• Obstructed urination , e . g . stricture of the urethra , reflux of urine back into the kidneys
• Conditions that compromise the immune system , e . g . diabetes , pregnancy , oral steroid use , kidney transplants , and the frail elderly
What should I do if I suspect a UTI ? Consult your family doctor , gynaecologist or urologist immediately when you start to experience the abovementioned symptoms . If this is your first episode of UTI symptoms , your doctor will usually take your detailed medical history to identify possible causes . He will ask you for a sample of your urine to send to the laboratory for urine analysis and culture .
If you are not having high fevers , he will usually prescribe a short three- to five-day course of oral antibiotics to treat the likely bacteria in your urinary tract . Commonly prescribed antibiotics include ciprofloxacin , nitrofurantoin , and trimethroprim / sulphamethozaxole . Once your urine culture result is available , he may contact you to substitute your treatment to the most appropriate antibiotic to eradicate the offending bacteria as efficiently as possible .
What if my UTI symptoms keep recurring despite antibiotics ? If you continue to experience recurrent UTI symptoms more than twice in a 12-month period despite completing your antibiotics , you should request further evaluation of your urinary tract . Your family doctor will usually refer you on to a urologist , who will arrange some or all these tests to identify correctable causes :
• Repeat urine culture and antibiotic sensitivities
• Uroflowmetry and residual urine measurement after urination to look for abnormalities of bladder emptying
• CT urogram with contrast to identify any abnormalities in the urinary tract , e . g . stones , urinary reflux into the kidneys ( ultrasonography is an alternative for pregnant women )
• Flexible cystoscopy to look for presence of bladder tumours or ulcers , in women with smoking history or above the age of 50 years – this is usually a painless procedure performed under local anaesthesia
• Voiding cystourethrogram to confirm presence of diverticulum ( abnormal pouches ) of the urethra , or abnormal connections between bladder and the large intestine ( colovesical fistula ) where these are suspected
Once the abnormality in the urinary tract is identified , your doctor can then advise you and begin appropriate treatment to prevent future recurrences .
What can I do to prevent UTI from recurring ? In women from 25 to 45 years , UTIs most commonly occur within one to two days after sexual intercourse . If this is a repeated pattern , observe the following measures to minimise recurrent infections :
• Empty the bladder and wash the vagina after sexual intercourse .
• Consider alternative forms of contraception to diaphragms or spermicidal lubricants .
• Take one tablet of antibiotic before or after sexual intercourse .
Post-menopausal women with recurrent UTIs should consider having the vagina and cervix assessed to rule out early cancers or atrophic vaginitis . In atrophic vaginitis , topical oestrogen creams can boost the vaginal lining and reduce the colonisation of aggressive bacteria .
Women whose UTIs are not related to sexual intercourse may consider self-directed therapy . Patients are given a three- day course of antibiotics to keep on standby , and they can start treatment immediately once they recognise the onset of UTI symptoms . However , they must consult their doctors should their symptoms persist after the course of antibiotics has ended . Another popular remedy is to take cranberry juice or supplements regularly , although this has still not been scientifically proven to reduce the incidence of UTIs .
Dr . Gerald Tan Yau Min is a consultant urologist at Advanced Urology with over 23 years of clinical experience with a record of 1,500 robotic radical prostatectomies performed . He is internationally renowned for his expertise in minimally invasive and robotic surgery for prostate , kidney and bladder diseases . He may be contacted via email at enquiry @ urology . com . sg .
GlobalHealthAsiaPacific . com NOVEMBER 2020
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