Ascending Pathway

The ascending pathway occurs when bacteria colonizing the urethra subsequently travel upwards, or ascend, the urethra to the bladder and cause cystitis (Fig. 79-1). The ascending route may help to explain why UTIs occur more commonly in women than in men. Women have a shorter urethra than men, and colonization of the female urethra is likely due to its proximity to the perirectal area. The use of spermicidal agents increases the colonization of the vagina with uropathogens.15 Additionally, massage of the urethra in women as well as sexual intercourse may lead to bacteria

gaining entrance into the bladder. , Once in the bladder, bacteria are not limited to causing cystitis. These bacteria may continue to ascend the urinary tract via the ureters and cause more complicated infections, such as pyelonephritis.

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