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QUESTION: I've recently had a routine ultrasound done and the doctor noticed my bladder lining was thickened at 8mm and both my kidneys had pielocalyceal hypotonia and microlithiasis.

The doctor told me I had a UTI and prescribed me antibiotics (Cephalexin) - he was very sure a UTI is what I had but was vaguely surprised by my lack of symptoms. My urine is clear, I have no difficulty urinating, or pain / burning, don't feel like going more often, or anything like that. No flank pain. I feel normal. I have had a bit of sweating during the night (mild sweating) & mild hot/cold flashes in the past 3 months but I attributed them to my anxiety problems... I don't have a fever, I have a good appetite and normal energy.

Around 4 months ago I did have some dicomfort in the urethra area - not related to passing urine and thought about maybe doing a urine culture, but it disappeared in a few days so I didn't.

I had an ultrasound done 3 months ago this and nothing was observed.

Can this be a UTI with no symptoms? Should I see another doctor or just continue taking the antibiotics? Should I recheck with an ultrasound later?

Can this be something other than a UTI, like cancer? I am 28 years old, I've heard bladder cancer is rare at this age, is that right? I'm very scared of that in particular.

Thank you!

ANSWER: Cristina:

By definition, if you don't have symptoms or some clear sign of inflammation, it's not a UTI.  A "uti without symptoms" is usually called bacteriuria and just means bacteria in the urine but no signs or symptoms of an infection so treatment is considered optional in most cases.

A thickened bladder wall is usually associated with inflammation so a course of antibiotics may not be unreasonable.

I don't know what pielocalyceal hypotonia is.  Pielocalyceal means inside the kidney in the area where the renal pelvis and the calyces meet.  This is an area where there is no muscle so "hypotonia" which means "weakened muscle tone" would not seem to apply.  

I would suggest you get another opinion from a urologist.

below is a copy of the "Preventing UTI's" patient guide I am writing which you might find useful.

Preventing Urinary Tract Infections in Women
Stephen W. Leslie, MD FACS

Urinary tract infections (UTIs) are extremely common especially in women.  About 50% of all women will have at least one such infection at some time.  While a UTI is usually just bothersome with symptoms such as burning on urination, urinary frequency, urgency, nocturia and odor, it is possible for a urinary tract infection to progress and affect the kidneys or other organs which can be serious.

When a patient has three or more urinary tract infections within one year, this is called a recurrent infection and a medical review may be recommended.  Much of the time, the problem can be easily corrected with some simple changes in personal hygiene.  Of course, you donít have to wait for three new infections before starting any of the following suggestions.  Donít feel bad if you are not doing everything correctly as most women will not do any better.  Just make the necessary changes starting right now and help reduce your future risk of urinary tract infections.
 
Wash Your Hands Before Wiping:  Wash your hands before you use the toilet to urinate or at least before wiping. You should also wash your hands before you get into the shower to avoid passing germs from your hands back to your body near the bladder opening area.
 
Wipe Front to Back:  Always wipe yourself from the front to the back after you urinate.  Start from the front and push down and away towards the rectum.  Donít try to reach from behind because your hand, wipes or tissues will pick up germs and bacteria from the rectum.  Most urinary infections are from bacteria that normally live around the rectum and anus.  Any wiping motion that starts nearer to the rectum and then approaches the bladder opening area will move potentially dangerous bacteria closer to the bladder and urinary tract.  Also wipe the same way, front to back, after a bowel movement.  
 
When You Wipe, Use Toilet Paper or Baby Wipes, But Only Wipe Once:  Itís OK to use toilet paper to wipe after urination, but just wipe once or you may actually add more bacteria to the bladder opening area.  Sterile baby wipes are even cleaner than toilet paper and you can carry them with you in your purse for use outside the home.  They can also be useful if no other wipes are available!  As a general rule, anything safe for babies can also be used in the delicate area around the vagina and bladder opening.
 
Avoid Baths:  Bath water is full of dirt and bacteria from your skin.  Sitting in a tub just gives the bacteria an easy way to reach the urethra and bladder opening area.  After all, you wouldnít drink that water, would you?  So donít put your bladder opening area, which we are trying to keep as clean as humanly possible, in the dirty filthy water!  If you absolutely must take a bath instead of shower, donít use any bubble bath or other cosmetic bath additives which tend to be irritating to the delicate skin of the vaginal mucosa.

Take Showers Instead:  Showers are much preferred to baths in women who are prone to urinary tract infections.  Just let the water run off naturally and donít spray any water directly into the vagina or bladder opening area.  
  
Avoid Luffas and All Reusable Sponges:  Luffas and other reusable sponges including nylon cannot be adequately cleaned or sterilized once used, so they retain bacteria that cannot be eliminated.  They also are used over and over for days, weeks or even months during which they can accumulate more and more bacteria and germs.  Women who are prone to infections, especially UTIs, should absolutely not use or even touch such reusable but heavily contaminated items.

Use A Gentle Liquid Soap:  Bar soap will always have some germs and bacteria on it just due to exposure to the air and bathroom environment.  Also, other household members may handle it and use it.  Body wash is fine for regular skin cleaning, but regular body wash is too harsh for the very gentle tissue of the vagina and bladder opening area.  Itís important to avoid using products with unnecessary perfumes, astringents, creams or other possibly irritating chemicals.  We recommend using a gentle liquid soap with minimal additives such as Ivory, Eucerin, Dial or Neutrogena.  You can also use any gentle liquid baby soap because if itís safe for babies, itís probably OK for the bladder opening area, too.  
     
Use Washcloths: The best and cleanest way to apply soap is to use a very clean washcloth.  The washcloths can be placed into a clean, sealable plastic bag immediately after they are washed and dried as they are cleanest when they are just coming out of the dryer.  This keeps them extra clean until they are used and avoids any bacterial contamination from body spray in the shower or unnecessary handling.  No matter how often you wash your hands, they will not be as clean as these freshly laundered washcloths.  You may want to use a second washcloth to finish your shower after youíve properly cleaned the bladder opening area.    

Clean the Bladder Opening Area First!:  The bladder is the only area of the body that can get infected if it isnít cleaned properly when you wash yourself.  Since itís the most important area to get clean, it should be washed first before the washcloth or your hands have picked up any dirt, germs or bacteria from other parts of your body.  When we do surgery, we clean the surgical site first before moving to the surrounding area.  The same principle applies to cleaning the bladder area.  Remember to only wipe once, wiping from the front towards the back.
  
How to Wash Yourself - Summary:  Wash your hands first, even before you get into the shower.  Take a fresh clean washcloth from the sealed plastic bag as described previously.  Wet the washcloth, add some clean liquid soap, and clean the bladder opening area first with a single front to back wipe with the washcloth.  Rinse well without directly spraying the bladder opening area.  The washcloth used to clean the bladder opening area should probably not be used for anything else and should only be used once before being laundered.

Douches May Be Okay, But Avoid Other Personal Hygiene Products:  In most cases, a vinegar and water douche or a douche with iodine or benzalkonium chloride is helpful if carried out correctly at appropriate intervals.  Donít use any feminine hygiene sprays, cosmetics, perfumes, medicated towelettes or similar products in the vagina or bladder opening area unless specifically approved by your physician.

Use Tampons For Periods:  Tampons are advised during your menstrual period rather than sanitary napkins or pads.  A tampon will keep the bladder opening area drier and cleaner than a sanitary pad and help keep any bacterial growth and contamination away.

Avoid Long Intervals Between Urinations:  Try to empty your bladder at least every four hours during the daytime while youíre awake even if you donít feel the specific need or urge to void.  When you do feel the need to empty your bladder, donít try to ďhold itĒ until a more convenient time or place.  When your bladder is telling you itís time to go potty, listen to it and use the restroom as quickly as possible.
Donít Wear Tight Clothes:  Avoid wearing pantyhose, bathing suits or tight slacks for  prolonged periods.  Cotton panties for general use are suggested.  Try to avoid habitual leg crossing.  All of these will tend to press the skin folds around the vagina into the body and may introduce more bacteria into the area around the bladder opening.          
 
Drink More Water:  Start with one extra glass with each meal.  If your urine appears any darker than a very pale yellow, this could mean that you are not drinking enough and should increase your fluid intake.  Cranberry juice is helpful in patients with urinary tract infections, but if you donít like cranberry juice you can or substitute other beverages.

Drink Cranberry Juice and Take Some Extra Vitamin C:  Your physician may recommend taking some additional Vitamin C.  This may help increase your bodyís resistance to infection.  Extra Vitamin C that your system canít use immediately will be released into the urine where it helps block bacterial growth.   As noted earlier, cranberry juice may be of some extra benefit in reducing urinary tract infections.  If you donít like cranberry juice, you can get the same benefit from cranberry pills which are available in most drug and health food stores.

Avoid Irritating Foods Like Caffeine:  Symptoms of bladder irritation may be aggravated by caffeine, regular coffee, tea, alcohol, ďhotĒ spices, ďNutraSweetĒ, chocolate, cola drinks and high potassium foods like bananas and oranges.

Avoid Activities That increase Your Risk of Bladder Infections:  Prolonged bicycling, motorcycling, horseback riding and similar physical activities and exercises may increase your risk of bladder infections.  You may need to limit these types of activities.  When you do engage in physical activity and exercise, make sure to empty your bladder frequently and drink plenty of water and other fluids.  Sexual activity may also increase your risk because it can introduce bacteria into the bladder area.

Take Special Precautions After Sexual Activity:  After intercourse, empty your bladder and drink two extra glasses water.  Some patients will be advised by their physicians to take a urinary antiseptic or antibiotic after sexual activity.  Make sure you take the medication exactly the way and at the time your physician suggested.


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

QUESTION: Thank you for your answer Doctor!

I have made an appointment with a urologist this week.

I also wanted to add I started noticing what looks like thin white tissue pieces in my urine, especially after holding it in for longer. They are not from the vagina. This has started 2-3 days ago, around the time I started taking the antibiotics. They were bigger the first two days, like 2 inches long and thin. Today they seem smaller, thinner.

I am sure I did NOT have these things 1 week ago, because I was testing for ovulation and looked at my urine every day.

Are these a sign of something? They don't look like pus, they're elastic  and very thin. They unfold to look like a very thin film.

Is bladder cancer a possibility at my age? Would it be visible on the ultrasound if it was? Would the ultrasound distinguish between a wall thickening due to cancer and one due to a benign cause?

Thank you so much.

Answer
Cristina:

I cannot determine from your description what the white substance is in the urine that you mentioned.  Certainly no antibiotic is associated with anything like that.

Bladder cancer is possible but unlikely.  It cannot be reliably visualized on ultrasound and neither can ultrasound distinguish wall thickening from cancer from a different etiology.  You should consult a urologist.

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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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