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Dr Patel
Dr Patel, Urologist
Category: Urology
Satisfied Customers: 865
Experience:  12 years of experience in urology; advanced training in minimally invasive surgery and oncology
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Hello, I have been experiencing offensive smelling urine for

Resolved Question:

Hello, I have been experiencing offensive smelling urine for a number of months. This problem is intermittent, but seems to be more frequent. My urine is strong, with an ammoniacal smell, sometimes it is orangey in colour other times not. There is rarely any cystitis type pain. I am 60yrs female and take a number of medications altho' none are newly prescribed. I take sodium valproate, atenolol, bendrofluazide, and simvastatin. I also take co-codamol for pain relief of fibromyalgia. I have had a painful urine infection in the past of 3 months duration which was finally cured by a specific antibiotic which I was told in the U.K was more expensive and therefore not usually prescribed!! I now live in Spain and am registered with a doctor I am not yet fluent and find this a little difficult to explain. This problem is now getting so bad that it is very embarrassing if someone uses the toilet behind me. I should be grateful for your comments on this. I also sometimes suffer from " urgency "
Submitted: 5 years ago.
Category: Urology
Expert:  Dr Patel replied 5 years ago.

Hello there,

With fould smelling urine and a recrent UTI the first thing to do is to rule out another UTI.

 

A urine culture is our gold standard test to see if you had an infection. A urine culture should be obtained before you start any antibiotics, even though this is hard to do so. If you did in fact have a culture proven UTI, the second reason to have a culture is that we can find the right antibiotic. So the first two steps are to make sure you are infact having infections and second that it is being treated appropriately.

 

If you do have a persistent infection, you should have an evaluation for anatomic/structural abnormalities and functional abnormalities.

 

Anatomic abnormalities include kidney swelling, cystocele (bladder dropping down), and stone disease. This can be evaluated with a good rectal exam, CT scan of the abdomen and pelvis with and without contrast, and cystoscopy (telescope inside your bladder).

 

Functional abnormalities include high pressure voiding or incomplete emptying of your bladder. Recurrent infections in women can be due to incomplete emptying of the bladder or high pressure voiding and these are best checked with a urodynamic study (pressure flow study done by a urologist to see how your bladder fills and empties) and voiding cystourethrogram (contrast study by radiology to see how your bladder empties).

 

In addition, it would be wise to get basic bloodwork to ensure your blood chemistries are okay (liver function, kidney function, blood glucose). In addition, we often find that hydration with fluids helps immensely.

 

I hope this helps.

 

Best of luck,

Dr Patel

Customer: replied 5 years ago.

Hello Dr Patel, Thank you for your reply. The UTI I mentioned was a few years ago - when I had a cytoscopy which then ruled out a kidney stone - of course I realise that one may have appeared since !! I have also had an operation for gall stones - would this mean that I am susceptable to a kidney stone ? I do not suffer from high pressure voiding but am told one side effect of the fibromyalgia may be incomplete emptying of the bladder due to muscle problems.I am aware of this and try to rectify this by 'waiting' a little.

Many Thanks for your advice

Expert:  Dr Patel replied 5 years ago.

Hello,

A few things- cytoscopy would rule out a bladder stone, not stones in your kidney (this can be best checked with a CT scan or ultrasound/xray of your abdomen).

 

Gall stones and kidney stones are not related- you are not more susceptible to kidney stones.

 

You should have an evaluation of your bladder with a uroflow (check how fast you void) and post void residual (to see how much urine is left in the bladder after you void)- if you are retaining a significant amount of urine this should be evaluated by a urologist, perhaps with a urodynamic study (pressure flow study done by a urologist to see how your bladder fills and empties).

 

Bets of luck,

Dr Patel

 

 

Dr Patel, Urologist
Category: Urology
Satisfied Customers: 865
Experience: 12 years of experience in urology; advanced training in minimally invasive surgery and oncology
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