Tuesday, March 06, 2012

The Urinary Tract Infection that wasn't one at all

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.”