From the Guidelines
Yes, urinary tract infections (UTIs) can cause obstruction in the urinary tract, as obstruction at any site is listed as a factor associated with complicated UTIs. According to the European Association of Urology guidelines on urological infections, summarized in the 2024 guidelines 1, obstruction can occur due to various factors, including foreign bodies, incomplete voiding, vesicoureteral reflux, and recent history of instrumentation.
The guidelines highlight that the microbial spectrum in complicated UTIs is greater, and antimicrobial resistance is more likely 1. Common species found in cultures include E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp.
Key factors that contribute to the development of obstruction in UTIs include:
- Incomplete voiding
- Vesicoureteral reflux
- Recent history of instrumentation
- Presence of foreign bodies in the urinary tract
Appropriate management of the underlying urological abnormality or complicating factor is mandatory, and optimal antimicrobial therapy depends on the severity of the illness, local resistance patterns, and specific host factors 1. Treatment typically involves antibiotics for 7 to 14 days, depending on the severity and the patient's response to treatment 1.
In cases where obstruction occurs, treatment may require urological intervention, such as catheterization or stenting, in addition to antibiotic therapy. Prompt treatment of UTIs is crucial to prevent progression to obstruction, especially in patients with risk factors like kidney stones, enlarged prostate, or congenital urinary tract abnormalities.
From the Research
UTI and Obstruction
- UTI can be associated with conditions causing urinary tract obstruction and stasis 2
- Urinary tract obstruction and stasis can predispose to UTI, as seen in conditions such as benign prostatic hyperplasia (BPH), hydronephrosis, obstruction, reflux, diverticulum, urethra, and stricture 2
- Experimental studies have shown that urethral obstruction can lead to cystitis, pyelonephritis, and bacteremia 2
Causes of Obstruction
- BPH is a common cause of urinary tract obstruction predisposing to UTI 2
- Urethral stricture remains a common cause of UTI in many parts of the world 2
- Urinary stasis in diverticula of the urethra or bladder can also predispose to UTI 2
Treatment and Management
- In patients with UTI and urinary tract obstruction, targeted antibiotic treatment according to urine culture should be complemented with urgent drainage (bladder catheterization, percutaneous nephrostomy or ureteric stenting) followed by definitive surgery to remove the cause of obstruction or stasis once infection is under control 2
- Early diagnosis and appropriate therapy with antibiotics are crucial in preventing complicated UTI conditions such as urosepsis 3