Patient
Profile: 62 year old woman
Problem: A 62 year old woman with recurrent urinary
tract infections (UTIs) and persistent urethral and bladder pain who had
reached the end of her available antibiotic therapies due to a combination of
medication allergies and microbial-antibiotic resistances.
Prior
diagnoses: The patient complained for 15 years of recurrent and persistent
urethral pain. With each visit to the
doctor, she would be diagnosed with a UTI and given antibiotics. In addition, she was started on urethral
dilations. Ultimately she required weekly
dilations just to function normally without pain and from the chronic
antibiotic usage, she developed severe drug allergy problems and
multi-antibiotic resistant microorganisms on her cultures. She came to Dr Schoor for a second opinion
in 2006 when she was diagnosed with a UTI from a “superbug” and she was told to
go “immediately” to the local hospital for long term intravenous antibiotic
therapy.
Evaluation
and Treatment: Dr Schoor first set out to determine whether or not her symptoms
were related to true UTIs or to something else.
After he performed multiple, clean catch and catheterized urine
specimens, it became apparent to Dr Schoor that her symptoms were likely not
due to UTIs, since the cultures in the face of her symptoms were never
positive. Further history determined
that her symptoms began shortly after she had a hysterectomy. Suspecting testosterone deficiency, Dr Schoor
started her on low dose transdermal testosterone therapy.
Outcome: Shortly thereafter the patient’s urethral
pain resolved. She has not had a
positive urine culture since prior to April 2006. She has not required a single dilation in
over 2 years. Her libido has
improved. She has no pain with sexual
intercourse. Her relationship with her
husband has improved.
Conclusion: Not all symptoms of a UTI are caused by
UTIs. Not all positive urine cultures
represent true UTIs. Many anatomic parts
of the female urogenital tract are testosterone dependent. Many patients can experience significant
relief with a low dose testosterone replacement therapy.
In his own words:
“This was
very challenging yet rewarding case.
This woman was at her wits end and really was out of options. Now she is 100% pain and UTI free. All-in-all a pretty good outcome.”
”UTIs are
very over diagnosed. The most important
factor in the diagnoses of a UTI in a woman is the quality of the urine
specimen—that is it must be free of contamination.”
“If the
clinical picture and urine culture result don’t match, suspect contamination.”
– Dr. Richard
Schoor
In the patient’s own words:
“I have been
given my life back.”
JD-patient.
