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Dr Su S
Dr Su S, Doctor(MD)
Category: Urology
Satisfied Customers: 18864
Experience:  25 years of experience as doctor
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I am wondering if I should see a nephrologist or a urologist

Customer Question

I am wondering if I should see a nephrologist or a urologist about this problem?

About a month and a half ago my urine started smelling putrid, esp. first thing in the morning. I asked my new family doctor about it. General checkup blood tests, including liver and kidneys, were okay. Urinalysis and urine culture were negative. She insists it is something I eat, but I have not changed my eating habits and do not eat asparagus, etc.

Parallel to this and I wonder if this is involved, I was recently diagnosed via endoscopy with bile reflux and under control acid reflux. My acid reflux med had been changed from 60 mg of Prevacid to 60 mg of Dexilant once a day and Carafate 10 ml liquid 4 times a day before the endoscopy and I am to remain on that. My larynx is inflamed, so the ENT has arranged for me to get a second GI opinion, since the pH monitoring the ENT did shows acid reflux reaching the larynx. My GI doctor did not agree with that acid reflux is the problem, hence the second opinion.

It occurred to me that perhaps the medication change was causing the smelly urine, so I tried temporarily stopping the Dexilant and Carafate and going back on the Prevacid four days ago. Two days ago I restricted what I am eating to rolls and cream cheese, thinking if the smell disappeared, I would add back in foods one by one.

Yesterday, that seemed to work, and I was very happy, but now the smell is back as strongly as ever. I think I might have been misled because I had trouble sleeping and so was up and the urine did not have time to concentrate. (I drink lots of water.)

For the last two weeks, I have also had burning and urgency in the mornings, but I think I may have traumatized the area trying to clean it due to the pungency, so I am not sure this is actually related. (Years ago I was diagnosed with vulvodynia and possibly interstitial cystitis, and they have been quiet for some time.)

I must admit that I dread seeing a urologist, because I saw one years ago and had a very painful exam and bled a great deal afterwards. Is there anyway to diagnose this problem without that?

Thanks very much.
Submitted: 3 years ago.
Category: Urology
Expert:  Dr Su S replied 3 years ago.
Greetings,

Do you take any supplement, vitamin, antibiotic? Do you take much protein? Was urine test done before the symptoms of burning and urgency in the morning? How much water do you take usually? What is your age?

Regards.
Customer: replied 3 years ago.
I take the following supplements otherwise I get vitamin mineral deficiencies: daily three Citrical Plus D, one Centrum Silver, ferrous gluconate 324 mg. Every other day one Doans back pill for the magnesium. A monthly B-12 shot. However, this week I have omitted the Centrum Silver since I read that B-6, which it contains, can cause smelly urine.

I was on three weeks of antibiotic in May when the reflux problem was erroneously thought to be sinusitis.

A dietician whom I was sent to to help me lose weight told me I was not eating enough protein.

The urine test was done before the burning and urgency symptoms.

I'm 67, 5'8", 200 lbs.

I am not sure how much water I drink, but probably 4-6 16 oz bottles of Poland Spring a day.

Thank you.
Expert:  Dr Su S replied 3 years ago.
Thank you for the input.

Besides urinary infection, the smell can come from concentrated urine if the water intake is low. But you are taking good amount of water. Antibiotics, vitamin and supplements can cause smell in the urine. High protein diet can cause smell in the urine. When urine test did not show any infection other causes can be possible. Recent burning and urgency can be due to probable interstitial cystitis. But infection should be ruled out again when you developed burning later. At least you need to repeat urine routine and culture test from your GP. If he does not find any probable cause for your symptoms he can refer you to an urologist. In perimenopause, the incidence of urinary tract infection increases. In case of females the chances of urine infection is more as woman's urethra is much shorter than a man's, so bacteria have less distance to travel from outside the body to the bladder. In female the position of urethra close to vagina & anus also facilitates bacteria to enter the bladder.

Any query, please feel free to ask.
It will be my privilege to assist you.
Regards.
Customer: replied 3 years ago.
Thanks. I will do as you suggest. But can you tell me what to expect at a urologist's office - would I have to have that painful and scary test, or is there some other way the problem might be diagnosed?
Expert:  Dr Su S replied 3 years ago.
You are always welcome to Just Answer.
If you are detected to have an infection, you may not need an urologist consultation & painful urological procedures. Your GP can treat it.
If you are satisfied with the answer, please press the ACCEPT button so that I can be compensated for my time & effort. Regards.
Customer: replied 3 years ago.
Sorry to repeat - is there any way, if I have to see a urologist, that he or she can diagnose whatever this problem is without that painful test? From a urine or blood sample perhaps?

And if it is not an infection that shows up in a urinalysis or urine culture, what could it be?
Expert:  Dr Su S replied 3 years ago.

He can take other non invasive tests like ultrasound/ scan. If those do not reveal any abnormality then he can go for cystoscopy.
Customer: replied 3 years ago.
Relist: Incomplete answer.
I don't feel that any indication was given of what the cause of this problem might be.
Expert:  Dr Su S replied 3 years ago.
The possible causes can be infection, interstitial cystitis, reflux, genital prolapse causing retention of urine.
Customer: replied 3 years ago.
Thanks very much for putting up with my trying to understand this.

Can intersticial cystitis cause smelly urine?

By reflux, do you mean the acid or bile reflux I have or some sort of urinary system reflux?

Could there be an infection that would not show up on a urinalysis or urine culture?
Expert:  Dr Su S replied 3 years ago.

You are always welcome to Just Answer. I explained before the cause of smelly urine. New symptoms can be due to infection, interstitial cystitis or urinary reflux. In interstitial cystitis or urinary reflux infection may or may not present. In past urine test infection was not present but it can develop later.
Customer: replied 3 years ago.
Thank you. As to the causes of the smelly urine, you said "Besides urinary infection, the smell can come from concentrated urine if the water intake is low. But you are taking good amount of water. Antibiotics, vitamin and supplements can cause smell in the urine. High protein diet can cause smell in the urine. When urine test did not show any infection other causes can be possible."

As to your last sentence in this quote, are the "other causes" something not listed in the quote? That is, is the complete list of possible causes of smelly urine: urinary infection, concentrated urine due to insufficient water, antibiotics, vitamin and mineral supplements, high protein diet?

I should perhaps add that by smelly, I mean putrid. It is not a normal concentrated urine smell, it smells like very rotten food or something.
Expert:  Dr Su S replied 3 years ago.
Did you have gynecological examination recently? Do you have vaginal discharge?
Customer: replied 3 years ago.
I have an appointment with my obgyn in 6 hours :-) Trying to cover all bases. Although there is no vaginal discharge.

Could you answer my question about is the list of things in the quote the complete list of causes of smelly urine? Sorry for trying to pin this down, you are being extremely patient.
Expert:  Dr Su S replied 3 years ago.

There are many other causes. As you do not have any such symptoms, I did not mention. Those can be recto vaginal fistula, vaginal infection, diabetic ketoacidosis, maple sugar urine disease, liver failure, phenyl ketonuria etc.
Dr Su S, Doctor(MD)
Category: Urology
Satisfied Customers: 18864
Experience: 25 years of experience as doctor
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