**5.2 Urine culture**

**4.5 Voiding disabilities**

mostly seen in catheterized patients [16].

**4.6 Urosurgical interventions**

**5. Diagnosis**

**5.1 Laboratory work-up**

**Risk factors**

Environmental and host factors

Urosurgical interventions

*Risk factors for urosepsis.*

**Table 2.**

**180**

Traumatic spinal injuries, cerebrovascular accidents, neurogenic bladder, cystocele and vesicoureteral reflux due to various aetiologies, either trauma or congenital, lead to increased usage of urinary catheterization and ultimately increased incidence of urosepsis. Urosepsis risks are multiplied due to indwelling long-term catheters and the spread of multidrug-resistant bacterial strains. Richards et al. showed that 23% of all cases of hospital-acquired sepsis were due to UTI and

*Clinical Management of Shock - The Science and Art of Physiological Restoration*

Trauma of urological intervention either diagnostic or therapeutic in the presence of bacteria can lead to the development of urosepsis. Common urological interventions are prostate biopsies, stone interventions and transurethral prostate resections. Urosepsis rate after these surgical interventions are transurethral resection of prostate up to 4% [17] trans rectal prostate biopsies up to 0.8% [18] lithotripsy: 1% [19] ureterostomy for stone treatment up to 9% patients will have severe sepsis [20] percutaneous kidney stone surgery up to 7% will develop sepsis [21] and

Typical presentation in community-acquired urosepsis patients is triad of loin pain, fever and leukocytosis. Hospital-acquired urosepsis patients frequently manifest leukocytosis and hypotension. Urosepsis quickly complicats into septic shock with multiple organ dysfunction. One third of these patients will have septic shock

Apart from complete blood count (CBC) and electrolyte monitoring, the serum C-reactive protein and procalcitonin (PCT) levels should be obtained. They will tell us the patient deterioration and presence of sepsis and septic shock. Serum lactate

up to 8% endoscopic urethrotomy patients develops sepsis [22] (**Table 2**).

with tachycardia and tachypnea and other organ dysfunctions [12]**.**

Comorbidities Diabetes mellitus, nephrocalcinosis and chronic kidney disease

pregnancy and the radiation therapy

cystocele and vesicoureteral reflux

Obstructive uropathy Ureteric, urethral strictures, phimosis, ureterocele, polycystic kidney disease,

Voiding disabilities Traumatic spinal injuries, cerebrovascular accidents, neurogenic bladder,

calculi, prostatic hypertrophy, tumours of the urinary tract, trauma,

Bacterial virulence, transmission of bacteria to host and compromise of host

Prostate biopsies, stone interventions and transurethral prostate resections

will give diagnostic as well as prognostic value [11]**.**

Age and gender More than 65 years and female

defences

Urinary culture and sensitivity are important not only in the diagnosis but also equally important in the management of urosepsis. The culture should be done within hours or persevered properly. A positive culture is highly diagnostic, and negative culture will rule out the urinary infections.
