Risk Factors for Urosepsis

Predisposing primary diseases such as advanced age, diabetes mellitus, malignancy, cachexia, immunodeficiency, radiotherapy, cytostatic therapy; obstructive uropathy (e.g., urethral stricture, benign prostatic hyperplasia [BPH]), carcinoma of the prostate, urolithia-

1. Hyperdynamic early stage

Precapillary sphincters shut the capillary bed, the blood rushes via precapillary arterial-venous shunts; gas exchange and removal of metabolites, e.g., lactate, cease Hyperventilation induces respiratory alkalosis The patient is warm

Cardiac output normal or increased (up to 10-20 l/min) Peripheral vascular resistance and arterial-venous oxygen gradient reduced Central venous pressure normal or increased Patient appears as seriously ill, is pale, and sweating profusely Pulse is frequent and soft Hypotension Nausea, emesis, diarrhea Agitation, confusion, disturbance of orientation

2. Intermediate stage

Accumulation of lactate results in metabolic acidosis Increasing myocardial depression Due to endothelial injury and increased vascular permeability, effusion of plasma into renal, hepatic, pulmonary interstitial space, increasing organ dysfunction followed by organ failure (shock kidney, shock liver, shock lung [ARDS])

Due to activation of the complement and coagulatory cascades and increased adherence of cellular elements (neu-trophils, thrombocytes, endothelial cells), disseminated intravascular coagulation (DIC) with consumption coa-gulopathy leading to hemorrhages, organ hypoxia, organ failure, and mostly lethal septic shock

3. Hypodynamie late stage

Patient's skin cold and cyanotic Reduced cardiac output

Peripheral vascular resistance increased due to vasoconstriction; central venous pressure reduced sis, neurogenic disturbances of micturition, inflammatory diseases (e.g., pyelonephritis, acute bacterial prostati-tis, epididymitis, renal abscess, paranephritic abscess, prostatic abscess), and nosocomial infections (e.g., patients with indwelling urinary catheters, after transure-thral/open surgery, endoscopy, and prostatic biopsies).

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