help to stop chronic UTIs please

[minmtn]

In 2007 chronic UTIs started (all with positive U&C >100,000) for various bacteria:  mostly E coli, but also staph, strep, E hermanos, kleb pneu, citro koseri.  So far, 13 episodes in past year.  Pain in groin, flank prior to and at onset of UTI & fatigue.  Only had 2-3 UTIs ever before 2007.  Also small kidney stone L mid-kidney, 2mm CT diag 2008; (Nov 09 renal scan 4mm).  Various antibiotics (adverse reactions w/numerous meds when trying low dose preventative therapy.)  No anatomical reason per UroGyn. (Fam Hist:  Brother had nephritis as child & kidney stones as adult & gout -- father's baby brother died Bright's Disease as 3yo in 1930's). Current NP for urologist said stone would not cause chronic infection.  [Was in exellent health until these troubling symptoms started in 2007:  Vit D deficiency (16.9) diag + low calcium Aug 08 and repleted now--doc said likely had it for quite a while (maybe from 2007).  WPW Heart condition ablated 2008, cardiologist said heart was inefficient prior to ablation.  Raynaud's, Neuropathy and muscle weakness/wasting.  Severe deterioration of teeth - have had a lot of invasive dental work in past 1.5 yrs & currently.  Bruising esp on legs that leaves lumps under skin after bruise fades, fluid retention in stomach and legs worsens throughout day but ankles and tummy look normal in morning.]  In March began drinking 10 oz sugar-free cranberry juice cocktail am & pm for pac's and went 3.5 months w/o infection but time in between UTIs diminished since then to about every 3 weeks while still on same cran protocol.  Clears up with Levaquin, then back again.  Read that some women are lack normal gammaglobulin in urinary tracts and vaccine may be available some day.  59 yo female, 5'4", 126 lbs. Exercise 3-5x week. Would appreciate your expert opinion of ideas/suggestions/treatment to stop chronic UTIs.  Many thanks!  minmtn  

[rmprdl1964]

Hi I too am bothered by UTI, from about 1994 to current I used to get about 3 to 4 UTI kidney infections a year.  You mention possibilty of Neuropathy.
After I had a urodynamis test in 1996 it was determined that I have a neurogenic bladder. Meaning that I cannot control the sphincters. I would be left with about 200 to 350 ml of urine. I was thought to use intermittant self catherization.
Later in 1998 I was diagnosed with a neuropathy. By self catherization I have better control of emptying my bladder and cutting down on the UTI.
A urodynamics test might be in order for you.

All the best.

Ron

[Stephen Liroff, MD]

I hear your frustration! Determining the cause of recurrent urinary tract infections can be difficult and at times unrewarding, but it is always necessary to try. First of all is the obvious: urinary infections related to sexual intercourse. Usually these occur within a day or two of sexual activity. If this is your pattern, then taking a single dose of an antibiotic (Bactrim, Macrodantin, Trimethoprim) shortly after sex (the next morning is usually close enough). If this does not fit your situation, then a post-void ultrasound to make sure that your bladder is emptying is needed. A good history of your voiding pattern (frequency, getting up at night, rushing to the bathroom even when you are  not infected) may suggest the need for a study of your bladder’s function (urodynamic evaluation). What are your u/a’s between infection? Are they clear? Passing any gas in your urine (not bubbles, passing gas through your urethra)? May indicate a hole between your intestine and your urinary system. Cystoscopy would be worthwhile.The stone may have something to do with your infections, and it has grown in the last year. If all else fails, may be worthwhile going after the stone . In some women a cause for UTI’s is never found, in which case a daily dose of an antibiotic (usually Macrodantin/ Septra/Trimethroprim) is tried. As this last treatment was a problem  for you, you may need to keep an antibiotic at home and take a short course when your symptoms flare.
I would get a CT urogram if nothing is found beforehand.
Good luck!
S.A.Liroff, M.D.