Tuesday, July 29, 2014
Recurrent Infection for 3 Years
Previous Question: Dear NetWellness, After taking twice reimplantation ureter (reflux grade IV) the second surgery still had lower grade reflux. I had symptoms pain in lower abdomain and pelvic, sometime pain on urination, and also feeling full of bladder. The result of urinalysis still had recurrent infection. Urodynamics test show that pressure is normal and obstruction urethra. Urologist did businasi for a couple time, but the symptoms and infection not gone. Can you help me identify the cause of lower pain and infection? I read article about bladder outlet obstruction. Is this different with obstruction urethra?
Previous Answer: If the urethra was obstructed, an evaluation and treatment plan for that condition would seem appropriate. I am not familiar with the procedure your urologist performed. If you can provide some further detail and clarification, I would be happy to revisit this.
New Question: Dear NetWellness, I will explain from the beginning. Start 2007, result BNOIVP show there’s a stricture ureter left side and hydronefrosis left. Kidney function (ureum & creatine still normal). Urologist perform surgery reimplantation ureter left but unfortunately after this surgery cause a high grade reflux in left ureter and ureter left become bigger. This cause recurrent infection (bacteria pseudomonas ). Several time injection antibiotic but the infection not gone. Because of this situation, the second surgery perform. BNO IVP & MCU show there’s a low grade reflux (urologist did restrict the mega ureter). Urologist said the low grade not a problem. After release catheter, I had a symptoms itch at vagina area and pain on urination. From this moment, I had pain in lower abdomain and pelvic. Culture urine show a bacteria pseudomonas. Cultur secret vagina show a 2 bacteria: pseudomonas and staphylococcus. Gynecologist didn’t give antibiotic only albothyl and betadine douch. Urologist didn’t give antibiotic too only urogetic (this because I already too much antibiotic and a few choice of sensitive antibiotic). This medicine didn’t give result , my lower abdomen and back still pain , pain on urination, fever also (but not high). I forget to said that I had kidney stone. Urologist did ESLW and the same time injection antibiotic again. Now the stone is clear, but the infection still there. Urodynamics test show: First sensation filling = 166, Cystometric capacity = 321, Max. rise in Pdet = 4, compliance = normal, instability fill = nil, Opening Pdet = 13, Pdet max = 40, Pdet.at.peak flow = 40, Volume voided = 230, Residual urine = 91, Uroflowmetri Q max = 13, Volume voided (ml) = 300, Calculated Residual Urin = 66.59. Based this result, urologist did businasi for a couple time, but the symptoms and infection not gone. It’s almost 3 years I had this infection and make me stress.
Would you help me identify the cause of this recurrent infection?
Thank you for visiting NetWellness. On this site, we try to answer general questions about health but cannot diagnose or recommend treatment. The information you've submitted is very specific but still hard to interpret completely. You should review all this with your doctor and insist that they answer these questions in a way that you are able to understand before consenting to any treatment. If you are not comfortable with the response, then take your file and films and get a second opinion. Take care.
Donald R Bodner, MD
Professor of Urology
School of Medicine
Case Western Reserve University