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Urinary Disorders

UTI Flank Pain

05/11/2010

Question:

I have had two UTIs since December. My first UTI had a lot of blood with clots. The bleeding cleared after about 6 hours. The culture showed E-Coli. I had flank pain for a few weeks. That`s when I got the second antibiotic. However, it is still hurting. An ultrasound for RUQ pain showed mildly prominent extrarenal pelvis which decreases with voiding. Should I return to see my doctor?  Is it time for me to consult with a specialist?

Answer:

Based upon your brief description, you suffered pyelonephritis. Urine culture should have provided information regarding best antibiotic (assuring that the bacteria is sensitive to the antibiotic selected). Usually 2 weeks of therapy is needed to clear infection of the kidney.

Persistent flank pain implies other causes beyond a sporadic upper urinary tract infection. The US is the least expensive imaging study but provides the least information. The bulging renal pelvis may be due to a stricture at the transition point between kidney and ureter (UPJ obstruction). Other factors include stones or reflux. Reflux is usually diagnosed in childhood, stones are best identified by CT scan.

The most comprehensive exam is a CT urogram (CT without and then with IV contrast). You are justified to seek specialist evaluation. Hope this helps.

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Response by:

James F Donovan, Jr, MD James F Donovan, Jr, MD
Professor of Surgery
Director of UC Urology
College of Medicine
University of Cincinnati