Leukoplakia, urine cultures laser surgery

  I am a female, age 46 with a 20 year history of chronic bladder infections.  I have never had a doctor suggest taking a culture of my urine.  I have pain and frequency and symptoms of infection and no bacteria present in the the urine.  I have been prescribed just about every medication for UTI's and tried all sorts of alternative therapies, with some relief at various times but constant recurrance of infections. I recently had a cystoscopy in Japan. The doctor said that I have a white area at the opening of the bladder.  The exam was done without anesthesia and he did a culture of my urine after the bladder was filled with water.  He also said that the white area could indicate scar tissue, or a fungal infection.  My questions are:  
  1.  What is leukoplakia?
  2.  Is it usual to have an exam without anesthesia?  (it was very painful)
  3.  Is it beneficial to culture the urine after a cystoscopy?
  4.  Is it possible to have a fungal infection in the bladder?
  5.  If so, what is the usual medication?
  6.  Under what conditions, would laser surgery be performed?
  Thank you very much for your response.
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Dear Jeri,
Based on the information provided by you it seems that you have had
recurrent urinary tract infections which have resulted in leukoplakia of
the bladder.  Even though urinary tract infections are common in women,
leukoplakia is a rare aftermath of chronic irritation of bladder lining due
to the recurrent infections. It is characterized by change in the nature of
bladder lining from typical transitional epithelium to squamous epithelial
(normally present on the skin).  This condition also carries (once proven
by biopsy) higher probability for cancer formation in future (up to 42%
reported in one series).
Based on the current understanding of natural history of leukoplakia, it is
important for you to undergo a cystoscopic biopsy of the bladder lesion
(white area) along with random biopsies of other areas.  This should be
done under some kind of anesthesia, so as to avoid discomfort and allow
adequate sampling of the bladder lining.  The biopsies should be reviewed
by a qualified pathologist.  If leukoplakia is confirmed, you should have
it removed either with laser treatment or other endoscopic methods.  There after
you should be under close follow-up  with 6 - 12 monthly cystoscopies and
adequate treatment of urinary tract infections.
If the biopsies turn out not to be leukoplakia, you need to treat your
bladder infection and still be under yearly follow-up to monitor the
behaviors of the white spot and other areas in the bladder.  Biopsies will
also help in identifying fungal infection.  If proven, fungal infection can
be treated by antifungal drugs.
As regards to urine culture- you should get a culture and sensitivity done on
a sample of urine while you are not on any kind of antibiotics.
This information is provided for general medical educational purposes only.
Please consult your physician for diagnostic and treatment options
pertaining to your specific medical condition. More individualized care is
available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely
HFHS-M.D.-AT
Key Word: Leukoplakia, premalignant, bladder infection