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Urology/E. Coli in urine prior to urodynamic test (in a cathetered patient).

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QUESTION: Dear Professor,

I have just received my results of microbiological examination of a urine sample. The examination found presence of Escherichia coli in quantities higher than 10^5.

The sample has been taken from an indwelling catheter (on the sixth day after its replacement) and the doctor who had been scheduling my future urological diagnostics had warned me that due to the nature of sample obtainment there is little chance of getting a pure sample; in the light of which, a result showing a presence of very commonplace bacteria, such as can be found on skin, etc., should not be seen as worrisome and can be left untreated. He said we should apply antibiotics only if some more specific bacterial strands be found. Unfortunately, I can't remember any of the example strands he had mentioned.

I would be very much interested in your opinion on the necessity of treatment in this situation, Professor. Obviously, I would much rather avoid taking antibiotics unless necessary.

I'm feeling well and have had no symptoms of an infection. I have had my urine tested microbiologically because this had been declared a prerequisite for the urodynamic test I'm having in about a month's time.

Thank you very much in advance.

ANSWER: Bartek:

We normally do not recommend any antibiotic treatment for asymptomatic patients with catheters since this only leads to more resistant bacteria.  If you develop symptoms such as fever, pain, bleeding, etc. then antibiotic treatment of the infection may be needed and appropriate.

Patients with catheters will almost always show some bacteria so we don't get too excited unless symptoms develop/

---------- FOLLOW-UP ----------

QUESTION: Thank you, Professor, for your extremely prompt and informative answer. I wonder if I could only ask you why is the microbiological examination of urine a prerequisite for the urodynamic test and if presence of bacteria prior and during the test translates into some increased risks of the procedure?

Answer
Bartek:

First, in the event that there is an infection related reaction to the testing, appropriate antibiotics can be used.  since we can't sterilize the bladder, there will be a small but increased risk of infection from the test since the bladder is filled during testing.

Second, in patients who do not have catheters, it is necessary to eliminate all infections and bacteria first.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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