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BRAIN ATTACK:

Recurrent Urinary Infections– Seek Help of a Nephrologist!

By Dr. Alka Bhasin in Nephrology

Nov 11 , 2020 | 1 min read

There are many reasons behind recurrent infections of the urinary tract in adults. Dr. Alka Bhasin, Director – Nephrology, Max Smart Super Speciality Hospital, Saket, gives some questions, which could help you identify the problem and seek immediate medical intervention.

  • Is the urinary microbe the same in each instance or varying?
  • Is the microbe causing the urinary infection truly identified by the laboratory and significant?
  • Is there urinary incontinence? As this can promote infection or be a consequence of the infection.
  • Are there accompanying symptoms of burning in the urine, voiding very frequently, urgency, pain over the kidneys, fever? Are there accompanying pus cells in the urine?
  • Any accompanying visible blood in urine? – This could be due to cystitis, a stone in the urinary system, prostate enlargement, trauma of the urethral passage, sloughed dead tissue passing out from the kidney.

5 Alarming Signals of UTI’s

  • In women—any untreated vaginal infection or pelvic inflammatory disease, recent gynaecological intervention/pap smear, prolapsed of bladder/uterus/rectum, use of intrauterine contraceptive device to be looked for with a thorough evaluation.

  • In men – any prostatitis, balanitis, epididymo-orchitis, inguinal hernia, hydrocele to be looked for.

  • Recent unprotected sexual activity could be a repeated trigger.

  • Recent / repeated urological interventions such as a urinary catheter placement, external catheter placement, cystoscopic examination, urodynamics study, surgery on the urinary tract may be important factors.

  • Lack of correct treatment for the bacteria responsible for the urinary infection – I am referring in particular to use of inappropriate antibiotic (multidrug resistant bacteria are increasingly common in the community and require specialised intravenous antibiotics only), inadequate duration of antibiotic course (minimum 2-3 week course of appropriate antibiotic is needed for kidney infection), improper interpretation of the urine culture report.

  • Need to evacuate pus from the site by needle aspiration so that antibiotic penetration occurs better.

  • Need to remove the offending stone causing obstruction or otherwise

  • Unable to use a preventive low-dose antibiotic wherever indicated.

  • Patient factors such as poorly controlled diabetes, use of immunological suppressants/chemotherapy, the doses of which may need to be reduced or eliminated.

  • Recent diarrhea and faecal incontinence are triggers to the increase of microbes into the urinary space.

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