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My mother is 53 years old and 87 kg. It has been four years…

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My mother is 53 years...
My mother is 53 years old and 87 kg. It has been four years since her menopause. She experienced severe pain and burning in the bladder area on 14th of April. After that she went through the following medications and diagnosis-
1. In the “Emergency” of the hospital, they did “Bed Side Urine Analysis”. It showed the presence of blood and protein in the urine.
2. After 2 days, she did “Urine Analysis” which showed presence of pus cell (6-8/HPF) and alkaline urine but no blood.
3. Following this, she took “Cefuroxime” (500 mg, 2 tablets a day) and “Tiemonium Methylsulphate” for 7 days. She still had the burning feeling in the bladder area.
4. One week after taking the antibiotic, she did “Urine Analysis”, “Urine Culture” and “Ultrasonography of Kidney, Ureter and Bladder”. “Urine Analysis” and “Ultrasonography” showed normal results with a minimal hydronephrosis in the kidney which had been there for a long time. However, “Urine Culture” showed the presence of the bacteria “Streptococcus Agalactiae”. The colony count of this bacteria was 100000 cfu/ml.
5. Then the doctor prescribed her “Doxycycline” (100 mg, 2 capsules/day for 14 days) and “Pyridium” (3 tablets a day for 10 days).
6. On completion of “Doxycycline”, my mother did “Urine Analysis” and “Urine Culture” again. Urine Analysis showed normal results, but Urine Culture showed the presence of the bacteria “Streptococcus Agalactiae”. This time the count was 1000 cfu/ml. The burning in the bladder area was still there.
7. Now the doctor gave her “Nitrofurantoin” (50 mg, 4 tablets/day for 7 days and then 100 mg, 1 tablet/day for 3 months). However, she experienced tingling effect on different parts of her body and stopped taking the medicine after 5 days as it was recommended on the patient information leaflet of the medicine to stop in case of the first sign of neural involvement. The doctor asked her to do “AFB Microscopy” test. The report was negative.
8. During this time, she saw another doctor who also advised her to stop Nitrofurantoin. He prescribed “Flavoxate Hydrochloride” and “Tolterodine”. She took these medicines for 1 month.
9. On 31st of July, she did “Urine Analysis” and “Urine Culture” again. The urine analysis report is normal, but culture report shows the presence of “Streptococcus Agalactiae” with a count of 1000 cfu/ml again. Her recent (May 26th) test report of “Complete Blood Count” also shows normal readings except a little bit of raised ESR (23 mm/1st hour where the normal range is less than 15).
10. As prescribed by her doctor, she has been taking levofloxacin since 6th of August until now (500 mg once a day for the first 10 days, then 250 mg once a day, ongoing). One week after starting levofloxacin, she developed severe pain around knee area. Sometimes this pain goes away and sometimes it comes back on prolonged standing or working. Now it became very difficult for her to sit and stand up.
Recent reports of Urine culture shows “Streptococcus species” with a count of 1000 cfu/ml. Unlike previous reports where the name was written as “Streptococcus Agalactiae”, this time it is mentioned as “species” and no antibiotic sensitivity test has been carried out on the isolated regime of the bacteria. Other reports including Creatinine level are normal.
It may be mentioned that my mother was diagnosed with Osteoarthritis in 2007. She has been also taking anti-depressant (Amitryptiline 25 mg, 1 tablet a day, before going to bed) for many years.
The burning sensation in the bladder subsided significantly after taking levofloxacin. However the doctor prescribed her to take it for 1 month 25 days (10 days: 500 mg then 1.5 month: 250 mg). Now she feels this burning sensation sometimes which is mild. It begins with more severity when the bladder starts filling up with urine. The symptom is worsen while she sits for a while.
Submitted: 11 months ago.Category: Urology
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9/10/2017
Urologist: Dr. Arun Phophalia, Urologist replied 11 months ago
Dr. Arun Phophalia
Category: Urology
Satisfied Customers: 39,103
Experience: MBBS MS (Surgery) Vast experience and routinely perform all urology procedures including endoscopy.
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Urologist: Dr. Arun Phophalia, Urologist replied 11 months ago

While her urine culture does not show a significant colony growth of bacteria, her persisting symptoms (some response to antibiotic especially Levofloxacin) are suggestive of chronic and recurrent urinary tract infection.

Following approach for the chronic / recurrent urinary tract infection may be helpful;

1) An estimation of residual urine. This is done by an ultrasound examination. An ultrasound is done with full bladder. Then you are asked to void and ultrasound is repeated. If there is a residual urine amount more than 50 ml; that is considered as significant amount. An high residual urine in bladder will not let the UTI eradicated. In a high residual urine following investigations would be done;

a) CMG (cystometrography); this tells about the bladder muscle and sphincter functions. A problem in these would not let the bladder empty properly and thus the recurrent UTI.

b) Pelvic floor EMG; tells about the pelvic muscle dysfunctions and help in above.

These will need medications to improve bladder emptying.

2) Medications which alter urinary pH helps in eradicating the recurrent or chronic UTI with the antibiotics.

3) Culture for the mycobacterium; this if grown will need different kind of medication regime specifically for the mycobacterium bacteria which do not respond to the antibiotics. This has been done for her.

4) Gynecological examination; to see for the major cystocele (bladder prolapse). This also predisposes for the recurrent UTI.

5) If above do no help the other investigation contemplated are;

a) Cystoscopy; camera exam to look for bladder diverticulum or any other abnormality.

b) MR urography (magnetic resonance urography to look for infective nidus elsewhere in the urinary tract).

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

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Urologist: Dr. Arun Phophalia, Urologist replied 11 months ago

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