Frequency of micturition and urinary tract infection

Mild dehydration: a risk factor of urinary tract infection?

Bacterial growth in the urinary tract is usually prevented by host factors including bacterial eradication by urinary and mucus flow, urothelial bactericidal activity, urinary secretory IgA, and blood group antigens in secretions which interfere with bacterial adherence. Bacterial eradication from the urinary tract is partially dependent on urine flow and voiding frequency. Therefore, it seems logical to postulate a connection between fluid intake and the risk of urinary tract infections (UTIs). However, experimental and clinical data on this subject are conflicting. Experimental studies concerning the effect of water intake on susceptibility and course of UTIs were predominantly performed in the 60s and 70s. Despite many open questions, there has been no continuous research in this field. Only few clinical studies producing contradictory results are available on the influence of fluid intake concerning the risk of UTI. One explanation for the inconsistency between the data might be the uncertainty about the exact amounts of fluid intake, which was mostly recorded in questionnaires. So far, there is no definitive evidence that the susceptibility for UTI is dependent on fluid intake. Nevertheless, adequate hydration is important and may improve the results of antimicrobial therapy in UTI. Results of experimental and clinical studies concerning urinary hydrodynamics are the basis for advice given by expert committees to patients with UTI to drink large volumes of fluid, void frequently, and completely empty the bladder. The combination of the behaviourally determined aspects of host defence and not simply increasing fluid intake is important in therapy and prophylaxis of UTI.

Toilet habits of children evaluated for urinary tract infection

The toilet habits of 77 girls and 24 boys who were evaluated after having a urinary tract infection were examined prospectively. Children with known urological conditions that can predispose to urinary tract infections were excluded. A voiding cystourethrogram and renal ultrasound were performed, and a diary of toilet habits was obtained for all patients. Six children were lost to followup. Of the remaining 95 children imaging studies were negative in 60 (negative imaging group) and positive in 35 (positive imaging group). Only 10% of the negative imaging group were without constipation or abnormal voiding compared to 60% of the positive imaging group (p = 0.0001). Toilet habits can affect the development of urinary tract infections. Our data suggest that the evaluation of urinary tract infection should include an inquiry into these habits. Among children with negative imaging studies there may be functional problems that promote the development of urinary tract infections.

Toilet habits and continence in children: an opportunity sampling in search of normal parameters

An opportunity sampling of 1,192 children regarding parameters of toilet training and elimination status was obtained by interview and questionnaire. Toilet training ages ranged from 0.75 to 5 years, with a mean of 2.4 +/- 0.6 years (standard deviation). Voiding frequency was inversely related to age; most children between 3 and 12 years old urinated 5 to 6 times per day. Influences of gender, urinary infections and parental recall were investigated. Nocturnal and diurnal enuresis was reported in 18% and 10% of our sample, respectively. Bowel movements per week ranged from 1 to 21, with a mean of 6.8 +/- 2.5.

Impact of site release vaginal pH buffer cream on introital colonization by gram-negative bacilli

Colonization of the vaginal introitus by gram-negative bacilli is a critical event in the pathogenesis of bacteriuria and is promoted by an abnormal pH elevation. To determine whether a pH reduction might inhibit colonization we conducted a placebo controlled, crossover study of a site release vaginal pH buffer cream. A total of 12 premenopausal women with a history of urinary tract infection participated in the 12-week investigation. The mean introital pH during application of the placebo and buffer was 4.87 and 4.61, respectively (p less than 0.01). However, the percentage of positive introital cultures during application of the placebo and buffer (40.3 and 35.3, respectively) and the mean density of colonization (23,600 and 22,700 bacteria per ml., respectively) were not significantly different. The percentage of positive introital cultures and the mean colonization density were also not different during application of the placebo and buffer when the patients were retrospectively stratified as light and heavy colonizers. These data suggest that alteration of the introital pH within a range of 4.5 to 5.0 does not influence the growth of uropathogens on the vaginal mucosa.