作者：（美国）霍夫曼（Barbara L.Hoffman） （美国）肖尔格（Schorge J.O.） （美国）莎孚（Schaffer J.I.）
Polycystic Ovarian Syndrome and Hyperandrogenism
Evaluation of the Infertile Couple
Treatment of the Infertile Couple
The Mature Woman
Pelvic Organ Prolapse
Anal Incontinence and Functional Anorectal Disorders
Genitourinary Fistula and Urethral Diverticulum
Principles of Chemotherapy
Principles of Radiation Therapy
Preinvasive Lesions of the Lower
Invasive Cancer of the Vulva
Epithelial Ovarian Cancer
Ovarian Germ Cell and Sex
Gestational Trophoblastic Disease
The most frequent presenting complaints in otherwise healthy,immunocompetent nonpregnant women are dysuria, frequency, urgency, and incontinence.
Studies conducted by the National Institutes of Health(NIH), the Mayo Clinic, and others have shown that mostpatients can be treated with a short course of antibiotics without examination, urinalysis, or urine culture for an isolatedepisode of acute uncomplicated bacterial cystitis. It must beemphasized that a patient in this category can always be seen ifshe prefers. In addition, women should be instructed on clinicalchanges that warrant further attention such as fever > 100.4°Cand persistence or recurrence of hematuria, dysuria, and frequency despite treatment.
Women with these exclusions and others require evaluationto exclude other potential causes of their symptoms . For example, hematuria in a postmenopausal womanmay reflect cervical, uterine, or colonic bleeding evident at thetime of urination, rather than upper and lower urinary tractinfection. Similarly, burning with urination may indicatevulvitis.
Complicated or Recurrent Cystitis
As many as 50 percent of women who suffer an uncomplicatedacute bacterial episode of cystitis will have another infectionwithin a year. Up to 5 percent have recurring symptoms soonafter treatment. When symptoms develop in such women,the likelihood that a true infection is present is greater than80 percent.
Thus, for selected women with complicated or recurrent infections or with persistent or new symptoms during treatment,urinalysis and urine culture are strongly encouraged. For aculture specimen to be informative, it must be accurately collected. A "clean catch" midstream voided urine specimen isusually sufficient. A patient should understand the reasons forand the steps associated with urine specimen collection, whichCulture. Urine culture allows accurate identification of aninciting pathogen and susceptibility testing of that pathogento a variety of antibiotics.