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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,
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
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,