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Urology/Recurrent UTIs and overactive bladder

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Hi I'll try to make this as succinct as possible. I have had recurrent UTIs for the past 25 years. I am a 63 year old female. It is always E. coli.  I used to get about 5 a year now it is down to 3 a year. I do everything you are supposed to: showers instead of baths, wiping front front to back, drinking plenty of water and I take a cranberry capsule twice a day. I have had a cystoscopy twice. The last one showed inflammation and was biopsied but came back benign. I also have overactive bladder and in the last year I started to have problems after I am done the antibiotic. I have had cramping at times, feeling like I still have to urinate after I urinate and going to the bathroom about 15 times a day, twice during the nite. I am not heavy, I weight 110 and the doctor started me on estrace again which doesn't seem to have helped. In December I had an ultrasound on my kidneys and bladder which I have had before but this time it showed inflammation on the one kidney. I had this done in the beginning of December and saw the doctor a few times but it was not mentioned. I went back to the doctor last week because I had another UTI and I asked about the ultrasound and he looked at the report and said that it showed inflammation and he recommended a cat scan. That is my dilemma. I have had numerous cat scans for other issues and I am worried about having another one. I guess if I was called right after it was taken I might have been worried, but I had to ask about the report 2 months later. Do you think it is prudent to have another ultrasound before I consent to a cat scan?  Your opinion would be appreciated. Thank you.

Answer
Lee, "inflammation" of the kidney as noted on and ultrasound (US) is a non-specific finding usually representing some scarring of the kidney.  Such scarring can be congenital but typically is due to old infection.  As long as there is no mass, stones or obstruction, further followup at this time is not necessary.  I would at most repeat the US in one year.  If further evaluation is deemed needed beyond the US, I prefer MRIs to CTs because there is no radiation risk with the latter.  To follow is some information I have written on UTIs in women.  

Urinary tract infections (UTIs) in women are very common compared to men.  This is due to the relatively short length of the female urethra.  This results in the bladder being nearer the external environment.  The most likely sources of bacteria are from the rectum, colonization in the vagina, or introduction via sexual activity.  Frequent bathing, as opposed to showering, also allows bath water to reflux into the bladder.  This may also be an entry path for bacteria.  In addition, refluxed soap residues often will irritate the lining of the bladder and urethra (mucosa) causing symptoms.  Females can lessen the likelihood of infection by not ignoring the desire to void, by emptying the bladder just prior to and soon after intercourse, by taking showers rather than baths and by always wiping from the urethra toward the rectum – NEVER the reverse!  The use of a diaphragm and spermicidal jellies also increase the risk of UTIs.  The typical symptoms of a UTI are frequency, burning, and urgency.  With more severe inflammation, blood may appear in the urine.  If bleeding occurs, you should seek consultation with a urologist once you are better to ensure that there are no other causes for the bleeding.  If the infection spreads from the bladder into the kidneys, the patient is much more ill and typically exhibits flank (kidney) pain, fever and chills.    If untreated, kidney infections may spread into the blood stream causing a life threatening disorder called septicemia.  This requires hospitalization, intravenous antibiotics and intensive care.

Most UTIs involve the lower urinary tract (urethra and/or bladder).  A tentative diagnosis is made by doing a urinalysis which typically demonstrates white blood cells (“pus cells”) and bacteria.  A positive dip stick test of the urine for nitrates or leukocyte esterase strongly suggests a UTI but culturing the urine for bacteria provides a definitive diagnosis.    Sensitivity studies are then done on the culture to determine which antibiotics will destroy the germ.  Most routine UTIs require 3-7 days of antibacterial therapy.  If the infections are frequent, long-term low dose daily or post-coital prophylactic antibacterial therapy may be needed.  In younger women, there is some evidence that cranberry products may prevent the recurrence of UTIs.  However, the dose is not standardized and they have not been successful in treating UTIs.   In the post-menopausal female, topical vaginal estrogen therapy may be of benefit.  Patients with recurrent UTIs often need to consult with a urologist to have their urinary system evaluated to try and find the reason for the frequent problems.  This usually involves imaging studies of the upper urinary tract, cystoscopic examination of the bladder and a measurement of residual urine (that urine still left in the bladder after urinating).    

I hope the information provided proves useful to you.  You might ask your urologist about continuous antibacterial prophylaxis to try and prevent acute flareups of your UTIs.  Good luck.

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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