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.
Diagnosis:
- 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)
Prevention:
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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