Cystitis (acute)

Summary: Urological referral not normally indicated for acute cystitis in women. Referral is always recommended after a single infection for full investigation in men.

Advice: Referral is always recommended after a single infection for full investigation in men.
Refer To: Any adult urologist (by generic referral)

Contents:

Children

Children do not need any further investigation for a single simple UTI with E coli that responds to first line antibiotics within 48h (usually trimethoprim) i.e. non-resistant organisms. Assessment of patients with UTI whould include a detailed history including family history (looking for vesicoureteric reflux) and a full physical examination including trying to express or palpate the bladder, checking for abnormal neurology (ano-cutaneous reflex and ankle jerks) and checking the lower back and buttocks for spina bifida occulta or sacral agenesis.
Children with systemic symptoms (high temperatures or loin tenderness), within the first month of life or non-E Coli infections should be investigated with a renal tract ultrasound and referred to Paediatrics/ Paediatric Urology.
Repeated UTIs should be referred to Paediatrics/ Paediatric Urology for further assessment.

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Women

Urological referral is not normally necessary for a single infection. Women should only be referred for symptoms suggestive of pyelonephritis and for recurrent cystitis which fails to respond to the usual conservative measures. Ultraasound, in advance, of any appointment is always helpful.

Please click here for our recurrent UTI guidelines page.

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Men 

Referral is always recommended after a single infection for full investigation; it is helpful to arrange urinary tract ultrasound in advance of any appointment.

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Acute pyelonephritis

This is usually associated with severe systemic symptoms as well as loin pain and features of lower tract infection. Whilst patients can be treated at home, a significant proportion will require emergency admission for parenteral antibiotics. Routine investigations (i.e. plain abdominal X-ray & ultrasound) will normally be performed during this admission

Please note: It can take as long as 6 weeks for patients to recover fully from acute pyelonephritis.

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