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Urology/Leukocytes in urine but no UTI?

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Recently, I went to a walk-in clinic because I suspected I had a UTI. I had been suffering from extreme urgency & frequency for 2-3 days. I do have neurogenic bladder due to multiple sclerosis, and am taking Toviaz for the symptoms. Since the symptoms came on suddenly and I didn't want to assume that they were due to MS/neurogenic bladder, I bought an OTC testing kit which showed a positive result for leukocytes (negative for nitrites). After I got that positive result, I went to the walk-in. Their urinalysis also showed leukocytes in my urine, but only "a little" bacteria that could be normal, so the doctor had it cultured. They said that the culture was negative, but didn't seem to have any possible explanations for my symptoms or for the presence of leukocytes. My symptoms haven't gotten any better, but they haven't gotten any worse either. I've been taking Toviaz for 2 months, and switched from 4mg to 8mg about 10 days ago. My current level of urgency & frequency is equivalent to what I experienced prior to taking any medications, and I've had to resort to wearing a thin pad due to little bits of leakage that occurs without warning. I've even had accidents when the urge hit very suddenly and forcefully. I know my case is complicated (to say the least) but I was wondering what other possible explanations there are? What could potentially cause leukocytes to appear in the urine if there is no infection present? And would any of those potentially explain my symptoms? Should I look into changing my medication or seeing a urologist? My neurologist had previously talked about the possibility of referring me to a urogynecologist.

Answer
LT:

If they hadn't done a culture, we wouldn't really be able to tell for sure if there was an infection or not. Even with a negative culture, an infection is still possible.

Truly sterile pyuria (positive leukocytes but no bacteria growing) could suggest yeast, unusual organisms or very slow growing infections like TB which would be unlikely in your case.

You definitely should be under the care of a urologist or urogynecologist.  

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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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