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Diabetic. Suffering from urinary infection. Sonography showed mildly flatty infiltration of liver. What should I do?

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Practicing since : 1991
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Hello doctor,
History: I am 43 years male & have been suffering from urinary infection since I was 20 yrs (almost every 2 to 3 yrs.). Earlier it used to be fever & burning sensation. I used to take Ciprofloxacin 500mg. Later when I was 32 first time blood came in urine. I had done urine culture, USG every thing. Nothing was found and again I took Ciprofloxacin. After that almost every year I am suffering from same i.e. Haemutra, pain while urinating, burning sensation, blood in urine (but no fever). I had done almost every test including CT Scan, IVF, endoscopy. Nothing was found. Used to take Prulifloxacin 600 mg once daily as advised by Urologist. Report said mildly uniformly thick walled urinary bladder due to cystitis, mild prostatomegaly, mild cystitis.Right renal nephrocalcinosis. Right Ureteric lesion at S1 level causing mild obstruction. S.G.O.T:64, S.G.P.T:107

Present Symptoms: Pain during urination, burning sensation, blood in urine once. Full Abdomen sonography reports says mildly flatty infiltration of liver,mildly thick walled urinary bladder most probaly due to cystitis. mild prostatic hypertrophy. Urologist specified Prulifloxacin 600 mg once daily for 10 days, Alfoo 10 mg for 10 days. After seeing urine culture (Enterococcus sps.colony count 0000 cfu/ml), PSA: 4.34, CBC: ok, Serum Creatinine 0.8, he prescribed Urifast 100mg twice daily for 10 days. I have completed the course of Prulifloxacin & Nitrofurantion. He advised to repeat PSA after 4 weeks. I am a diabetic under medication. Fasting:134, Post Lunch:196. Now just 2 days after completeing antibiotic course I am again having burning sensation during urination. Slight pain is also there during urination.

Pl. advise why this is repeating again & again and what should I do to prevent reoccurance. Also to get rid of the current burning sensation & mild pain what medicine should I take (Already completed 9 days Prulifloxacin & 15 days Nitrofurantoin).
Posted Thu, 25 Oct 2012 in Urinary and Bladder Problems
Answered by Dr. G.Srinivasan 51 minutes later
Thanks for your query to XXXXXXX
i APPRECIATE your detailed history narration and will try to be as helpful as possible.
You need the following things.
1. Treatment of UTI and prevention of recurrence.
2. Relief from symptoms.
3. Relief of obstruction.
I think you are in the right line of treatment for the infection. You may require long term antibiotics - say about 3 to 6 months in a low dose manner.
Symptom relief can be obtained by urinary analgesics and antispasmodics.
If the long term antibiotics do not help, you may need relief of obstruction of the ureter either endoscopically or by open surgery.
Pls discuss all these issues with your doctor and get well soon.


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Follow-up: Diabetic. Suffering from urinary infection. Sonography showed mildly flatty infiltration of liver. What should I do? 33 minutes later
Dear Doctor,
Thank you for your reply. Actually after seeing my IVU, CT Scan & USG report, my urologist performed endoscopy in March 2007. That time he said it was ok and there was some very minor blockage which was cleaned by him. After that he said I need not be worried about anything in future regarding this. However again and again this is happening. Can you please help me understanding what you mean by open surgery. What exact obstruction you are referring to? What is the relevance of PSA of 4.34 means. I am really worried.

Fyi, I have used in past medicines like Voveran, Pan 40, Canestan cream (because normally I used to have some minor scratch like cuts in the foreskin of the penis, which used to be little aggravated during masturbation & dryness). The foreskin scratch also comes very often. I am married and my foreskin opens properly (no issue there). On this occurance, I have used Pan 40 & Alfoo 10 mg alongwith the Nitrofurantion.

Also pl. let me know if any other problem might be there?

Answered by Dr. G.Srinivasan 6 hours later

I would be happy to see your reports of the procedures done for you to comment better.
If repeat PSA AFTER 4 WEEKS is still in the same range, it is wise to do a prostate biopsy to rule out tumor in the prostate.
I would prefer to repeat the IVU now and if necessary renogram to check the level of obstruction and the possible cause ( stone/ stricture etc).
If endoscopy is not effective to keep the ureter open, open/ lap surgery to remove the block and reunite the ureter may be the best option.
Till then you need low dose antibiotics/ urinary analgesics to give you relief, at least temporarily.


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