Recurrent Urinary Tract Infections: Diagnosis

One of the most common precursors to recurring urinary tract infection is that you had a UTI in the past. Your doctor will want to get a urine sample to diagnose if you have a urinary tract infection. The urine sample will provide a look into the urine for specific bacteria. This helps to identify which treatment would be the best solution. However, your doctor  may order additional testing in the form of x-rays or kidney scans to look for any underlying kidney damage. With recurring UTI’s, you may be asked for a cystoscopy procedure to look inside your urethra and bladder to identifies any abnormalities that would keep the urinary tract infection recurring.

A good medical history and physical exam are important, including a pelvic examination to look for anatomic and neurologic problems. A urine culture, especially when you have bothersome symptoms, is essential. We often check a post-void residual (PVR) urine to see if you can empty your bladder completely. We check for signs of vaginal atrophy (lack of estrogen). Women with complicated UTIs will need additional testing. Often these women have a history of:

• A known birth anomaly of the kidneys – egg, congenital UPJ obstruction
• Prior passage of kidney stones
• Prior pelvic surgery or pelvic trauma, including complicated childbirth
• Bloody urine that persists well past the treatment of a UTI
• Problems emptying the bladder, high PVR urine
• Urine cultures that show bacteria associated with stone formation
• Bacterial persistence despite prior treatment with an antibiotic to which the bacteria was sensitive
• Prior cancer in the abdomen or pelvis
• Diabetes
• Immunosuppression (diseases or use of steroid medications that impair your ability to fight infections)
• Neurologic conditions that might impair bladder emptying
• Diverticulitis with reports of passing air or fecal material in the urine (suggesting a fistula, i.e., a connection, between the bowel and bladder)
• Repeat bouts of pyelonephritis (infection that ascended from the bladder into the kidney)

In these instances, a CAT scan of the abdomen and pelvis may be the best way to find abnormalities that cause recurrent UTIs. A renal ultrasound may be a less expensive alternative and has no radiation exposure, but it may not give as fine detail as a CAT scan.

Office Cystoscopy (looking in the bladder with a telescope) may be necessary, especially if there was prior bladder surgery to correct incontinence or repair an injury.

Urodynamics may be required as well. This test of bladder function involves placement of a small catheter in the bladder, slow filling of the bladder with sterile water, and a recording of bladder capacity, compliance and bladder motor function.