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Rezidivierende Harnweginfektion der Frau — Diagnostik

Symptomatic urinary tract infection of the female – diagnostics

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Zusammenfassung

Bei der rezidivierenden Zystitis wird die Basis der Diagnostik durch die exakte Anamnese im Wissen um die Pathogenese von Harnweginfekten (HWI) geschaffen. Die Anamnese sollte auch Faktoren, welche die natürliche Vaginalflora beeinflussen (Geschlechtsverkehr, Hygiene), aber auch vorausgegangene Antibiotikabehandlungen und den Immunstatus beeinflussende Erkrankungen (Diabetes mellitus) erfassen.

Im Zentrum der Labordiagnostik steht die Untersuchung des Urins. Die Diagnosesicherung erfolgt zeitnah durch Analyse einer einwandfrei gewonnenen Mittelstrahlprobe im Sofortverfahren (Zählkammer, Teststreifenverfahren). Grundsätzlich folgt immer eine mikrobiologische Diagnostik.

Die erweiterte Diagnostik (urologische Stufendiagnostik) hat zum Ziel, funktionelle und anatomische Veränderungen (Abnormalitäten, komplizierende Faktoren) aufzudecken. Während diese Faktoren prämenopausal nur eine untergeordnete Rolle spielen, gewinnen sie postmenopausal an Bedeutung. Hier kommt dem lokalen Östrogendefizit eine Schlüsselrolle zu.

Abstract

The basis for the diagnostic work-up of recurrent cystitis is formed by taking a precise medical history against the background of knowledge of the pathogenesis of urinary tract infections. The anamnesis should also focus on factors that influence the natural flora (sexual intercourse, hygiene) but additionally include preceding antibiotic treatment and diseases that affect the immune status (diabetes mellitus).

Urinalysis is the principal examination among the laboratory diagnostic procedures. The diagnosis is promptly confirmed by immediate analysis of a clean catch midstream urine sample using a counting chamber or a test strip. As a matter of principle, microbiological diagnosis always ensues.

Extended diagnostic work-up (urological staging) is aimed at detecting functional and anatomic abnormalities. While these factors only play a subordinate role during the premenopausal phase, they gain in importance during the postmenopausal phase. A key role is also attributed to local estrogen deficiency.

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Authors and Affiliations

  1. Urologische Praxisgemeinschaft, Hamburg

    H. Piechota & P. Schneede

  2. Urologische Praxisgemeinschaft, Blankeneser Bahnhofstraße 15, 22587, Hamburg

    T. Bruns

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  1. T. Bruns
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  3. P. Schneede
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Correspondence to T. Bruns.

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Bruns, T., Piechota, H. & Schneede, P. Rezidivierende Harnweginfektion der Frau — Diagnostik. Urologe 45, 421–428 (2006). https://doi.org/10.1007/s00120-006-1026-6

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