Urinary tract infections (UTIs) refer to the colonization of urinary tract (Urethra, ureter, bladder or Kidneys) by E. coli bacteria; (up to 80% of community-acquired uncomplicated UTIs). However, other viruses, parasites, and fungi can also lead to infection. Huether and McCance (2019) reveal that when UTIs occur within the lower tract, bladder, it is referred to as cystitis. When they occur in the upper tract, kidneys, interstitium, renal pelvis, or the ureters, it is referred to as pyelonephritis. According to Walsh (2017, p.293), the symptoms and signs differ according to the site of infection. For cystitis, suprapubic tenderness, frequency, hematuria, and dysuria are experienced while pyelonephritis presents fever, tenderness, pyrexia, and flank pain. According to the American Congress of Obstetricians and Gynecologists (2017), infections that occur in the bladder are called cystitis while those of the urethra are referred to as urethritis.
Acute cystitis is characterized by edema, inflammation, puss formation and bleeding, and occurs when infecting organisms including Escherichia coli and Staphylococcus saphrophyticus move up the urethra into the bladder (McLellan & Hunstad, 2016). Acute pyelonephritis is less common compared to cystitis and is often as a result of vesicoureteral reflux or obstruction – the invasion of the ureter, interstitium and renal pelvis by bacteria – Escherichia coli, Pseudomonas and Proteus. Walsh (2017) reveals that upper UTI involvement is often accompanied by lower UTI signs and symptoms.
Similarities and Differences between Lower and Upper UTIs
A notable difference between the Lower and Upper UTIs is that they affect different parts of the urinary tract. Pyelonephritis involves infection of the kidneys, interstitium, pelvis, renal and ureter while lower UTIs affect the urethra and the urinary bladder. Although both can be treated with antibiotics, treatment of upper UTIs takes longer than lower UTIs and requires hospitalization and intravenous medication in most cases (American Congress of Obstetricians and Gynecologists, 2015). To prevent further complications and chronic disorders such as sepsis that can lead to premature death, timely identification of both lower and upper UTIs is crucial.
Impact of Gender and Behavior on the Pathophysiology, Diagnosis, and Treatment of Upper and Lower UTIs
According to the Urology Care Foundation (2017), women are at a higher risk of acquiring UTI infections compared to men due to their anatomy (location of their urethra too close to the anus) – more than 50% of women will have at least one UTI in their lifetime. According to Huether and McCance (2019), antibiotics use disrupts healthy microbiome in the vagina- a factor that increases susceptibility to UTI infections. Prevalence of UTIs in elderly women and men is similar (Rowe & Juthani-Mehta, 2013). UTIs are more common in sexually active individuals and old age. However, behavior plays a significant role in the prevention of UTIs. Maintaining proper hygiene- wiping from front-to-back to prevent bacteria from traveling upwards to infect the bladder, washing after intercourse, proper birth control, and frequent intake of fluids are essential in preventing UTIs.
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