There have been several calls from hospital emergency staff in the recent past to alleviate retention of urine in elderly male and the associated pain. The urethral opening is completely closed by phimosed prepuce, the fore skin of penis. The common cause of retention of urine in elderly male is a prostatic enlargement. And in a situation where there is such type of phimosis remains associated, it gives rise to problem in introducing a silicon pipe through urethra to relieve the acute retention. Such type of peculiar situation probably is best encountered in India; where the people do not give attention to the phimosis they might be carrying from their childhood. Here, there is custom circumcision in Muslims and Hindus only go for it as a part of medical treatment. Perhaps there is no atheistic consideration, and people generally shy away from speaking about it. Even these people had enjoyed a good family life.
In this situation, first the prepuce is to be slit open to see the urethra, and glans is to be inspected for cancerous growths; as phimosis is associated with penile cancer in glans and prepuce. Many times there have been very much narrowing of urethral opening to obstruct the passage of urine. The urethra is to be dilated to allow the entry of a silastic pipe called catheter, and first of all the retention is to be relieved as it is a very painful condition, better known to a person who might had been compelled to postpone passing urine after the urge for it due to some reason. After that, a formal circumcision has to be performed. The stricture of urethral meatus may need a minor surgery to keep it open. All these can be performed under local anesthesia.
Though phimosis is apparently an innocent disease may a cause of grave concern.
Urine Culture Showing E.Coli a common bacteria causing urinary infection.
The burning sensation and severe urge for urination is very much distressing for of a patients of urinary tract infection.Urinary tract stretches right from the kidneys to the urethra.Any part of it may get infected.It is mostly bacterial in origin.But may be due to TB,Sexually transmitted agents and other systemic diseases.Infection may come from local surroundings or from systemic infection. The proximity of urethra to the anus makes it vulnerable to contact infection from the bacterias present in faeces.It affects females more as the urethra is short i.e. only four centimeters in comparison to males where the length of urethra is nearly twenty centimeters. Once infection sets in there is fever,burning urination ,scanty frequent urination and painful urge for urination.Infection may complicate an already existing urinary stone disease.Or may set in an anomalous urinary passage.It may also set in a disease condition causing stagnation or obstruction to urine flow i.e. enlarged prostate or stricture of urethra.
Diagnosis is not that difficult if proper history is taken.Mainstay of investigations rest on a routine and microscopic urine examination,a culture and sensitivity test to know the type of infection and appropriate antibacterial agents required .Investigation like ultrasonography is done to rule out any other associated or facilitating diseases.Other blood tests to know diabetic and kidney status are also performed. In ladies a little prolonged antibacterial treatment is needed as compared to the males where eradication of microbe is a little bit difficult. Diseases complicating urinary infection or as a result of it need to be treated in it own merit.
Dysuria,the painful micturition is very distressing and if added to it frequent urination with fever makes the patient’s condition miserable.And these are hallmark of urinary tractinfection.Urinary tract includes right from kidneys to to urethra.It is commonly due to bacterial infection and females predisposed to it due to proximity of urethra to the anus.E.Coli, the organism present in feces is isolated frequently now-a-days.Gonorrheal and syphilitic infections are also seen but less than before because of rampant use of good antibiotics.Some thing called honeymoon cystitis occurs after first honeymoon in females infecting the urinary bladder. Another source of contacting infection is door handle of common toilets at community places.
Commonly urine is subjected to microscopic examination which may reveal number of pus cells and sometimes red blood cells.Culture and sensitivity of urine will give information about suitable antibiotic required.
A little long term use of antibiotics in female is recommended .Though it is cured without any sequel but in gonorrheal infection complications like narrowing of urethra called stricture of urethra and other systemic complication do occur.Syphilis is more notorious for causing more dreaded complications even involve the central nervous system.
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