50 Years of Urinary Tract Infections and Treatments

Has Much Changed?

Brandon Lajiness; Michelle J. Lajiness


Urol Nurs. 2019;39(5):235-239. 

In This Article

UTI Diagnosis

The diagnosis of a UTI was initially based on a visual inspection of the urine for cloudiness and color. In the last 50 years, this has been significantly improved by the development of assays to determine white blood cell and red blood cell counts in the urine. White blood cells in the urine (pyuria) remains the first step in diagnosis of a UTI (Nickel, 2005), even today.

The nitrite test was developed in 1920 to detect nitrite, a byproduct of bacterial growth. This is often performed as a urine dipstick in the office. The major concern with this method is that it does not identify the uropathogen to determine the correct antibiotic. The urine culture is the only assay capable of identifying the uropathogen and establishing a definitive diagnosis. The urine culture was created by Koch and Petri in the 1880s and was further refined in the 20th century. The major refinements have been in inoculating the growth medium and reading the cultures; the time to culture bacteria (from 1 to 5 days, depending on the bacteria) has not significantly changed, even with advancements in growth media.

Urinalysis (UA) and culture are sufficient for uncomplicated UTI and treatment. Complicated or recurrent UTI may require further diagnostic testing to determine site or structural abnormality. In the second half of the 20th century, this has evolved and improved. Diagnostic imaging has greatly improved and includes X-ray (kidney, ureter, and bladder [KUB]; voiding cystograms), ultrasound, computerized tomography (CT) scans, magnetic resonance imaging (MRI), and cystoscopy. The advance of these therapies has improved the treatment of the UTI when the cause is not just the bacteria, but contributing anatomic issues in the genitourinary tract as well.