgical procedures concerning the prostate. Remember that the male prostate is located in the bladder neck. By accessing to the prostate, other surrounding tissues will likely be affected. This is the prostatic fossa.
The manipulation of the prostate may also cause mild tearing in the bladder. Thus, continuous irrigation of the bladder is recommended in many cases. It is actually considered a routine post-operative procedure for some doctors. Still, if your doctor does not consider CBI necessary, he may have valid reasons, too .
We mentioned above the reasons why we typically advocate CBI after prostate surgery. In the case of prostatectomy, patients will already have a catheter placed after surgery. An additional reason in this particular case is to avoid collapsing the lumen of the catheter.
But if your doctor decided not to perform continuous irrigation, heres a list of possible reasons :
For all of the above, your doctor may or may not consider CBI in your case. If he does not use CBI, it is probably because your surgery had some bleeding. But if youre a candidate for CBI, rest assured it is for your sake.
Are Any Tests Needed
A urine sample can confirm the diagnosis and identify the germ causing the infection. Further tests are not usually necessary if you are otherwise well and have a one-off infection. However, your doctor may advise tests of your kidney, prostate gland, or bladder if an underlying problem is suspected.
An underlying problem is more likely if the infection does not clear with an antibiotic medicine, or if you have:
- Symptoms that suggest a kidney is infected .
- Recurring urine infections. For example, two or more in a three-month period.
- Had problems with your kidney in the past, such as kidney stones or a damaged kidney.
- Symptoms that suggest an obstruction to the flow of urine.
- Blood-stained urine which persists after treatment with antibiotics.
Tests may include:
- An examination of your prostate gland by examination of your back passage .
- Tests to see how well your bladder is working, called urodynamic tests.
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About Urinary Tract Infections
Urinary tract infections are common infections that can affect the bladder, the kidneys and the tubes connected to them.
Anyone can get them, but theyre particularly common in women. Some women experience them regularly .
UTIs can be painful and uncomfortable, but usually pass within a few days and can be easily treated with antibiotics.
This page is about UTIs in adults. There is a separate article about UTIs in children.
This page covers:
Diagnosis Of Enlarged Prostate Gland And Urinary Problems
If you are troubled by urination problems, see a doctor no matter what your age. If your doctor agrees that your symptoms need further evaluation and treatment, you may need to undergo a few tests.These may include:
- general examination medical history and review of any health conditions including obesity, diabetes, obstructive sleep apnoea, depression and erectile dysfunction. A rectal examination may be done to check the size and shape of your prostate gland
- a urine check to ensure the prostate is not infected
- a flow-rate check to estimate the speed with which you pass urine
- an ultrasound examination to assess if the bladder is emptying completely and to examine your kidneys
- urodynamics a series of tests on the bladder to see how your urinary system is functioning may be recommended in some circumstances.
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What Are The Symptoms Of A Uti
Urinary Tract Infections in men are usually caused due to infection by bacteria such as Escherichia coli, Klebsiella, Pseudomonas, or Staphylococcus. The infection can spread from the urethra through the urinary tract and reach the bloodstream from the kidneys. Common symptoms of a UTI include:
- Pain or burning during urination
- Urethral discharge
How Is A Uti Diagnosed
Your healthcare provider will ask about your signs and symptoms. Your provider may press on your abdomen, sides, and back to check if you feel pain. You may need any of the following:
- Urinalysis will show infection and your overall health.
- Urine cultures may show which germ is causing your infection.
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Prostatitis Epididymitis Urethritis And Orchitis
In contrast to UTI, prostatitis affects men of all ages and, from 1990-1994, accounted for almost 2 million office visits per year in the United States. Prostatitis syndromes account for 25% of male office visits for genitourinary complaints, 8% of visits to urologists, and 1% of visits to primary care physicians. Of these men, 5% have bacterial prostatitis, 64% have nonbacterial prostatitis, and 31% have prostatodynia. Digital examination of the prostate in the setting of probable or possible UTI should be avoided to prevent the risk of inciting bacteremia.
Epididymitis has a bimodal distribution, corresponding to different age groups and pathogens. Most cases in men younger than 35 years are due to sexually transmitted pathogens. Older patients are more likely to have obstructive prostatism or a history of instrumentation or catheterization.
Gonococcal urethritis is more common in ethnic minorities, lower socioeconomic groups, and persons living in urban centers. The risk to a male having intercourse with an infected female is 17%. Some of these associations may be limited by confounding. The peak age for urethritis is 20-24 years.
Mumps orchitis occurs in 18% of postpubertal boys infected with the mumps virus.
John L Brusch, MD, FACP Corresponding Faculty Member, Harvard Medical SchoolJohn L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of AmericaDisclosure: Nothing to disclose.
When To Seek Medical Advice
While you’re recovering, you should contact a GP immediately or call 111 if:
- you have a high temperature
- you have severe pain when peeing
- there’s a lot of blood in your pee or this gets worse
- there are blood clots in your pee
These symptoms can be a sign of a problem, such as internal bleeding or a urinary infection, that needs to be treated.
Page last reviewed: 14 September 2021 Next review due: 14 September 2024
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Why A Urinary Tract Infection Is More Common After Surgery
A urinary tract infection after having a urinary catheter placed is called a Catheter Associated Urinary Tract Infection, or CAUTI. Health center team strives to avoid this kind of infection, yet there are times when a catheter is essential, specifically when the patient could not pee after surgery.
A condition called urinary retention is also common after anesthesia, as well as could raise the probability of a UTI. Urinary retention suggests that the bladder does not fully empty during urination, leaving urine sitting in the bladder longer compared to is regular. This can be minor, leading to urinary regularity, or more significant, needing catheterization and also extra treatment.
What Are Symptoms Of Contracture Of The Bladder Neck
Men usually begin to experience symptoms of bladder neck contracture within three to six months after prostate surgery. At first, a man may notice a gradual reduction in the flow of urine. This symptom may be overlooked at first, and can progress to the point where he becomes unable to urinate. In other cases, a man might experience urine leakage when the bladder becomes too full. This condition is known as overflow incontinence.
Some of the symptoms associated with contracture of the bladder neck include:
- Needing to push to begin urination
- Delayed onset of urination
- Slow or diminished force of urine stream
- Urine stream that starts and stops
- Sensation of incomplete emptying
Behaviors That May Be Telling You About Urinary Tract Infection:
- Problem behaviors that happen shortly before, during, or shortly after urination
- Wants to urinate more often, even when bladder isnât full
- Difficulty urinating able to pass only a few drops of urine at a time
- Wetting accidents, urine leakage
- Poor hygiene, inability to clean area properly
- Increased confusion
Risks Of Prostate Surgery
The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:
- Reactions to anesthesia
- Blood clots in the legs or lungs
- Damage to nearby organs
- Infections at the surgery site.
Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.
If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.
In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.
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Bladder Control Problems After Prostate Surgery
Bladder control or urinary incontinence after prostate surgery is very common. Fortunately after a matter of weeks, the majority of patients issues resolve naturally. Dr. Jerry Blaivas, explains ways to deal with the issue during those weeks and what to do if the symptoms do not subside.
Jerry Blaivas, MD: Urinary incontinence, which is not being able to control the urination, is very very common after prostate cancer surgery. Fortunately, in a vast majority of patients, over time that symptom gets better. So the treatment really depends on where the spectrum you fall.
Immediately after the surgery, most people cannot control their urination and the best way to manage that for the short-term is to simply wear some kind of absorbent pads that you can get from any drug store. After a matter of weeks or months if it is not getting better, then we need to have a better understanding of what the causes are.
Overwhelmingly, the most common cause of incontinence after prostate cancer surgery is what we call sphincteric incontinence.
Sphincteric incontinence means that the muscles that were in the wall of the prostate that ordinarily kept the urethra closed, have either been completely or partially removed or damaged.
When he made this incision here, he does so based on the prostate where the prostate in the cancer ends. He does not have much control over where he can cut. He must cut out all the prostate or the cancer.
In Men Over : Bph May Be The Cause Of High Psa
BPH is the most common prostate problem in men over age 50. It may not need to be treated unless its causing frequent or difficult urination.
Your primary care doctor may be able to tell the difference between BPH and prostate cancer by doing a digital rectal exam, but commonly this will require evaluation by a urologist and further testing, such as a biopsy or imaging studies.
‘just Cant Wait’ Card
You can get a card to show to staff in shops or pubs etc. It allows you to use their toilets, without them asking awkward questions. You can get the cards from Disability Rights UK or the Bladder and Bowel Community. They also have a map of all the public toilets in the UK.
You could get a key to disabled toilets if you need to access them quickly. You buy the RADAR key from Disability Rights UK. But this should only be used by people who need quick access to a disabled toilet due to a disability or medical condition.
Life After Prostate Cancer Treatment
Adjusting to life after prostate cancer treatment can take time. For some men, the emotional impact of what they have been through may not hit them until they have finished treatment. For others, working through the physical side effects is their immediate focus.
Although prostate cancer treatment can be lifesaving, it can also take a toll on the body. This can result in a disruption to normal urinary, bowel and sexual function.
Whether you have surgery, radiation or hormone therapy, you are likely to have side effects.
“It’s important to talk with your health care provider about these side effects before you start treatment, so you can learn about the range of options to treat them,” says Anne Calvaresi, DNP, CRNP, RNFA, Urology Nurse Practitioner at the Kimmel Cancer Center, Thomas Jefferson University in Philadelphia.
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What You Can Do To Help
Pelvic floor exercises
Pelvic floor exercises target and strengthen the muscles that control your bladder. Your doctor or specialist nurse will talk you through what to do. Research has shown that pelvic floor exercises can help you stop or reduce urine leakage.
If you have not had information about pelvic floor exercises, ask your specialist nurse. Or ask to see a physiotherapist that can talk you through them.
You can find out more about how to do pelvic floor exercises on the NHS website.
Drink plenty of fluids
Dont cut down on your fluids, drink at least 2 litres a day. You can drink plenty during the day, but it might help to limit fluids 2 hours before bedtime. Drinking plenty helps your bladder regain its tone.
Incontinence pads and sheets
You might need to wear pads when you first start going out. There are different types of pads. You might be able to get some pads for free on the NHS, although this may depend on the service in your area. Some GP practices have a continence nurse you can see.
It can also help to visit places where you know there are toilets. Or you can telephone beforehand to find out about toilets and how easy they are to get to.