From the Guidelines
A thorough physical examination is essential for patients with urinary tract infections (UTIs), as it helps identify the severity and location of the infection, guiding treatment decisions and improving patient outcomes. The physical exam for a UTI typically includes assessment of vital signs, abdominal examination, and possibly a genital examination depending on the patient's symptoms 1. The clinician will check for fever, which may indicate upper UTI or pyelonephritis. Abdominal palpation focuses on the suprapubic region and flanks to assess for tenderness, with costovertebral angle tenderness suggesting kidney involvement. For women, a pelvic exam may be performed to rule out other conditions like vaginitis, while men might require a prostate examination.
The physical exam findings should be interpreted alongside the patient's symptoms (dysuria, frequency, urgency, hematuria) and urinalysis results showing pyuria, bacteriuria, and possibly nitrites or leukocyte esterase. While the physical exam is important, diagnosis primarily relies on urinalysis and urine culture. Treatment typically involves antibiotics, with the choice and duration of treatment depending on the severity and location of the infection, as well as the presence of any complicating factors.
Some key points to consider during the physical exam include:
- Checking for fever and other signs of systemic infection
- Assessing for abdominal tenderness, particularly in the suprapubic region and flanks
- Performing a genital examination, as indicated by the patient's symptoms and medical history
- Interpreting physical exam findings in the context of urinalysis and urine culture results
- Using the physical exam to distinguish between lower and upper UTIs, which require different treatment approaches and durations 1.
It is also important to note that the European Association of Urology guidelines on urological infections emphasize the importance of antimicrobial stewardship and provide recommendations for antibiotic selection, dosing, and duration based on the latest evidence 1.
From the Research
Physical Exam for UTI
The physical exam for a urinary tract infection (UTI) typically involves assessing the patient's symptoms and medical history. Some common symptoms of UTI include:
- Dysuria (painful urination) 2
- Frequency (frequent urination) 2
- Hematuria (blood in the urine) 2
- Nocturia (urination at night) 2
- Urgency (sudden need to urinate) 2
- Vaginal discharge (in women) 2
Diagnostic Accuracy of Symptoms and Signs
The diagnostic accuracy of symptoms and signs in women presenting with suspected UTI has been studied extensively. A systematic review found that the presence of certain symptoms, such as dysuria, frequency, hematuria, nocturia, and urgency, can increase the probability of UTI 2. The presence of vaginal discharge, on the other hand, can decrease the probability of UTI 2.
Laboratory Tests
Laboratory tests, such as urine culture and dipstick tests, can also be used to diagnose UTI. A urine culture can help identify the type of bacteria causing the infection, while dipstick tests can detect the presence of nitrites, leukocyte esterase, or blood in the urine 2.
Treatment Options
Treatment options for UTI typically involve antibiotics, such as:
- Nitrofurantoin 3, 4, 5, 6
- Trimethoprim-sulfamethoxazole 3, 4, 5, 6
- Fosfomycin 3, 5, 6
- Fluoroquinolones 3, 5, 6
- Cephalosporins 3, 6
- Amoxicillin-clavulanate 3, 6
The choice of antibiotic depends on the type of bacteria causing the infection, as well as the patient's medical history and allergies. It is essential to use antibiotics wisely to avoid the development of antibiotic resistance 3.