Introduction
Urinary tract infections (UTIs) are among the most widespread types of infectious diseases in the world. UTIs are mostly caused by bacteria such as Escherichia coli, although some parasitic invasions are also possible (Huether & McCance, 2017). The classification of UTIs usually includes upper and lower types which are based on the place of the infection as well as complicated and uncomplicated conditions, depending on the state of the urinary tract (Hammer & McPhee, 2014).
Both upper and lower UTIs have a higher prevalence in women than in men. It can be explained by the fact that women’s urethra is short and is located near the anus, thus raising the danger of bacterial infection (Huether & McCance, 2017). Moreover, the infections are also common among older people and infants due to their responsiveness to bacteria. Overall, upper and lower UTIs have similar causes of disease and rates of prevalence among genders and ages, but their pathophysiology and clinical presentations differ.
Pathophysiology
UTIs are initiated by bacterial contamination or parasitic invasion into one’s urinary tract. In the case of lower UTIs such as cystitis, E. coli or other organisms enter the sterile urine and move upwards into the urethra, bladder, ureter, and kidney (Huether & McCance, 2017). The immune system responds to the infection which leads to the inflammation of the bladder. The bladder wall becomes edematous, creating pressure and the feeling of the bladder being full. Thus, the affected person feels the need to urinate frequently, although the bladder contains only a small volume of urine. Upper UTI is pyelonephritis – the infection of ureters and renal pelvis.
In this case, the bacteria (E. coli or others) make alkaline urine by splitting urea into ammonia (Huether & McCance, 2017). Furthermore, they spread along the ureters and initiate the inflammatory process which affects the pelvis, medulla, and calyces. Here, renal edema leads to purulent urine, pain, and abscesses.
The main similarity between the two UTIs is the cause of the infection – bacteria and parasites enter the tract but lead to different inflammatory responses. Thus, the differences include the site of edema as well as pus formation in pyelonephritis and pressure on the bladder in cystitis (Hammer & McPhee, 2014). One can see that clinical presentations of the diseases differ. Moreover, upper UTIs may result in other symptoms that are not constrained to the urinary tract, including fever and chills.
Patient Factors
Age and gender are the main patient factors that significantly affect the pathophysiology of UTIs. In female patients, the prevalence of UTIs is much higher than in males due to the position of their urethra. Females of all ages may be affected by UTIs, especially cystitis (Flores-Mireles, Walker, Caparon, & Hultgren, 2015). Women are also at risk of having frequent UTIs due to the alteration of the vagina’s microbiota.
Their care should recognize the effect of antibiotics, the primary way of treating UTIs, on the vagina in order to avoid repeating infections (Flores-Mireles et al., 2015). Another risk group is older people, including both female and male patients. In older men, the rate of UTIs becomes closer to that of older women (Schaeffer & Nicolle, 2016). Their diagnosis should also acknowledge the asymptomatic course of the infection and possible complications of the weakened immune system.
Conclusion
UTIs are a widespread problem that can affect individuals of all ages and genders. Its pathophysiology separates the infections into upper and lower ones. Pyelonephritis and cystitis have similar causes but different symptoms and pathophysiological processes. Women are more likely to acquire UTIs because of the urethra’s location and length. Older people, including both men and women, are also at risk of developing UTIs. These groups should be treated with antibiotics that do not alter the microflora of the body significantly.
References
Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary tract infections: Epidemiology, mechanisms of infection and treatment options. Nature Reviews Microbiology, 13(5), 269-284.
Hammer, G. D., & McPhee, S. J. (2014). Pathophysiology of disease: An introduction to clinical medicine (7th ed.). New York, NY: McGraw-Hill Education.
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Schaeffer, A. J., & Nicolle, L. E. (2016). Urinary tract infections in older men. New England Journal of Medicine, 374(6), 562-571.