Abstract
Complicated urinary tract infections (C-UTIs) are those associated with structural or functional genitourinary abnormalities or with conditions that impair the host defence mechanisms, leading to an increased risk of acquiring infection or failing therapy. C-UTIs occur in patients with risk factors such as neurogenic dysfunction, bladder outlet obstruction, obstructive uropathy, bladder catheterisation, urologic instrumentation or indwelling stent, urinary tract post-surgical modifications, chemotherapy- or radiation-induced damage, renal impairment, diabetes and immunodeficiency.Multidetector CT and MRI allow comprehensive investigation of C-UTIs and systemic infection from an unknown source. Based upon personal experience at a tertiary care hospital focused on the treatment of infectious illnesses, this pictorial essay reviews with examples the clinical features and cross-sectional imaging findings of C-UTIs affecting the lower urinary tract and male genital organs. The disorders presented include acute infectious cystitis, bladder mural abscesses, infections of the prostate and seminal vesicles, acute urethritis and related perineal abscesses, funiculitis, epididymo-orchitis and scrotal abscesses. Emphasis is placed on the possible differential diagnoses of lower C-UTIs.The aim is to provide radiologists greater familiarity with these potentially severe disorders which frequently require intensive in-hospital antibiotic therapy, percutaneous drainage or surgery.Teaching Points• Complicated urinary tract infections occur in patients with structural or functional risk factors.• CT and MRI comprehensively investigate complicated urinary infections and sepsis from unknown sources.• Infections of the urinary bladder, prostate, seminal vesicles, urethra and scrotum are presented.• Emphasis is placed on differential diagnoses of complicated lower urogenital infections.• Unsuspected urinary infections may be detected on CT performed for other clinical reasons.
Highlights
BackgroundWorldwide, urinary tract infections (UTIs) account for hundreds of thousands of outpatient visits and emergency and hospital admissions each year
According to the guidelines issued by the European Association of Urology (EAU), complicated UTIs (C-UTIs) are those associated with structural or functional abnormalities of the genitourinary tract, or with the presence of an underlying disease that interferes with host defence mechanisms, Insights Imaging (2016) 7:689–711 resulting in increased risk of acquiring infection or failing therapy
Tuberculosis Varicocele Inguino-crural hernia Spermatocele/sperm granuloma Rare epididymal tumours, e.g. neurofibroma, metastasis Testicular torsion Testicular tumours, e.g. lymphoma, seminoma, germ cell tumours Necrotizing fasciitis (Fournier’s gangrene) from non-urinary source Hidradenitis suppurativa suggested by asymmetry with enlargement and increased contrast enhancement of the affected testis compared to the contralateral structure; signs of funiculitis and epididymitis are generally associated (Figs. 17 and 18)
Summary
BackgroundWorldwide, urinary tract infections (UTIs) account for hundreds of thousands of outpatient visits and emergency and hospital admissions each year. Compared to TRUS, CT with multiplanar image reconstruction provides a more comprehensive visualisation of PAs. The usual appearance is single, septated or multiple fluid-like (−19 to 13 HU attenuation) collections, often with perceptible peripheral or septal enhancement, which cause more or less symmetric prostatic enlargement of variable entity
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