Treatment Failure or Recurrence?

Why do we care about urinary tract infections (UTIs)?

  • UTIs can colonize any portion of the urinary tract and lead to irritation, discomfort, renal damage, sepsis
  • Mostly bacterial in origin and ascend over time.


  • Cystocentesis vs. free catch urine cultures
  • Urinalysis
  • Abdominal Radiographs
  • Urinary ultrasound

Traditional therapies:

  • Antibiotics- empirical vs. culture and sensitivity based
  • Dissolve or remove any uroliths/fragments present
  • Eliminate any anatomical abnormalities
    • Ectopic ureter, vaginal/vestibule anomaly persistent urachus, episioplasty (these can all be resolved with a minimally invasive procedure via a scope with a laser)
  • Medically manage functional abnormalities:
    • LMN bladder, UMN bladder, reflex dyssynergia, urinary retention
  • Treat any predisposing condition or eliminate medication that may be causing immunocompromise

Treatment Failures Checklist:

– Drug dose, frequency, duration (owner compliance)
– Urine concentrations, absorption, resistance
– Nidus of infection
– Local defect in resistance to bacteria colonization
–  Re-infection vs. persistent infection

Further diagnostics “get to the root of the problem”:

– Cystoscopy, urethroscopy (male and female)
– Vaginoscopy
– Episioplasty
– Prostatic wash and aspirate (as indicated)
– Biopsies of the Urinary tract (bladder, kidney, prostate)


Routine evaluation of the urinary tract every 3-6 months
o   Abdominal x-rays, focal ultrasound, urine culture, urinalysis

Urinary antiseptics:
o   Nitrofurantoin, methenamine/methionine

For more information, please contact our Internal Medicine Department at (310) 558-6100.

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