Suggest treatment for re-occurring bladder infections
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I have been having re-occurring bladder infections for over two years and they subside after treatment with antibiotics for a ten day period. After stopping the antibiotics the infection tends to return after two weeks, and I have to start them again. This has been going on now for over two years. My doctor doesn't seem to know what to do at this point. I have had various tests and they all indicate 30 % retention. but no reason. I was told I should get a supropubic cathater but am relunctant to do that life changing procedure. Any help would be apppreciated. I am 78 years old male.
Posted Mon, 10 Feb 2014 in Urinary and Bladder Problems
Answered by Dr. V. Sasanka 39 minutes later
Brief Answer: Catheter unlikely to be a good solution Detailed Answer: Hi, What you have described is a fairly common condition we see among diabetics, especially in the elderly. You have not described what you mean by having a urinary infection, but i assume you probably have some sort of a voiding dysfunction,i.e. pain while passing urine, may be with fever and lower abdominal pain,. the reason I mentioned that is - many patients of your age will have some degree of bacterial colonization of urine, and we need to treat only those patients who are symptomatic, so that the chances of the bacteria developing resistance are lower. also, should you indeed have to get the infection treated, you should go by the protocol, and ensure you give a sample of urine for culture and sensitivity, and wait till the report comes in, and take the antibiotics only as prescribed by the sensitivity pattern. Once you finish the 10-14 day course, you should confirm that bacteria have indeed been eradicated by means of a repeat culture of urine. if the bacteria are persistent, as they could be in 20% of patients, you should get a few tests done like at least an ultrasound of bladder and kidneys, and other imaging tests as required depending on the scan report. Sometimes, the kidney or the bladder are sources of continuing sepsis, and in these patients, the culture shows that an infection has been eradicated, but promptly after some time, the urine will again show pus cells and bacteria. this is called relapse, especially if the organism is not the same one that was present earlier. To prevent such relapses, you could be started on a low dose anti-bacterials like Septra or Nitrofurantoin at bedtime for long term. in low doses, these do not cause resistance in the micro-organisms, and also provide sufficient protection. 3-4 months later, you can guardedly withdraw the protection offered by these antibiotics, and see if the infection recurs. I personally feel that you are not going to get better by use of catheter, but indeed should look to be voiding on your own. If you have a slightly high residual urine, you can try alpha-blockers like Flomax which could improve bladder emptying. If you have had diabetes for a while, your bladder could have become weak, and such patients are prescribed drugs to improve bladder tone as well.if these measures are not successful, you learn technique of intermittent self-catheterization which is definitely better than having a long term catheter. A supra pubic catheter is slightly better than having a urethral permanent catheter, but I would prefer that you try drugs like Flomax, and if infection persists, and if there is any evidence of obstruction, as could happen if you have a large prostate, you might even have a surgery to get rid of the obstruction which should not be too difficult. This decision can be made by a urologist after a test called urodynamics. Hope I have been able to help you.
Follow-up: Suggest treatment for re-occurring bladder infections 11 minutes later
I have had bladder and kidney ultrasounds which showed no unusual problems. I think you might be right about the low dose anti-bacterials for a long term as that is what I though I should be taking too. Will appproach my specialist about this option. Thank you for your help.I also have had uniary incontinance for about three years, but still retain the 30% after voiding even with the incontinenance.
Answered by Dr. V. Sasanka 17 hours later
Brief Answer: Urodynamics could be useful Detailed Answer: Hi again, I thought I would like you to know that there is a test called urodynamics which might be useful in predicting how much of obstruction your bladder has, and how much of underactivity or overactivity. As I said earlier, if a properly performed urodynamics is suggestive of obstruction, getting the obstruction removed can be the solution to your problem. You will need no catheter or diaper after a few weeks. Low dose antibiotics will be useful, especially if you could be having a test like urodynamics which involves removing and re-inserting urinary catheters. But a general internist might not understand this concept the way a urologist would. Glad to have been of help.