Urology/UTI in Women
My wife's age is 58.Recently on a routine test(No complications) and culture it has been detected that she has some minor bacterial infection like small amount of Pus Cell 4-5/HPF,Epithelial Cell 1-2/HPF and growth of Escherichia Coli 75000 Org/ml which were detected on a routine test and culture basis.USG showed a Post Void Residual Volume of Urine(100cc).Urologist has suggested minor surgery(Bladder Neck Incision) Doctor has given her Antibiotics.
I HAVE TWO QUESTIONS 1)I was familiar with the term B COLI(only know name,nothing more).What is the DIFFERENCE BETWEEN E COLI and B COLI infection in urine.Can she develop B Coli infection also.
2) What should be the approximate correct value of Post Void Residual Volume of Urine in Ultra Sonogram(USG) test exceeding which CORRECTIVE action like Cystoscopy/ Bladder Neck Incision has to be done to reduce thickening of Urinary Bladder .The patient has absolutely no complication like urinary incontinence/pain/burning sensation.TO AVOID/REDUCE PVR VOLUME IN URINE WHAT MEDICINE SHOULD BE USED TO AVOID SURGERY which should be a last step.Please help
Kalyan, based on the information provided, your wife does NOT need surgery. I am not even sure that she has a urinary problem and probably does not need any form of treatment. I strongly suggest a second opinion. Let me explain the reasons for my strong statements.
Balantidium coli (B. coli) is a type of parasite of the ciliated protozoan classification. It occurs mainly in pigs but can be passed to humans. It mainly gives abdominal symptoms and diarrhea but to the best of my knowledge, no urinary manifestations. It is unrelated to the bacterium Escherichia coli (E. coli) which is a normal bowel inhabitant in humans. This is also the most common bacteria that causes urinary tract infections (UTIs) in humans.
White blood cells (also referred to as WBCs or pus cells) in the urine generally indicate an inflammation (often due to a UTI) somewhere in the urinary tract. The source can be anywhere from the kidneys to the bladder and urethra. However, it is very important, especially in a woman to have the urine collected so as to avoid contamination from the vaginal secretions (which almost always contain WBCs, epithelial cells and bacteria). This is usually done by collecting a proper mid-stream urinary sample after the vaginal opening and urethra are wiped several times with an antiseptic sponge (such as Betadine). Not all women are successful with this technique. If doubt exists as to the specimen, a simple catheterized sample can be taken.
I suspect that your wife's urine sample was contaminated unless collected properly. Generally, a UTI is diagnosed when there are more than 100,000 bacteria/ml. Ranges less than this (75,00 in your wife's case) usually are due to contamination. This fact combined with just a few WBCs and epithelial cells and no symptoms are all against a true infection being present. If still concerned, a catheterized specimen once she is off of medication will resolve the question.
Normally, after urination the bladder should retain less than 30 cc (one ounce) of urine. This is called the "residual urine". Significantly excessive residual urine can predispose to urinary infections and kidney damage from back pressure. However, it takes a large amount of residual urine (probably over 200-300 ml minimum) over a long period of time to do damage. That being said, a bladder ultrasound is NOT a very reliable way to determine residual urine. It is best done by catheterizing the patient just after voiding and accurately measuring the urine obtained. Again, if you see another urologist, he can with one catheterization obtain both an accurate urine for culture and a residual urine.
Again, I do not think your wife has a urologic problem. If she was my wife, I would do no further evaluation at this time. If you decide on a second opinion, feel free to take a copy of my note with you. Of course, do NOT consent to surgery on your wife. Good luck.