Urinary tract infection

{{Short description|Infection that affects part of the urinary tract}} {{cs1 config|name-list-style=vanc|display-authors=6}} {{Redirect|UTI|other uses}} {{Good article}}{{Use dmy dates|date=March 2025}} {{Infobox medical condition (new) | name = Urinary tract infection | image = Pyuria.JPG | caption = Multiple white cells seen in the urine of a person with a urinary tract infection using microscopy | field = Infectious disease Urology | synonyms = Acute cystitis, simple cystitis, bladder infection, symptomatic bacteriuria | symptoms = Pain with urination, frequent urination, cloudy urine, feeling the urge to urinate despite having an empty bladder<ref name=CDC2015/> | complications = | onset = | duration = | causes = Most often ''E. coli'' bacteria<ref name="Flo2015">{{cite journal | vauthors = Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ | title = Urinary tract infections: epidemiology, mechanisms of infection and treatment options | journal = Nature Reviews. Microbiology | volume = 13 | issue = 5 | pages = 269–284 | date = May 2015 | pmid = 25853778 | pmc = 4457377 | doi = 10.1038/nrmicro3432 }}</ref> | risks = Catheterisation (foley catheter), female anatomy, sexual intercourse, diabetes, obesity, family history<ref name=Flo2015/> | diagnosis = Based on symptoms, urine culture<ref name=Pylo2011/><ref name=Review08/> | differential = Vulvovaginitis, urethritis, pelvic inflammatory disease, interstitial cystitis,<ref>{{cite book| vauthors = Caterino JM, Kahan S |title=In a Page: Emergency medicine|date=2003|publisher=Lippincott Williams & Wilkins|isbn=978-1-4051-0357-2|page=95|url=https://books.google.com/books?id=O0LwFPZDKbsC&pg=PA95|url-status=live|archive-url=https://web.archive.org/web/20170424173759/https://books.google.com/books?id=O0LwFPZDKbsC&pg=PA95|archive-date=24 April 2017}}</ref> kidney stone disease<ref name=statspe/> | prevention = | treatment = Antibiotics<ref name="kranz-2024" /> | medication = | prognosis = | frequency = 405 million (2019)<ref name=He2025>{{Cite journal |last1=He |first1=Yining |last2=Zhao |first2=Jing |last3=Wang |first3=Lanhui |last4=Han |first4=Chao |last5=Yan |first5=Ruxue |last6=Zhu |first6=Peiqi |last7=Qian |first7=Tianyang |last8=Yu |first8=Siyao |last9=Zhu |first9=Xiaolin |last10=He |first10=Weiming |date=2025-02-08 |title=Epidemiological trends and predictions of urinary tract infections in the global burden of disease study 2021 |journal=Scientific Reports |language=en |volume=15 |issue=1 |article-number=4702 |doi=10.1038/s41598-025-89240-5 |issn=2045-2322 |pmc=11807111 |pmid=39922870 |bibcode=2025NatSR..15.4702H }}</ref> | deaths = 260,000 (2021)<ref name=He2025 /> }}

A '''urinary tract infection''' ('''UTI''') is an infection that affects a part of the urinary tract, which includes the bladder, urethra and the kidney.<ref name="cdc">{{Cite web |last=CDC |date=2024-04-24 |title=Urinary Tract Infection Basics |url=https://www.cdc.gov/uti/about/index.html |access-date=2026-01-10 |website=Urinary Tract Infection |language=en-us}}</ref> Lower UTIs affect the bladder ('''cystitis''') or urethra while upper UTIs affect the kidney (pyelonephritis).<ref name="EM2011">{{cite journal | vauthors = Lane DR, Takhar SS | title = Diagnosis and management of urinary tract infection and pyelonephritis | journal = Emergency Medicine Clinics of North America | volume = 29 | issue = 3 | pages = 539–552 | date = August 2011 | pmid = 21782073 | doi = 10.1016/j.emc.2011.04.001 }}</ref> Symptoms from a lower UTI include burning or pain during urination, pain in the lower abdomen and the urge to urinate even when the bladder is empty.<ref name=cdc/> Symptoms of a kidney infection are more systemic and include fever or flank pain, usually in addition to the symptoms of a lower UTI.<ref name="EM2011" /> Rarely, the urine may appear bloody.<ref name="Sal2011" /> Symptoms may be less clear in very young or old people.<ref name="CDC2015">{{cite web |date=17 April 2015 |title=Urinary Tract Infection |url=https://www.cdc.gov/getsmart/community/for-patients/common-illnesses/uti.html |archive-url=https://web.archive.org/web/20160222034940/http://www.cdc.gov/getsmart/community/for-patients/common-illnesses/uti.html |archive-date=22 February 2016 |access-date=9 February 2016 |website=Centers for Disease Control and Prevention (CDC)}}</ref><ref name="Elder2011">{{cite journal |vauthors=Woodford HJ, George J |title=Diagnosis and management of urinary infections in older people |journal=Clinical Medicine |volume=11 |issue=1 |pages=80–83 |date=February 2011 |pmid=21404794 |pmc=5873814 |doi=10.7861/clinmedicine.11-1-80}}</ref>

The most common cause of infection is ''E. coli'', though other bacteria or fungi may sometimes be the cause.<ref name="Flo2015" /> Risk factors include being female, sexual intercourse, diabetes, using a catheter, and family history.<ref name=cdc/><ref>{{Cite web |date=2025 |title=Urinary tract infections (UTIs) |url=https://www.nhs.uk/conditions/urinary-tract-infections-utis/ |access-date=2026-01-14 |website=NHS |language=en}}</ref><ref name="kranz-2024" /> Kidney infections usually occurs when a bladder infection spreads, but may also come from bacteria in the blood.<ref>{{cite book|title=Introduction to Medical-Surgical Nursing|date=2015|publisher=Elsevier Health Sciences|isbn=978-1-4557-7641-2|page=909|url=https://books.google.com/books?id=mi3uBgAAQBAJ&pg=PA909|access-date=17 September 2017|archive-date=11 January 2023|archive-url=https://web.archive.org/web/20230111182932/https://books.google.com/books?id=mi3uBgAAQBAJ&pg=PA909|url-status=live}}</ref> Diagnosis in young healthy women can be based on symptoms alone.<ref name="Review08">{{cite journal | vauthors = Nicolle LE | title = Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis | journal = The Urologic Clinics of North America | volume = 35 | issue = 1 | pages = 1–12, v | date = February 2008 | pmid = 18061019 | doi = 10.1016/j.ucl.2007.09.004 }}</ref> In those with vague symptoms, diagnosis can be harder because bacteria may be present even if there is no infection.<ref>{{cite book| vauthors = Jarvis WR |title=Bennett & Brachman's hospital infections.|date=2007|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-6383-7|page=474|edition=5th|url=https://books.google.com/books?id=tuy4zw5G4v4C&pg=PA474|url-status=live|archive-url=https://web.archive.org/web/20160216175245/https://books.google.com/books?id=tuy4zw5G4v4C&pg=PA474|archive-date=16 February 2016}}</ref><ref name="Pylo2011" />

In uncomplicated cases, UTIs are usually treated with a short course of antibiotics. <ref name="kranz-2024" /> Resistance to many of the antibiotics used to treat this condition is increasing.<ref name="CDC2015" /> In complicated cases, a longer course or intravenous antibiotics may be needed.<ref name="Sal2011" /> If symptoms do not improve in two or three days, further diagnostic testing may be needed.<ref name="Pylo2011">{{cite journal | vauthors = Colgan R, Williams M, Johnson JR | title = Diagnosis and treatment of acute pyelonephritis in women | journal = American Family Physician | volume = 84 | issue = 5 | pages = 519–526 | date = September 2011 | pmid = 21888302 }}</ref> People with bacteria or white blood cells in their urine but no symptoms usually do not need antibiotics.<ref>{{cite journal | vauthors = Ferroni M, Taylor AK | title = Asymptomatic Bacteriuria in Noncatheterized Adults | journal = The Urologic Clinics of North America | volume = 42 | issue = 4 | pages = 537–545 | date = November 2015 | pmid = 26475950 | doi = 10.1016/j.ucl.2015.07.003 }}</ref> For people with recurrent infections, methenamine may be prescribed. Postmenopausal women may also be offered vaginal estrogen replacement. If these do not work, preventative antibiotics can be considered.<ref name="kranz-2024">{{Cite journal |last1=Kranz |first1=Jennifer |last2=Bartoletti |first2=Riccardo |last3=Bruyère |first3=Franck |last4=Cai |first4=Tommaso |last5=Geerlings |first5=Suzanne |last6=Köves |first6=Bela |last7=Schubert |first7=Sören |last8=Pilatz |first8=Adrian |last9=Veeratterapillay |first9=Rajan |last10=Wagenlehner |first10=Florian M E |last11=Bausch |first11=Kathrin |last12=Devlies |first12=Wout |last13=Horváth |first13=József |last14=Leitner |first14=Lorenz |last15=Mantica |first15=Guglielmo |date=2024 |title=European Association of Urology Guidelines on Urological Infections: Summary of the 2024 Guidelines |url=https://linkinghub.elsevier.com/retrieve/pii/S0302283824022632 |journal=European Urology |language=en |volume=86 |issue=1 |pages=27–41 |doi=10.1016/j.eururo.2024.03.035 |pmid=38714379 }}</ref>

Approximately 400 million UTI cases occur each year.<ref name=He2025 /> They are more common in women than men,<ref name="Sal2011" /> and are the most common bacterial infection in women.<ref name="AFP2011">{{cite journal | vauthors = Colgan R, Williams M | title = Diagnosis and treatment of acute uncomplicated cystitis | journal = American Family Physician | volume = 84 | issue = 7 | pages = 771–776 | date = October 2011 | pmid = 22010614 }}</ref> Up to 10% of women have a urinary tract infection in a given year, and half of women have at least one infection at some point in their lifetime.<ref name="Review08" /><ref name="Sal2011" /> They occur most frequently between the ages of 16 and 35{{nbsp}}years.<ref name="Sal2011" /> Recurrences are common.<ref name="Sal2011">{{cite journal | vauthors = Salvatore S, Salvatore S, Cattoni E, Siesto G, Serati M, Sorice P, Torella M | title = Urinary tract infections in women | journal = European Journal of Obstetrics, Gynecology, and Reproductive Biology | volume = 156 | issue = 2 | pages = 131–136 | date = June 2011 | pmid = 21349630 | doi = 10.1016/j.ejogrb.2011.01.028 }}</ref> Urinary tract infections have been described since ancient times with the first documented description in the Ebers Papyrus dated to c. 1550 BC.<ref name="His2008">{{cite book| vauthors = Al-Achi A |title=An introduction to botanical medicines: history, science, uses, and dangers|year=2008|publisher=Praeger Publishers|location=Westport, Conn.|isbn=978-0-313-35009-2|page=126|url=https://books.google.com/books?id=HMzxKua4_rcC&pg=PA126|url-status=live|archive-url=https://web.archive.org/web/20160528215426/https://books.google.com/books?id=HMzxKua4_rcC&pg=PA126|archive-date=28 May 2016}}</ref> [[File:En.Wikipedia-VideoWiki-Urinary tract infection.webm|thumb|thumbtime=0:01|upright=1.3|Video summary (script)]]

==Signs and symptoms== [[File:Pyuria2011.JPG|thumb|Urine may contain pus (a condition known as pyuria) as seen from a person with sepsis due to a urinary tract infection.]]

The most common symptoms of a UTI are burning with urination and having to urinate frequently (or an urge to urinate) in the absence of vaginal discharge and significant pain.<ref name=Review08/> These symptoms may vary from mild to severe<ref name=EM2011/> and in healthy women last an average of six{{nbsp}}days.<ref name=AFP2011/> Some pain above the pubic bone or in the lower back may be present. People experiencing an upper urinary tract infection, or pyelonephritis, may experience flank pain, fever, or nausea and vomiting in addition to the classic symptoms of a lower urinary tract infection.<ref name=EM2011/> Rarely, there may be blood<ref name=Sal2011/> or visible pus in the urine.<ref>{{cite book| vauthors = Arellano RS |title=Non-vascular interventional radiology of the abdomen|publisher=Springer|location=New York|isbn=978-1-4419-7731-1|page=67|url=https://books.google.com/books?id=au-OpXwnibMC&pg=PA67|url-status=live|archive-url=https://web.archive.org/web/20160610151717/https://books.google.com/books?id=au-OpXwnibMC&pg=PA67|archive-date=10 June 2016|date=19 January 2011}}</ref>

===Children=== In young children, the only symptom of a urinary tract infection (UTI) may be a fever.<ref name=PeadsNA2011/> Because of the lack of more obvious symptoms, when girls under the age of two or uncircumcised boys less than a year old exhibit a fever, a culture of the urine is recommended by many medical associations.<ref name=PeadsNA2011/> Infants may feed poorly, vomit, sleep more, or show signs of jaundice.<ref name=PeadsNA2011/> In older children, new onset urinary incontinence (loss of bladder control) may occur.<ref name=PeadsNA2011/> About 1 in 400 infants of one to three months of age with a UTI also have bacterial meningitis.<ref>{{cite journal | vauthors = Nugent J, Childers M, Singh-Miller N, Howard R, Allard R, Eberly M | title = Risk of Meningitis in Infants Aged 29 to 90 Days with Urinary Tract Infection: A Systematic Review and Meta-Analysis | journal = The Journal of Pediatrics | volume = 212 | pages = 102–110.e5 | date = September 2019 | pmid = 31230888 | doi = 10.1016/j.jpeds.2019.04.053 | s2cid = 195327630 }}</ref>

===Elderly=== Urinary tract symptoms are frequently lacking in the elderly.<ref name=Elder2011/> The presentations may be vague and include incontinence, a change in mental status, or fatigue as the only symptoms.<ref name=EM2011/> Delirium can co-occur with UTIs in elderly people.<ref>{{Cite journal |last1=Krinitski |first1=Damir |last2=Kasina |first2=Rafal |last3=Klöppel |first3=Stefan |last4=Lenouvel |first4=Eric |date=2021 |title=Associations of delirium with urinary tract infections and asymptomatic bacteriuria in adults aged 65 and older: A systematic review and meta-analysis |journal=Journal of the American Geriatrics Society |volume=69 |issue=11 |pages=3312–3323 |doi=10.1111/jgs.17418 |issn=1532-5415 |pmc=9292354 |pmid=34448496}}</ref> Some present to a health care provider with sepsis, an infection of the blood, as the first symptoms.<ref name=Sal2011/> Diagnosis can be complicated by the fact that many elderly people have preexisting incontinence or dementia.<ref name=Elder2011/> Rarely, for UTIs associated with urinary catheters, the urine turns purple (purple urine bag syndrome).<ref>{{Cite journal |last1=Basehi |first1=Mohammed F. |last2=Dallak |first2=Fatimah H. |last3=Darraj |first3=Atheer I. |last4=Almalki |first4=Sultan J. |date=2025 |title=Purple urine bag syndrome: An unusual presentation of urinary tract infection: A case series and literature review |journal=Medicine |language=en |volume=104 |issue=38 |article-number=e44638 |doi=10.1097/MD.0000000000044638 |pmid=40988186 |pmc=12459526 |issn=0025-7974}}</ref>

It is reasonable to obtain a urine culture in those with signs of systemic infection who may be unable to report urinary symptoms, such as when advanced dementia is present.<ref name=AMDA2015>{{Citation |author1 = AMDA – The Society for Post-Acute and Long-Term Care Medicine |author1-link = AMDA – The Society for Post-Acute and Long-Term Care Medicine |date = February 2014 |title = Ten Things Physicians and Patients Should Question |publisher = AMDA – The Society for Post-Acute and Long-Term Care Medicine |work = Choosing Wisely: an initiative of the ABIM Foundation |url = http://www.choosingwisely.org/doctor-patient-lists/amda/ |access-date = 20 April 2015 |url-status = live |archive-url = https://web.archive.org/web/20140913011101/http://www.choosingwisely.org/doctor-patient-lists/amda/ |archive-date = 13 September 2014 }}</ref> Systemic signs of infection include a fever or increase in temperature of more than {{convert|1.1|C-change|F-change}} from usual, chills, and an increased white blood cell count.<ref name=AMDA2015/>

==Cause== [[File:UPEC adhered to BEC.jpg|thumb|Uropathogenic ''Escherichia coli'' (UPEC) cells adhered to bladder epithelial cell]] thumb|An awareness video about Urinary Tract Infection(UTI) Pathogenic ''E. coli'' from the gut is the cause of 75% of uncomplicated UTIs, and 65% of complicated UTIs.<ref name="timm-2025">{{Cite journal |last1=Timm |first1=Morgan R. |last2=Russell |first2=Seongmi K. |last3=Hultgren |first3=Scott J. |date=2025 |title=Urinary tract infections: pathogenesis, host susceptibility and emerging therapeutics |url=https://www.nature.com/articles/s41579-024-01092-4 |journal=Nature Reviews Microbiology |language=en |volume=23 |issue=2 |pages=72–86 |doi=10.1038/s41579-024-01092-4 |pmid=39251839 |issn=1740-1526}}</ref> Rarely they may be due to viral or fungal infections.<ref>{{cite journal | vauthors = Amdekar S, Singh V, Singh DD | title = Probiotic therapy: immunomodulating approach toward urinary tract infection | journal = Current Microbiology | volume = 63 | issue = 5 | pages = 484–490 | date = November 2011 | pmid = 21901556 | doi = 10.1007/s00284-011-0006-2 | s2cid = 24123416 }}</ref> Healthcare-associated urinary tract infections (mostly related to urinary catheterization) involve a much broader range of pathogens including: ''Klebsiella pneumoniae'', ''Proteus mirabilis'', ''Pseudomonas aeruginosa'' and ''Enterococcus faecalis.'' These species can form biofilms and colonise catheters.<ref name="timm-2025" /> In sub-Saharan Africa, ''Staphylococcus aureus'', which typically occurs secondary to blood-borne infections, is more common.<ref name="timm-2025" />

''Chlamydia trachomatis'' and ''Mycoplasma genitalium'' can infect the urethra but not the bladder.<ref>{{cite web |url=http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/ |title=Urinary Tract Infections in Adults |access-date=1 January 2015 |archive-url=https://web.archive.org/web/20150109084836/http://kidney.niddk.nih.gov/KUDiseases/pubs/utiadult/ |archive-date=9 January 2015 }}</ref> These infections are usually classified as a urethritis rather than urinary tract infection.<ref>{{cite journal | vauthors = Brill JR | title = Diagnosis and treatment of urethritis in men | journal = American Family Physician | volume = 81 | issue = 7 | pages = 873–878 | date = April 2010 | pmid = 20353145 }}</ref>

==={{anchor|Honeymoon cystitis}}Intercourse=== In young sexually active women, sexual activity is the cause of 75–90% of bladder infections, with the risk of infection related to the frequency of sex.<ref name=Review08/> The term "honeymoon cystitis" has been applied to this phenomenon of frequent UTIs during early marriage. In post-menopausal women, sexual activity does not affect the risk of developing a UTI.<ref name=Review08/> Spermicide use, independent of sexual frequency, increases the risk of UTIs.<ref name=Review08 /> Diaphragm use is also associated.<ref name="recurrent uti">{{cite journal | vauthors = Franco AV | title = Recurrent urinary tract infections | journal = Best Practice & Research. Clinical Obstetrics & Gynaecology | volume = 19 | issue = 6 | pages = 861–873 | date = December 2005 | pmid = 16298166 | doi = 10.1016/j.bpobgyn.2005.08.003 }}</ref> Condom use without spermicide or use of birth control pills does not increase the risk of uncomplicated urinary tract infection.<ref name=Review08/><ref>{{cite book | vauthors = Engleberg NC, DiRita V, Dermody TS |title=Schaechter's Mechanism of Microbial Disease |year=2007 |publisher=Lippincott Williams & Wilkins |location= Baltimore|isbn=978-0-7817-5342-5}}</ref>

Anal intercourse may increase the risk of UTI in men and in women if followed by vaginal sex.<ref>{{Cite journal|title=Redefining Urological History Taking – Anal Intercourse as the Cause of Unexplained Symptoms in Heterosexuals|first1=Nadine|last1=Coull|first2=Heleni|last2=Mastoroudes|first3=Rick|last3=Popert|first4=Timothy S|last4=O'Brien|date=15 July 2008|journal=The Annals of the Royal College of Surgeons of England|volume=90|issue=5|pages=403–405|doi=10.1308/003588408X301000|pmid=18634737|pmc=2645743}}</ref><ref>{{cite web|last=Dunkin|first=Mary|title=Anal Sex Safety: What to Know|url=https://www.webmd.com/sex/anal-sex-health-concerns|date=2024-04-11|website=WebMD}}</ref>

Although sex is a risk factor, UTIs are not classified as sexually transmitted infections (STIs).<ref>{{cite book |url=https://books.google.com/books?id=YvskCwAAQBAJ&pg=PA272 |title=Study Guide for Pathophysiology |date=2013 |publisher=Elsevier Health Sciences |isbn=978-0-323-29318-1 |edition=5 |page=272 |archive-url=https://web.archive.org/web/20160216173856/https://books.google.com/books?id=YvskCwAAQBAJ&pg=PA272 |archive-date=16 February 2016 |url-status=live}}</ref>

=== Sex === Women are more prone to UTIs than men because, in females, the urethra is much shorter and closer to the anus.<ref name=NA2011>{{cite journal | vauthors = Dielubanza EJ, Schaeffer AJ | title = Urinary tract infections in women | journal = The Medical Clinics of North America | volume = 95 | issue = 1 | pages = 27–41 | date = January 2011 | pmid = 21095409 | doi = 10.1016/j.mcna.2010.08.023 | doi-access = free }}</ref> As a woman's estrogen levels decrease with menopause, her risk of urinary tract infections increases due to the loss of protective vaginal flora.<ref name=NA2011/> Additionally, vaginal atrophy that can sometimes occur after menopause is associated with recurrent urinary tract infections.<ref name="vaginal atrophy">{{cite journal | vauthors = Goldstein I, Dicks B, Kim NN, Hartzell R | title = Multidisciplinary overview of vaginal atrophy and associated genitourinary symptoms in postmenopausal women | journal = Sexual Medicine | volume = 1 | issue = 2 | pages = 44–53 | date = December 2013 | pmid = 25356287 | pmc = 4184497 | doi = 10.1002/sm2.17 }}</ref>

Chronic prostatitis in the forms of chronic prostatitis/chronic pelvic pain syndrome and chronic bacterial prostatitis (not acute bacterial prostatitis or asymptomatic inflammatory prostatitis) may cause recurrent urinary tract infections in males. Risk of infections increases as males age. While bacteria is commonly present in the urine of older males this does not appear to affect the risk of urinary tract infections.<ref name=AFP2016ChronProst>{{cite journal | vauthors = Holt JD, Garrett WA, McCurry TK, Teichman JM | title = Common Questions About Chronic Prostatitis | journal = American Family Physician | volume = 93 | issue = 4 | pages = 290–296 | date = February 2016 | pmid = 26926816 }}</ref>

===Urinary catheters=== Urinary catheterization increases the risk for urinary tract infections. The risk of bacteriuria (bacteria in the urine) is between three and six percent per day, and prophylactic antibiotics are not effective in decreasing symptomatic infections.<ref name=NA2011/> The risk of an associated infection can be decreased by catheterizing only when necessary, using aseptic technique for insertion, and maintaining unobstructed closed drainage of the catheter.<ref name="Nic2001"/><ref>{{cite journal | vauthors = Phipps S, Lim YN, McClinton S, Barry C, Rane A, N'Dow J | title = Short term urinary catheter policies following urogenital surgery in adults | journal = The Cochrane Database of Systematic Reviews | issue = 2 | article-number = CD004374 | date = April 2006 | pmid = 16625600 | doi = 10.1002/14651858.CD004374.pub2 | veditors = Phipps S }}</ref><ref name="Gould2009"/>

Male scuba divers using condom catheters and female divers using external catching devices for their dry suits are also susceptible to urinary tract infections.<ref name="pmid22752741">{{cite journal | vauthors = Harris R | title = Genitourinary infection and barotrauma as complications of 'P-valve' use in drysuit divers | journal = Diving and Hyperbaric Medicine | volume = 39 | issue = 4 | pages = 210–212 | date = December 2009 | pmid = 22752741 | url = http://archive.rubicon-foundation.org/9482 | access-date = 4 April 2013 | url-status = usurped | archive-url = https://web.archive.org/web/20130526025635/http://archive.rubicon-foundation.org/xmlui/handle/123456789/9482 | archive-date = 26 May 2013 }}</ref>

===Others=== A predisposition for bladder infections may run in families.<ref name=Review08/> This is believed to be related to genetics.<ref>{{Cite journal |last1=Yu |first1=Jiakun |last2=Pereira |first2=Glaucia Miranda Varella |last3=Allen-Brady |first3=Kristina |last4=Cuffolo |first4=Romana |last5=Siddharth |first5=Aditi |last6=Koch |first6=Marianne |last7=Chua |first7=John W. F. |last8=Sorrentino |first8=Felice |last9=Dytko |first9=Oskar |last10=Ng |first10=Kaa-Yung |last11=Violette |first11=Philippe |last12=Khullar |first12=Vik |last13=Wang |first13=Zhan Tao |last14=Cartwright |first14=Rufus |date=2024-06-01 |title=Genetic polymorphisms associated with urinary tract infection in children and adults: a systematic review and meta-analysis |url=https://www.ajog.org/article/S0002-9378(23)02169-5/fulltext |journal=American Journal of Obstetrics & Gynecology |language=English |volume=230 |issue=6 |pages=600–609.e3 |doi=10.1016/j.ajog.2023.12.018 |issn=0002-9378 |pmid=38128862}}</ref> Other risk factors include diabetes,<ref name=Review08/> being uncircumcised,<ref name="pmid23152269">{{cite journal | vauthors = Jagannath VA, Fedorowicz Z, Sud V, Verma AK, Hajebrahimi S | title = Routine neonatal circumcision for the prevention of urinary tract infections in infancy | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | article-number = CD009129 | date = November 2012 | issue = 11 | pmid = 23152269 | doi = 10.1002/14651858.CD009129.pub2 | pmc = 12186870 | quote = The incidence of urinary tract infection (UTI) is greater in uncircumcised babies }}</ref><ref>{{cite journal | vauthors = Morris BJ, Wiswell TE | title = Circumcision and lifetime risk of urinary tract infection: a systematic review and meta-analysis | journal = The Journal of Urology | volume = 189 | issue = 6 | pages = 2118–2124 | date = June 2013 | pmid = 23201382 | doi = 10.1016/j.juro.2012.11.114 }}</ref> and having a large prostate.<ref name=EM2011/> In children UTIs are associated with vesicoureteral reflux (an abnormal movement of urine from the bladder into ureters or kidneys) and constipation.<ref name=PeadsNA2011/>

Persons with spinal cord injury are at increased risk for urinary tract infection in part because of chronic use of a catheter, and in part because of voiding dysfunction.<ref name=Spine2010>{{cite journal | vauthors = Eves FJ, Rivera N | title = Prevention of urinary tract infections in persons with spinal cord injury in home health care | journal = Home Healthcare Nurse | volume = 28 | issue = 4 | pages = 230–241 | date = April 2010 | pmid = 20520263 | doi = 10.1097/NHH.0b013e3181dc1bcb | s2cid = 35850310 | doi-access = free }}</ref> It is the most common cause of infection in this population, as well as the most common cause of hospitalization.<ref name=Spine2010/>

==Pathogenesis== thumb|Bladder infection The bacteria that cause urinary tract infections typically enter the bladder via the urethra. However, infection may also occur via the blood or lymph.<ref name=Sal2011/> It is believed that the bacteria are usually transmitted to the urethra from the bowel, with females at greater risk due to their anatomy.<ref name=Sal2011/> After gaining entry to the bladder, ''E. coli'' are able to attach to the bladder wall and form a biofilm that resists the body's immune response.<ref name=Sal2011/>

About half of the recurrent infections have the same strain as the first infection. This implies that there is a reservoir of the pathogen somewhere in the body. Potential locations of these reservoirs are the gut or vaginal microbiome, or even the bladder itself. Bacteria that cause UTIs have been found in all three locations.<ref name="timm-2025" />

==Diagnosis== [[File:Bacteriuria pyuria 4.jpg|thumb|Multiple bacilli (rod-shaped bacteria, here shown as black and bean-shaped) shown between white blood cells in urinary microscopy. These changes are indicative of a urinary tract infection.]] In straightforward cases, a diagnosis may be made and treatment given based on symptoms alone without further laboratory confirmation.<ref name=Review08/>

=== Urine analysis === In complicated or questionable cases, it may be useful to confirm the diagnosis via urinalysis. For instance, a nitrate test can diagnose some UTIs, as a subset of bacteria produce this. Not all bacteria do, however, so a negative test does not exclude a UTI. Other dipstick values useful for diagnosing UTIs are high pH (some bacteria split urea), the presence of blood, and or leukocyte esterase.<ref name="statspe">{{cite journal |vauthors=Bono MJ, Leslie SW |date=2025 |title=Uncomplicated Urinary Tract Infection |url=https://www.ncbi.nlm.nih.gov/books/NBK470195/ |journal=Statpearls |pmid=29261874}} </ref> Another test, urine microscopy, looks for the presence of red blood cells, white blood cells, or bacteria.<ref name=Review08/>

Urine culture is deemed positive if it shows a bacterial colony count of greater than or equal to 103 colony-forming units per mL of a typical urinary tract organism. Antibiotic sensitivity can also be tested with these cultures, making them useful in the selection of antibiotic treatment. As symptoms can be vague and without reliable tests for urinary tract infections, diagnosis can be difficult in the elderly.<ref name="Elder2011" />

===Classification=== A urinary tract infection may involve only the lower urinary tract, in which case it is known as a bladder infection. Alternatively, it may involve the upper urinary tract, in which case it is known as pyelonephritis. If the urine contains significant bacteria but there are no symptoms, the condition is known as asymptomatic bacteriuria.<ref name=EM2011/> If a urinary tract infection involves the upper tract, and the person has diabetes mellitus, is pregnant, is male, or immunocompromised, it is considered complicated.<ref name=Sal2011/><ref name=AFP2011/> Otherwise if a woman is healthy and premenopausal it is considered uncomplicated.<ref name=AFP2011/> In children when a urinary tract infection is associated with a fever, it is deemed to be an upper urinary tract infection.<ref name=PeadsNA2011>{{cite journal | vauthors = Bhat RG, Katy TA, Place FC | title = Pediatric urinary tract infections | journal = Emergency Medicine Clinics of North America | volume = 29 | issue = 3 | pages = 637–653 | date = August 2011 | pmid = 21782079 | doi = 10.1016/j.emc.2011.04.004 }}</ref>

===Children=== To make the diagnosis of a urinary tract infection in children, a positive urinary culture is required. Contamination poses a frequent challenge depending on the method of collection used, thus a cutoff of 105{{nbsp}}CFU/mL is used for a "clean-catch" mid stream sample, 104{{nbsp}}CFU/mL is used for catheter-obtained specimens, and 102{{nbsp}}CFU/mL is used for suprapubic aspirations (a sample drawn directly from the bladder with a needle). The use of "urine bags" to collect samples is discouraged by the World Health Organization due to the high rate of contamination when cultured, and catheterization is preferred in those not toilet trained.<ref name="PeadsNA2011" />

Some, such as the American Academy of Pediatrics recommends renal ultrasound and voiding cystourethrogram (watching a person's urethra and urinary bladder with real time x-rays while they urinate) in all children less than two years old who have had a urinary tract infection. However, because there is a lack of effective treatment if problems are found, others such as the National Institute for Health and Care Excellence only recommends routine imaging in those less than six months old or who have unusual findings.<ref name="PeadsNA2011" />

===Differential diagnosis=== In women with cervicitis (inflammation of the cervix) or vaginitis (inflammation of the vagina) and in young men with UTI symptoms, a ''Chlamydia trachomatis'' or ''Neisseria gonorrhoeae'' infection may be the cause.<ref name=EM2011/><ref>{{cite journal | vauthors = Raynor MC, Carson CC | title = Urinary infections in men | journal = The Medical Clinics of North America | volume = 95 | issue = 1 | pages = 43–54 | date = January 2011 | pmid = 21095410 | doi = 10.1016/j.mcna.2010.08.015 }}</ref> These infections are typically classified as a urethritis rather than a urinary tract infection. Vaginitis may also be due to a yeast infection.<ref name=Book2011>{{cite book| vauthors = Hui D | veditors = Leung A, Padwal R |title=Approach to internal medicine: a resource book for clinical practice|publisher=Springer|location=New York|isbn=978-1-4419-6504-2|page=244 |url=https://books.google.com/books?id=lnXNpj5ZzKMC&pg=PA244 |edition=3rd |url-status=live|archive-url=https://web.archive.org/web/20160520142217/https://books.google.com/books?id=lnXNpj5ZzKMC&pg=PA244|archive-date=20 May 2016|date=15 January 2011}}</ref> Interstitial cystitis (chronic pain in the bladder) may be considered for people who experience multiple episodes of UTI symptoms but urine cultures remain negative and not improved with antibiotics.<ref>{{cite book| veditors = Kursh ED, Ulchaker JC |title=Office urology|year=2000|publisher=Humana Press|location=Totowa, N.J.|isbn=978-0-89603-789-2|page=131|url=https://books.google.com/books?id=AdYs-QwU8KQC&pg=PA131|url-status=live|archive-url=https://web.archive.org/web/20160504192213/https://books.google.com/books?id=AdYs-QwU8KQC&pg=PA131|archive-date=4 May 2016}}</ref> Prostatitis (inflammation of the prostate) may also be considered in the differential diagnosis.<ref>{{cite book | veditors = Mick NW, Peters JR, Egan D, Nadel ES, Walls R, Silvers S |title=Blueprints emergency medicine|year=2006|publisher=Lippincott Williams & Wilkins|location=Baltimore, Md.|isbn=978-1-4051-0461-6|page=152|url=https://books.google.com/books?id=NvqaWHi1OTsC&pg=RA1-PA152|edition=2nd|url-status=live|archive-url=https://web.archive.org/web/20160527135605/https://books.google.com/books?id=NvqaWHi1OTsC&pg=RA1-PA152|archive-date=27 May 2016}}</ref>

Hemorrhagic cystitis, characterized by blood in the urine, can occur secondary to several causes, including infections, radiation therapy, underlying cancer, medications, and toxins.<ref name=Keanse2009/> Medications that commonly cause this problem include the chemotherapeutic agent cyclophosphamide with rates of 2–40%.<ref name=Keanse2009>{{cite book | veditors = Graham SD, Keane, James TE, Glenn F |title=Glenn's urologic surgery|year=2009|publisher=Lippincott Williams & Wilkins|location=Philadelphia, Pa.|isbn=978-0-7817-9141-0|page=148|url=https://books.google.com/books?id=GahMzaKgMKAC&pg=PA148|edition=7th|url-status=live|archive-url=https://web.archive.org/web/20160424192313/https://books.google.com/books?id=GahMzaKgMKAC&pg=PA148|archive-date=24 April 2016}}</ref> Eosinophilic cystitis is a rare condition where eosinophiles are present in the bladder wall.<ref name=Kramer2002/> Signs and symptoms are similar to a bladder infection.<ref name=Kramer2002>{{cite book| veditors = Belman AB, King LR, Kramer SA |title=Clinical pediatric urology |year=2002 |publisher=Dunitz |location=London |isbn=978-1-901865-63-9 |page=338 |url= https://books.google.com/books?id=IKexq6xCRmIC&pg=PA338|edition=4.|url-status=live|archive-url=https://web.archive.org/web/20160515140354/https://books.google.com/books?id=IKexq6xCRmIC&pg=PA338|archive-date=15 May 2016}}</ref> Its cause is not entirely clear; however, it may be linked to food allergies, infections, and medications among others.<ref>{{cite journal | vauthors = Popescu OE, Landas SK, Haas GP | title = The spectrum of eosinophilic cystitis in males: case series and literature review | journal = Archives of Pathology & Laboratory Medicine | volume = 133 | issue = 2 | pages = 289–294 | date = February 2009 | pmid = 19195972 | doi = 10.5858/133.2.289 }}</ref>

==Prevention== A number of behaviors are recommended to prevent UTIs from recurring. They include urinating after sex, avoiding douching, wiping from front to back after defecation, and wearing breathable underwear. It is unclear how much these help; clinical guidelines typically regard the evidence as weak.<ref>{{Cite journal |last1=Kwok |first1=Michael |last2=McGeorge |first2=Stephen |last3=Mayer-Coverdale |first3=Johanna |last4=Graves |first4=Bianca |last5=Paterson |first5=David L. |last6=Harris |first6=Patrick N.A. |last7=Esler |first7=Rachel |last8=Dowling |first8=Caroline |last9=Britton |first9=Sumudu |last10=Roberts |first10=Matthew J. |date=2022 |title=Guideline of guidelines: management of recurrent urinary tract infections in women |journal=BJU International |language=en |volume=130 |issue=S3 |pages=11–22 |doi=10.1111/bju.15756 |issn=1464-410X |pmc=9790742 |pmid=35579121}}</ref> NICE also recommends not holding up urine frequently and drinking sufficiently.<ref>{{Cite web |date=February 2025 |title=Scenario: Recurrent UTI (no haematuria, not pregnant or catheterised) |url=https://cks.nice.org.uk/topics/urinary-tract-infection-lower-women/management/recurrent-uti-no-haematuria-not-pregnant-or-catheterized/ |website=NICE: Clinical Knowledge Summaries}}</ref> There is lack of evidence surrounding the effect of tampon use.<ref name=NA2011/> In those with frequent urinary tract infections who use spermicide or a diaphragm as a method of contraception, they are advised to use alternative methods.<ref name=Sal2011/>

Using urinary catheters as little and for as short a time as possible, in addition to appropriate care of the catheter when used, prevents catheter-associated urinary tract infections.<ref name=Nic2001>{{cite journal | vauthors = Nicolle LE | title = The chronic indwelling catheter and urinary infection in long-term-care facility residents | journal = Infection Control and Hospital Epidemiology | volume = 22 | issue = 5 | pages = 316–321 | date = May 2001 | pmid = 11428445 | doi = 10.1086/501908 | s2cid = 40832193 }}</ref> They should be inserted using sterile technique in hospital; however, non-sterile technique may be appropriate in those who self-catheterize.<ref name=Gould2009>{{cite journal | vauthors = Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA | title = Guideline for prevention of catheter-associated urinary tract infections 2009 | journal = Infection Control and Hospital Epidemiology | volume = 31 | issue = 4 | pages = 319–326 | date = April 2010 | pmid = 20156062 | doi = 10.1086/651091 | s2cid = 31266013 | url = https://zenodo.org/record/1235702 | access-date = 2 July 2019 | archive-date = 16 March 2020 | archive-url = https://web.archive.org/web/20200316015723/https://zenodo.org/record/1235702 | url-status = live }}</ref> The urinary catheter set up should also be kept sealed.<ref name=Gould2009/> Evidence does not support a significant decrease in risk when silver-alloy catheters are used.<ref name=Lam2014>{{cite journal | vauthors = Lam TB, Omar MI, Fisher E, Gillies K, MacLennan S | title = Types of indwelling urethral catheters for short-term catheterisation in hospitalised adults | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 9 | article-number = CD004013 | date = September 2014 | pmid = 25248140 | doi = 10.1002/14651858.CD004013.pub4 | pmc = 11197149 }}</ref>

===Medications=== For peri-menopausal or postmenopausal women with recurrent infections, topical vaginal estrogen has been found to reduce recurrence.<ref name="BeerepootGeerlings2016">{{cite journal |vauthors=Beerepoot M, Geerlings S |date=April 2016 |title=Non-Antibiotic Prophylaxis for Urinary Tract Infections |journal=Pathogens |type=Review |volume=5 |issue=2 |page=36 |doi=10.3390/pathogens5020036 |pmc=4931387 |pmid=27092529 |doi-access=free}}</ref><ref name="nice">{{Cite web |last=NICE |date=2024 |title=Recommendations {{!}} Urinary tract infection (recurrent): antimicrobial prescribing {{!}} Guidance |url=https://www.nice.org.uk/guidance/ng112/chapter/Recommendations |access-date=2026-01-11 |website=www.nice.org.uk}}</ref> For other people, or if topical estrogen does not work sufficiently, a single dose of antibiotics after a triggering event (like intercourse) can be considered.<ref name=nice/> Methenamine is another medication used for prevention. As an anti-septic, antibiotic resistance does not develop against it.<ref name="kranz-2024" />

European guidelines, including the UK guidelines, recommend a prolonged course of daily antibiotics after other options are proven ineffective or inappropriate.<ref name="kranz-2024" /><ref name=nice/> Where possible, the choice of antibiotic should be informed by a recent culture and the results of a susceptibility test.<ref name="kranz-2024" /> The American Urological Association recommends continuous antibiotics as one of many first-line options for recurrent UTIs.<ref>{{Cite web |title=Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025) - American Urological Association |url=https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti |access-date=2026-01-11 |website=www.auanet.org |language=en}}</ref>

Antibiotics following short-term urinary catheterization decrease the subsequent risk of a bladder infection.<ref>{{cite journal | vauthors = Marschall J, Carpenter CR, Fowler S, Trautner BW | title = Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter: meta-analysis | journal = BMJ | volume = 346 | article-number = f3147 | date = June 2013 | pmid = 23757735 | pmc = 3678514 | doi = 10.1136/bmj.f3147 }}</ref> A number of UTI vaccines are in development as of 2025.<ref name="timm-2025" />

===Children=== Low-dose antibiotics slightly reduce the risk of recurrent UTIs in children. However, the benefit is small; many children stop having repeat infections without antibiotics, and antibiotic use can increase the likelihood that future UTIs will be resistant to treatment.<ref>{{Cite journal |last1=Williams |first1=Gabrielle |last2=Craig |first2=Jonathan C |date=2019-04-01 |editor-last=Cochrane Kidney and Transplant Group |title=Long-term antibiotics for preventing recurrent urinary tract infection in children |url=https://doi.wiley.com/10.1002/14651858.CD001534.pub4 |journal=Cochrane Database of Systematic Reviews |language=en |doi=10.1002/14651858.CD001534.pub4 |pmid=30932167 }}</ref> Circumcision of boys has been observed to exhibit a strong protective effect against UTIs, with some research suggesting as much as a 90% reduction in symptomatic UTI incidence among male infants, if they are circumcised.<ref>{{Cite journal |last1=Shaikh |first1=Nader |last2=Morone |first2=Natalia E. |last3=Bost |first3=James E. |last4=Farrell |first4=Max H. |date=Apr 2008 |title=Prevalence of Urinary Tract Infection in Childhood: A Meta-Analysis |url=https://journals.lww.com/00006454-200804000-00004 |journal=Pediatric Infectious Disease Journal |volume=27 |issue=4 |pages=302–308 |doi=10.1097/INF.0b013e31815e4122 |pmid=18316994 |issn=0891-3668 |url-access=subscription}}</ref><ref name="dave-2018">{{Cite journal |last1=Dave |first1=Sumit |last2=Afshar |first2=Kourosh |last3=Braga |first3=Luis H. |last4=Anderson |first4=Peter |date=Feb 2018 |title=Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version) |journal=Canadian Urological Association Journal |volume=12 |issue=2 |pages=E76–E99 |doi=10.5489/cuaj.5033 |issn=1911-6470 |pmc=5937400 |pmid=29381458}}</ref> The protective effect is even stronger in boys born with urogenital abnormalities.<ref name="dave-2018" />

===Dietary supplements=== Cranberry products can reduce the risk of UTIs in certain groups (women with reoccurring UTIs, children, and people having had clinical interventions), but not in pregnant women, the elderly or people with urination disorders.<ref>{{cite journal |vauthors=Williams G, Stothart CI, Hahn D, Stephens JH, Craig JC, Hodson EM |date=November 2023 |title=Cranberries for preventing urinary tract infections |journal=The Cochrane Database of Systematic Reviews |volume=2023 |issue=11 |doi=10.1002/14651858.CD001321.pub7 |pmc=10636779 |pmid=37947276 |article-number=CD001321}}</ref> They can also be used as an adjuvant to antibiotics and other standard treatments.<ref name="xia-2021">{{Cite journal |last1=Xia |first1=Jia-yue |last2=Yang |first2=Chao |last3=Xu |first3=Deng-feng |last4=Xia |first4=Hui |last5=Yang |first5=Li-gang |last6=Sun |first6=Gui-ju |date=2 September 2021 |title=Consumption of cranberry as adjuvant therapy for urinary tract infections in susceptible populations: A systematic review and meta-analysis with trial sequential analysis |journal=PLOS ONE |volume=16 |issue=9 |article-number=e0256992 |doi=10.1371/journal.pone.0256992 |doi-access=free |issn=1932-6203 |pmc=8412316 |pmid=34473789|bibcode=2021PLoSO..1656992X }}</ref> Some evidence suggests that cranberry juice is more effective at UTI control than dehydrated tablets or capsules.<ref name="xia-2021" /> Cranberry supplements are high in sugar content, which may worsen the risks associated with UTIs in patients with diabetes mellitus.<ref>{{Cite journal |last1=Jepson |first1=Ruth G |last2=Williams |first2=Gabrielle |last3=Craig |first3=Jonathan C |date=17 October 2012 |title=Cranberries for preventing urinary tract infections |journal=The Cochrane Database of Systematic Reviews |volume=2012 |issue=10 |article-number=CD001321 |doi=10.1002/14651858.CD001321.pub5 |issn=1469-493X |pmc=7027998 |pmid=23076891}}</ref>

D-mannose is often marketed as a dietary supplement that prevents UTIs; however, there is little evidence supporting its use. A randomised controlled trial compared daily d-mannose with a placebo (fructose) among women with recurrent urinary tract infections over 6 months. D-mannose offered no benefit over placebo in reducing UTIs.<ref>{{Cite journal |last1=Hayward |first1=Gail |last2=Mort |first2=Sam |last3=Hay |first3=Alastair D. |last4=Moore |first4=Michael |last5=Thomas |first5=Nicholas P. B. |last6=Cook |first6=Johanna |last7=Robinson |first7=Jared |last8=Williams |first8=Nicola |last9=Maeder |first9=Nicola |last10=Edeson |first10=Rebecca |last11=Franssen |first11=Marloes |last12=Grabey |first12=Jenna |last13=Glogowska |first13=Margaret |last14=Yang |first14=Yaling |last15=Allen |first15=Julie |date=1 June 2024 |title=d-Mannose for Prevention of Recurrent Urinary Tract Infection Among Women: A Randomized Clinical Trial |journal=JAMA Internal Medicine |volume=184 |issue=6 |pages=619–628 |doi=10.1001/jamainternmed.2024.0264 |pmid=38587819 |issn=2168-6106|doi-access=free |pmc=11002776 }}</ref><ref>{{Cite journal |date=6 February 2025 |title=D-mannose does not prevent urinary tract infections |url=https://evidence.nihr.ac.uk/alert/d-mannose-does-not-prevent-urinary-tract-infections-utis/ |journal=NIHR Evidence}}</ref>

Certain probiotics might help reduce UTI recurrence, but evidence is weaker than for cranberries.<ref>{{Cite journal |last1=González Rodríguez |first1=Juan David |last2=Fraga Rodríguez |first2=Gloria María |last3=García Vera |first3=César Joaquín |last4=Gómez Fraile |first4=Andrés |last5=Martín Sánchez |first5=Juan Ignacio |last6=Mengual Gil |first6=José María |last7=Ochoa Sangrador |first7=Carlos |last8=Valenciano Fuentes |first8=Blanca |last9=Escribano Subías |first9=Joaquín |date=2024 |title=Update of the Spanish clinical practice guideline for urinary tract infection in infants and children. Summary of recommendations for diagnosis, treatment and follow-up |url=https://linkinghub.elsevier.com/retrieve/pii/S234128792400200X |journal=Anales de Pediatría (English Edition) |language=en |volume=101 |issue=2 |pages=132–144 |doi=10.1016/j.anpede.2024.07.010 |pmid=39098586 }}</ref>

==Treatment== The mainstay of treatment is antibiotics. Fosfomycin can be used as an effective treatment for both UTIs and complicated UTIs, including acute pyelonephritis.<ref name="Zhanel Zhanel Karlowsky 2020 pp. 1–11">{{cite journal |vauthors=Zhanel GG, Zhanel MA, Karlowsky JA |date=28 March 2020 |title=Oral and Intravenous Fosfomycin for the Treatment of Complicated Urinary Tract Infections |journal=The Canadian Journal of Infectious Diseases & Medical Microbiology |publisher=Hindawi Limited |volume=2020 |doi=10.1155/2020/8513405 |pmc=7142339 |pmid=32300381 |doi-access=free |article-number=8513405}}</ref> The standard regimen for complicated UTIs is an oral 3 g dose administered once every 48 or 72 hours for a total of 3 doses or a 6 grams every 8 hours for 7 days to 14 days when fosfomycin is given in IV form.<ref name="Zhanel Zhanel Karlowsky 2020 pp. 1–11" /> Gepotidacin was approved for medical use in the United States in March 2025.<ref name="GSK PR 20250325">{{cite press release |title=Blujepa (gepotidacin) approved by US FDA for treatment of uncomplicated urinary tract infections (uUTIs) in female adults and pediatric patients 12 years of age and older |date=25 March 2025 |url=https://us.gsk.com/en-us/media/press-releases/blujepa-gepotidacin-approved-by-us-fda-for-treatment-of-uncomplicated-urinary-tract-infections-uutis-in-female-adults-and-pediatric-patients-12-years-of-age-and-older/ |access-date=28 March 2025 |website=GSK}}</ref> It is the first new antibiotic approved in the US for UTIs in nearly 30 years.<ref>{{Cite web |date=25 March 2025 |title=FDA approves first new antibiotic for UTIs in nearly 30 years |url=https://www.nbcnews.com/health/health-news/fda-approves-first-new-antibiotic-utis-nearly-30-years-rcna197953 |access-date=26 March 2025 |website=NBC News}}</ref><ref>{{Cite web |last=Goodman |first=Brenda |date=25 March 2025 |title=Millions of women get painful UTIs that keep coming back. A new kind of antibiotic may help break the cycle |url=https://www.cnn.com/2025/03/25/health/uti-antibiotic-fda-gepotidacin-blujepa/index.html |access-date=26 March 2025 |website=CNN}}</ref>

Phenazopyridine is occasionally prescribed during the first few days in addition to antibiotics to help with the burning and urgency sometimes felt during a bladder infection.<ref>{{cite journal | vauthors = Gaines KK | title = Phenazopyridine hydrochloride: the use and abuse of an old standby for UTI | journal = Urologic Nursing | volume = 24 | issue = 3 | pages = 207–209 | date = June 2004 | pmid = 15311491 }}</ref> However, it is not routinely recommended due to safety concerns with its use, specifically an elevated risk of methemoglobinemia (higher than normal level of methemoglobin in the blood).<ref>{{cite book| veditors = Aronson JK |title=Meyler's side effects of analgesics and anti-inflammatory drugs|year=2008|publisher=Elsevier Science|location=Amsterdam|isbn=978-0-444-53273-2|page=219|url=https://books.google.com/books?id=2WxotnWiiWkC&pg=PA219|url-status=live|archive-url=https://web.archive.org/web/20160507143221/https://books.google.com/books?id=2WxotnWiiWkC&pg=PA219|archive-date=7 May 2016}}</ref> Paracetamol may be used for fevers.<ref>{{cite book| vauthors = Cash JC, Glass CA |title=Family practice guidelines|year=2010|publisher=Springer|location=New York|isbn=978-0-8261-1812-7|page=271|url=https://books.google.com/books?id=4uKsZZ4BoRUC&pg=PA271|edition=2nd|url-status=live|archive-url=https://web.archive.org/web/20160611013523/https://books.google.com/books?id=4uKsZZ4BoRUC&pg=PA271|archive-date=11 June 2016}}</ref> There is no good evidence for the use of cranberry products for treating current infections.<ref>{{cite journal | vauthors = Santillo VM, Lowe FC | title = Cranberry juice for the prevention and treatment of urinary tract infections | journal = Drugs of Today | volume = 43 | issue = 1 | pages = 47–54 | date = January 2007 | pmid = 17315052 | doi = 10.1358/dot.2007.43.1.1032055 }}</ref><ref>{{cite journal | vauthors = Guay DR | title = Cranberry and urinary tract infections | journal = Drugs | volume = 69 | issue = 7 | pages = 775–807 | year = 2009 | pmid = 19441868 | doi = 10.2165/00003495-200969070-00002 | s2cid = 26916844 }}</ref>

===Uncomplicated=== Uncomplicated infections can be diagnosed and treated based on symptoms alone.<ref name="Review08" /> Antibiotics taken by mouth such as nitrofurantoin, pivmecillinam, or fosfomycin are typically first line. Fosfomycin may be used as a single dose, whereas nitrofurantoin and pivmecillinam require a 3 to 5 day course. Cephalosporins, amoxicillin/clavulanic acid, or a fluoroquinolone may also be used.<ref name="kranz-2024" /> Antibiotic resistance to bacteria that cause UTIs has been increasing, and trimethoprim/sulfamethoxazole is now only recommended in areas with low ''E. coli'' antibiotic resistance.<ref name="kranz-2024" />

The Food and Drug Administration (FDA) recommends against the use of fluoroquinolones, including a Boxed Warning, when other options are available due to higher risks of serious side effects, such as tendinitis, tendon rupture and worsening of myasthenia gravis.<ref>{{cite web | title = FDA Drug Safety Communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects | url = https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics | website = Food and Drug Administration (FDA) | access-date = 17 July 2019 | date = 8 March 2018 | url-status = live | archive-url = https://web.archive.org/web/20190718015612/https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics | archive-date = 18 July 2019 }}</ref> The Infectious Diseases Society of America noted concern of generating resistance to this class of medication.<ref name="IDSA2010">{{cite journal | vauthors = Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE | title = International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases | journal = Clinical Infectious Diseases | volume = 52 | issue = 5 | pages = e103–e120 | date = March 2011 | pmid = 21292654 | doi = 10.1093/cid/ciq257 | doi-access = free }}</ref> Amoxicillin-clavulanate appears less effective than other options.<ref>{{cite journal | vauthors = Knottnerus BJ, Grigoryan L, Geerlings SE, Moll van Charante EP, Verheij TJ, Kessels AG, ter Riet G | title = Comparative effectiveness of antibiotics for uncomplicated urinary tract infections: network meta-analysis of randomized trials | journal = Family Practice | volume = 29 | issue = 6 | pages = 659–670 | date = December 2012 | pmid = 22516128 | doi = 10.1093/fampra/cms029 | doi-access = free }}</ref> For simple UTIs, children often respond to a three-day course of antibiotics.<ref>{{cite web|url=http://www.bestbets.org/bets/bet.php?id=939| vauthors = Afzalnia S |date=15 December 2006|title=BestBets: Is a short course of antibiotics better than a long course in the treatment of UTI in children|website=www.bestbets.org|url-status=live|archive-url=https://web.archive.org/web/20090814225657/http://www.bestbets.org/bets/bet.php?id=939|archive-date=14 August 2009}}</ref> The combination sulopenem etzadroxil/probenecid (Orlynvah) was approved for medical use in the United States in October 2024.<ref name="FDA Orlynvah">{{cite web |date=1 October 2024 |title=FDA approves new treatment for women with uncomplicated UTIs |url=https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-new-treatment-uncomplicated-urinary-tract-infections-adult-women-who-have-limited-or-no |archive-url=https://web.archive.org/web/20241026232334/https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-new-treatment-uncomplicated-urinary-tract-infections-adult-women-who-have-limited-or-no |archive-date=26 October 2024 |access-date=25 October 2024 |website=U.S. Food and Drug Administration (FDA)}}</ref><ref>{{cite press release |title=Iterum Therapeutics Receives U.S. FDA Approval of Orlynvah (Oral Sulopenem) for the Treatment of Uncomplicated Urinary Tract Infections |date=25 October 2024 |url=https://ir.iterumtx.com/press-releases/detail/136/iterum-therapeutics-receives-u-s-fda-approval-of |access-date=25 October 2024 |website=Iterum Therapeutics}}</ref>

Women with recurrent simple UTIs are over 90% accurate in identifying new infections.<ref name="Review08" /> They may benefit from self-treatment upon occurrence of symptoms, with medical follow-up only if the initial treatment fails.<ref name="Review08" />

For mild to moderate uncomplicated UTIs, antibiotics may be completely avoided initially, following discussion with the patient.<ref name="kranz-2024" /> For instance, ibuprofen can be recommended while a culture is performed to confirm diagnosis and to test how susceptible the infection is to various antibiotics. Delaying or avoiding antibiotics leads to a longer recovery period, but many UTIs do resolve without antibiotics. The risk of progression to a kidney infection is higher than with antibiotic use, but remains low. A 'wait-and-see' antibiotic prescription can be provided. Overall, this strategy substantially reduces antibiotic use.<ref>{{Cite journal |last1=Frimodt-Møller |first1=Niels |last2=Bjerrum |first2=Lars |date=2023-12-02 |title=Treating urinary tract infections in the era of antibiotic resistance |url=https://www.tandfonline.com/doi/full/10.1080/14787210.2023.2279104 |journal=Expert Review of Anti-infective Therapy |language=en |volume=21 |issue=12 |pages=1301–1308 |doi=10.1080/14787210.2023.2279104 |pmid=37922147 |issn=1478-7210}}</ref>

===Complicated=== Complicated UTIs are more difficult to treat and usually requires more aggressive evaluation, treatment, and follow-up.<ref name="Bryan2002">{{cite book | vauthors = Bryan CS |title=Infectious diseases in primary care |publisher=W.B. Saunders |location=Philadelphia |year=2002 |page=319 |isbn=978-0-7216-9056-8 |url=http://pathmicro.med.sc.edu/infectious%20disease/Urinary%20Tract%20Infections.htm |url-status=live |archive-url=https://web.archive.org/web/20120213052452/http://pathmicro.med.sc.edu/Infectious%20Disease/Urinary%20Tract%20Infections.htm |archive-date=13 February 2012 }}</ref> It may require identifying and addressing the underlying complication.<ref>{{cite journal | vauthors = Wagenlehner FM, Vahlensieck W, Bauer HW, Weidner W, Piechota HJ, Naber KG | title = Prevention of recurrent urinary tract infections | journal = Minerva Urologica e Nefrologica | volume = 65 | issue = 1 | pages = 9–20 | date = March 2013 | pmid = 23538307 }}</ref> Increasing antibiotic resistance is causing concern about the future of treating those with complicated and recurrent UTI.<ref name="Pallett-2010">{{cite journal | vauthors = Pallett A, Hand K | title = Complicated urinary tract infections: practical solutions for the treatment of multiresistant Gram-negative bacteria | journal = The Journal of Antimicrobial Chemotherapy | volume = 65 | issue = Suppl 3 | pages = iii25–iii33 | date = November 2010 | pmid = 20876625 | doi = 10.1093/jac/dkq298 | doi-access = free }}</ref><ref name="Shepherd-2013">{{cite journal | vauthors = Shepherd AK, Pottinger PS | title = Management of urinary tract infections in the era of increasing antimicrobial resistance | journal = The Medical Clinics of North America | volume = 97 | issue = 4 | pages = 737–57, xii | date = July 2013 | pmid = 23809723 | doi = 10.1016/j.mcna.2013.03.006 }}</ref><ref>{{cite journal | vauthors = Karlović K, Nikolić J, Arapović J | title = Ceftriaxone treatment of complicated urinary tract infections as a risk factor for enterococcal re-infection and prolonged hospitalization: A 6-year retrospective study | journal = Bosnian Journal of Basic Medical Sciences | volume = 18 | issue = 4 | pages = 361–366 | date = November 2018 | pmid = 29750894 | pmc = 6252101 | doi = 10.17305/bjbms.2018.3544 }}</ref>

===Asymptomatic bacteriuria=== Those who have bacteria in the urine but no symptoms should not generally be treated with antibiotics.<ref name="Ariathianto">{{cite journal | vauthors = Ariathianto Y | title = Asymptomatic bacteriuria - prevalence in the elderly population | journal = Australian Family Physician | volume = 40 | issue = 10 | pages = 805–809 | date = October 2011 | pmid = 22003486 }}</ref> This includes those who are old, those with spinal cord injuries, and those who have urinary catheters.<ref name="Colgan">{{cite journal | vauthors = Colgan R, Nicolle LE, McGlone A, Hooton TM | title = Asymptomatic bacteriuria in adults | journal = American Family Physician | volume = 74 | issue = 6 | pages = 985–990 | date = September 2006 | pmid = 17002033 }}</ref><ref name="AGSfive">{{Citation |author1=American Geriatrics Society |title=Five Things Physicians and Patients Should Question |url=http://www.choosingwisely.org/doctor-patient-lists/american-geriatrics-society/ |work=Choosing Wisely: an initiative of the ABIM Foundation |archive-url=https://web.archive.org/web/20130901100140/http://www.choosingwisely.org/doctor-patient-lists/american-geriatrics-society/ |publisher=American Geriatrics Society |access-date=1 August 2013 |archive-date=1 September 2013 |author1-link=American Geriatrics Society |url-status=live}}</ref> Pregnancy is an exception and it is recommended that women take seven{{nbsp}}days of antibiotics.<ref>{{cite journal | vauthors = Widmer M, Lopez I, Gülmezoglu AM, Mignini L, Roganti A | title = Duration of treatment for asymptomatic bacteriuria during pregnancy | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 11 | article-number = CD000491 | date = November 2015 | pmid = 26560337 | pmc = 7043273 | doi = 10.1002/14651858.CD000491.pub3 }}</ref><ref name="Guinto-2010">{{cite journal | vauthors = Guinto VT, De Guia B, Festin MR, Dowswell T | title = Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy | journal = The Cochrane Database of Systematic Reviews | issue = 9 | article-number = CD007855 | date = September 2010 | pmid = 20824868 | pmc = 4033758 | doi = 10.1002/14651858.CD007855.pub2 }}</ref> If not treated it causes up to 30% of mothers to develop pyelonephritis and increases risk of low birth weight and preterm birth.<ref name="smaill-2019" /> Some also support treatment of those with diabetes mellitus<ref>{{cite journal | vauthors = Julka S | title = Genitourinary infection in diabetes | journal = Indian Journal of Endocrinology and Metabolism | volume = 17 | issue = Suppl 1 | pages = S83–S87 | date = October 2013 | pmid = 24251228 | pmc = 3830375 | doi = 10.4103/2230-8210.119512 | doi-access = free }}</ref> and treatment before urinary tract procedures which will likely cause bleeding.<ref name="AGSfive" />

=== Pregnant women === Urinary tract infections, even asymptomatic presence of bacteria in the urine, are more concerning in pregnancy due to the increased risk of kidney infections.<ref name="NA2011" /> During pregnancy, high progesterone levels elevate the risk of decreased muscle tone of the ureters and bladder, which leads to a greater likelihood of reflux, where urine flows back up the ureters and towards the kidneys.<ref name="NA2011" /> While pregnant women do not have an increased risk of asymptomatic bacteriuria, if bacteriuria is present they do have a 25–40% risk of a kidney infection.<ref name="NA2011" /> Thus if urine testing shows signs of an infection—even in the absence of symptoms—treatment is recommended.<ref name="smaill-2019" /><ref name="Guinto-2010" /> Cephalexin or nitrofurantoin are typically used because they are generally considered safe in pregnancy.<ref name="Guinto-2010" /> A kidney infection during pregnancy may result in preterm birth or pre-eclampsia (a state of high blood pressure and kidney dysfunction during pregnancy that can lead to seizures).<ref name="NA2011" /> Some women have UTIs that keep coming back in pregnancy.<ref name="pmid26221993">{{cite journal |vauthors=Schneeberger C, Geerlings SE, Middleton P, Crowther CA |date=July 2015 |title=Interventions for preventing recurrent urinary tract infection during pregnancy |journal=The Cochrane Database of Systematic Reviews |volume=2015 |issue=7 |article-number=CD009279 |doi=10.1002/14651858.CD009279.pub3 |pmc=6457953 |pmid=26221993}}</ref> There is insufficient research on how to best treat these recurrent infections.<ref name="pmid26221993" />

===Pyelonephritis=== Pyelonephritis is treated more aggressively than a simple bladder infection using either a longer course of oral antibiotics or intravenous antibiotics.<ref name=Pylo2011/> Seven days of the oral fluoroquinolone ciprofloxacin is typically used in areas where the resistance rate is less than 10%. If the local antibiotic resistance rates are greater than 10%, a dose of intravenous ceftriaxone is often prescribed.<ref name=Pylo2011/> Trimethoprim/sulfamethoxazole or amoxicillin/clavulanate orally for 14 days is another reasonable option.<ref>{{cite book |title=The Sanford Guide to Antimicrobial Therapy 2011 (Guide to Antimicrobial Therapy (Sanford)) |publisher=Antimicrobial Therapy |year=2011 |pages=[https://archive.org/details/sanfordguidetoan00davi_0/page/30 30] |isbn=978-1-930808-65-2 |url=https://archive.org/details/sanfordguidetoan00davi_0/page/30 }}</ref> In those who exhibit more severe symptoms, admission to a hospital for ongoing antibiotics may be needed.<ref name=Pylo2011/> Complications such as ureteral obstruction from a kidney stone may be considered if symptoms do not improve following two or three days of treatment.<ref name=EM2011/><ref name=Pylo2011/>

==Prognosis== With treatment, symptoms generally improve within 36{{nbsp}}hours.<ref name=AFP2011/> Up to 42% of uncomplicated infections may resolve on their own within a few days or weeks.<ref name=Review08/><ref name=pmid30296999>{{cite journal | vauthors = Long B, Koyfman A | title = The Emergency Department Diagnosis and Management of Urinary Tract Infection | journal = Emergency Medicine Clinics of North America | volume = 36 | issue = 4 | pages = 685–710 | date = November 2018 | pmid = 30296999 | doi = 10.1016/j.emc.2018.06.003 | s2cid = 52942247 }}</ref>

15–25% of adults and children have chronic symptomatic UTIs including recurrent infections, persistent infections (infection with the same pathogen), a re-infection (new pathogen), or a relapsed infection (the same pathogen causes a new infection after it was completely gone).<ref name="cooper">{{cite journal |vauthors=Cooper TE, Teng C, Howell M, Teixeira-Pinto A, Jaure A, Wong G |date=August 2022 |title=D-mannose for preventing and treating urinary tract infections |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=8 |article-number=CD013608 |doi=10.1002/14651858.CD013608.pub2 |pmc=9427198 |pmid=36041061}}</ref> Recurrent urinary tract infections are defined as at least two infections (episodes) in a six-month time period or three infections in twelve months, and can occur in adults and in children.<ref name="cooper"/>

About 10–20% of children with upper urinary tract infection, which involves the kidney (pyelonephritis), will go on to develop scarring of the affected kidney. Then, 10–20% of those who develop scarring will have an increased risk of hypertension in later life.<ref name="pmid8692483">{{cite journal | vauthors = MacKenzie JR | title = A review of renal scarring in children | journal = Nuclear Medicine Communications | volume = 17 | issue = 3 | pages = 176–190 | date = March 1996 | pmid = 8692483 | doi = 10.1097/00006231-199603000-00002 | s2cid = 22331470 }}</ref> Recurrent UTIs are a rare cause of further kidney problems if there are no underlying abnormalities of the kidneys, resulting in less than a third of a percent (0.33%) of chronic kidney disease in adults.<ref>{{cite journal |vauthors=Salo J, Ikäheimo R, Tapiainen T, Uhari M |date=November 2011 |title=Childhood urinary tract infections as a cause of chronic kidney disease |journal=Pediatrics |volume=128 |issue=5 |pages=840–847 |doi=10.1542/peds.2010-3520 |pmid=21987701 |s2cid=41304559}}</ref>

==Epidemiology== Urinary tract infections occur almost four times more frequently in females than in males.<ref name="timm-2025" /> Urinary tract infections are the most frequent bacterial infection in women.<ref name=AFP2011/> They occur most frequently between the ages of 16 and 35{{nbsp}}years, with 10% of women getting an infection yearly and more than 40–60% having an infection at some point in their lives.<ref name=Sal2011/><ref name=Review08/> Recurrences are common, with nearly half of people getting a second infection within a year.

Pyelonephritis occurs between 20 and 30 times less frequently.<ref name=Review08/> They are the most common cause of hospital-acquired infections accounting for approximately 40%.<ref name=Nurse2010>{{cite book | vauthors = Smeltzer SC, Bare BG, Hinkle JL, Cheever KH | chapter = Management of Patients with Urinary Disorders |title=Brunner & Suddarth's textbook of medical-surgical nursing. |year=2010 | publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-8589-1|page=1359|chapter-url=https://books.google.com/books?id=SmtjSD1x688C&pg=PA1359|edition=12th|url-status=live|archive-url=https://web.archive.org/web/20160428194226/https://books.google.com/books?id=SmtjSD1x688C&pg=PA1359|archive-date=28 April 2016}}</ref> Rates of asymptomatic bacteria in the urine increase with age from two to seven percent in women of child-bearing age to as high as 50% in elderly women in care homes.<ref name=NA2011/> Rates of asymptomatic bacteria in the urine among men over 75 are between 7–10%.<ref name=Elder2011/> 2–10% of pregnant women have asymptomatic bacteria in the urine and higher rates are reported in women who live in some underdeveloped countries.<ref name="smaill-2019">{{cite journal | vauthors = Smaill FM, Vazquez JC | title = Antibiotics for asymptomatic bacteriuria in pregnancy | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 11 | article-number = CD000490 | date = November 2019 | pmid = 31765489 | pmc = 6953361 | doi = 10.1002/14651858.CD000490.pub4 }}</ref>

Urinary tract infections may affect 10% of people during childhood.<ref name=Sal2011/> Among children, urinary tract infections are most common in uncircumcised males less than three months of age, followed by females less than one year old.<ref name=PeadsNA2011/> Estimates of frequency among children, however, vary widely. In a group of children with a fever, ranging in age between birth and two years, 2–20% were diagnosed with a UTI.<ref name=PeadsNA2011/>

== Veterinary medicine == Domestic cats are less susceptible to bacterial urinary tract infections than domestic dogs.<ref>{{Cite journal |last1=Dorsch |first1=Roswitha |last2=Teichmann-Knorrn |first2=Svenja |last3=Sjetne Lund |first3=Heidi |date=1 November 2019 |title=Urinary tract infection and subclinical bacteriuria in cats: A clinical update |journal=Journal of Feline Medicine and Surgery |volume=21 |issue=11 |pages=1023–1038 |doi=10.1177/1098612X19880435 |issn=1098-612X |pmc=6826873 |pmid=31601143}}</ref>

==History== Urinary tract infections have been described since ancient times with the first documented description in the Ebers Papyrus dated to c. 1550 BC.<ref name=His2008/> It was described by the Egyptians as "sending forth heat from the bladder".<ref>{{cite book | vauthors = Whiteman W, Topley C|title=Topley and Wilson's Principles of bacteriology, virology and immunity: in 4 volumes |year=1990 |publisher=Arnold |location=London |isbn=978-0-7131-4591-5 |page=198|edition=8th}}</ref> Effective treatment did not occur until the development and availability of antibiotics in the 1930s, before which time herbs, bloodletting and rest were recommended.<ref name=His2008/>

==See also== *Urinary anti-infective agent

== References == {{Reflist}}

== External links == {{Portal|medicine}} {{Medical condition classification and resources | ICD11 = {{ICD11|GC00}}, {{ICD11|GC02}}, {{ICD11|GC08}} | ICD10 = {{ICD10|N|39|0|n|30}} | ICD9 = {{ICD9|599.0}} | ICDO = | OMIM = | OMIM_mult = | MedlinePlus = 000521 | eMedicineSubj = emerg | eMedicineTopic = 625 | eMedicine_mult = {{eMedicine2|emerg|626}} | DiseasesDB = 13657 | MeshID = D014552 }}

{{DEFAULTSORT:Urinary Tract Infection}} Category:Infectious diseases Category:Urological conditions Category:Wikipedia medicine articles ready to translate (full) Category:Wikipedia emergency medicine articles ready to translate