Controversies in Urinary Tract Infection

Abstract

There has been some controversy in the past concerning the pathogenesis of urinary tract infection. The routes of infection considered to be of significance are: the ascending or retrograde route; the lymphatic route; and the hematogenous route. It is now felt that the urinary tract, especially in the female, is infected in a retrograde fashion. The female is autoinfected from her own stool. The bacteria colonize the perineum then progress to the vagina, urethra, bladder and possibly the kidneys. In an infection prone female, the prelude to the infection is colonization of the vagina with gram negative bacteria (1). In the female who does not have a history of urinary tract infection or who is not prone to urinary tract infection, colonization of the vagina with typical urinary pathogens is not a common event.