Question

A 30-year-old lady comes to you with urinary symptoms.
How will diagnostically approach a patient with urinary tract infection?

Hint:

Urine culture remains the gold standard for confirming UTI and identifying the causative organism. Always consider imaging in complicated cases or recurrent infections.

Answer 1

Step 1: Clinical History.
The first step in diagnosing UTI is obtaining a detailed history. Symptoms of UTI typically include dysuria, frequency, urgency, hematuria, and lower abdominal pain. It is important to distinguish between uncomplicated and complicated UTIs, as well as to identify any risk factors (e.g., pregnancy, diabetes, catheter use, previous UTIs).

Step 2: Physical Examination.
Physical examination should focus on the abdomen and the costovertebral angle. Tenderness over the bladder or the lower abdomen may suggest a lower UTI (cystitis), whereas costovertebral angle tenderness may indicate a kidney infection (pyelonephritis).

Step 3: Urine Analysis (Urinalysis).
Urinalysis is the primary diagnostic test for UTIs. It helps detect:
- Leukocyte esterase (indicating white blood cells in the urine)
- Nitrites (suggesting bacterial infection)
- Hematuria (blood in the urine, common in UTIs)

Step 4: Urine Culture.
Urine culture is essential to confirm the diagnosis and identify the causative organism, especially in complicated or recurrent cases. It helps guide antibiotic therapy.

Step 5: Imaging (if required).
Imaging studies, such as an ultrasound or CT scan, are indicated in cases of complicated UTI, recurrent infections, or if there is suspicion of anatomical abnormalities or kidney damage.

Step 6: Conclusion.
A comprehensive diagnostic approach involving history, physical examination, urinalysis, and urine culture is necessary to diagnose and guide the management of UTIs. Imaging may be needed in certain cases.