Clinical Presentation
Dysuria, urgency, frequency, flank pain, costovertebral angle tenderness, suprapubic pain and fever are usually suggestive of UTI extending beyond the bladder. Patients with complicated UTI may also present with signs and symptoms of pyelonephritis and/or sepsis, including hypotension, tender subcostal or costovertebral angle tenderness, intractable nausea and vomiting, fever or hypothermia, leukocytosis or leukopenia, tachycardia and tachypnea. The presence of pelvic or perineal pain in males may suggest accompanying prostatitis. Symptoms may vary from severe obstructive acute pyelonephritis with imminent urosepsis to a post-operative catheter-associated UTI (CA-UTI) which spontaneously resolves after catheter removal. Complicated UTI may present atypical symptoms in patients with neurogenic lower urinary tract dysfunction, CA-UTI, nephrostomy, or those who underwent radical cystectomy with urinary diversion. It must be noted that concomitant medical conditions (eg renal disease, diabetes mellitus [DM], immunosuppression) are often present.
History
In history taking, specific questioning is necessary to determine the presence or absence of prior urinary infections and therapy, genitourinary surgeries, nephrolithiasis, gross hematuria, sickle cell disease and other associated diseases.
Physical Examination
In the physical examination, the costovertebral angle, abdominal, and suprapubic tenderness are assessed. In sexually active women, a pelvic examination may be warranted to evaluate for cervical motion or uterine tenderness to assess for pelvic inflammatory disease. Pelvic or perineal pain in men may warrant a digital rectal examination to evaluate for prostate pathology.
Urinary Tract Infection - Complicated_Initial Assesment