Care at NUH

Services for Urinary Tract Infection

Diagnosis and Examinations


To diagnose UTI, a series of test may be needed. Your family doctor or urologist will take review your medical history and perform a physical examination, which may include an examination of the genitalia regions. If required, other tests will be performed. 

Medical history 

The doctor will collect a detailed medical history , asking questions about the symptoms. Questions may include: 

  • Describe the current symptoms; 
  • Duration of symptoms; 
  • List of medications you are currently taking (including previous antibiotics); 
  • Details of any previous surgical procedures; 
  • Other existing diseases or conditions (e.g., diabetes)
  • Lifestyle factors (e.g., exercise, smoking, alcohol consumption and diet) 
  • Daily fluid intake  
  • Sexual history and menopausal history for females 

Physical examination 

The urologist will conduct a general physical examination on: 

  • Abdomen 
  • Genitals 

Urine test 
You will be required to provide a urine sample for testing to exclude any current urinary tract infection and traces of blood in the urine. 

This simple test electronically records the rate of urine flow as you urinate into a container known as a uroflowmeter. It assists your doctor in assessing whether there is any obstruction to the urine flow. 

Imaging of the bladder/kidneys 
You may undergo an ultrasound of the bladder and kidneys, using high-frequency sounds to create images. Additionally, an X-ray/CT scan at the Diagnostic Imaging Centre may be needed to exclude any causes for persistent/recurrent infections (e.g., stones in the urinary tract). 

In cases of blood in the urine or abnormal ultrasound/X-ray/CT, a flexible cystoscopy may be recommended. This day procedure enables the urologist to examine the bladder for any other conditions. Please refer to the flexible cystoscopy pamphlet for more information. 

How to do a clean-catch specimen for females 
Obtaining an uncontaminated specimen for female patients is often challenging but crucial for diagnosing UTI and blood in the urine. Please seek help from your doctor or nurse if you need advice on obtaining a clean-catch specimen. In some cases, a catheter (a thin tube inserted into the bladder via the urethra) may be used to ensure accurate results. 

Recurrent UTIs in males 
Male UTIs are considered complicated. 

Investigation by a urologist is recommended as there may be an obstruction to urination or an underlying bladder condition. 
Assessment for common conditions such stones, benign prostatic enlargement and prostatitis (inflammation of prostate) is necessary. 

Symptoms may include lower urinary tract symptoms (e.g., pain during urination at the tip of the penis), pain in the abdomen, blood in the urine, inability to urinate, kidney infection and testicular infection. 

Lifestyle Changes/Coping Mechanisms for Females
  • Increase daytime fluid intake. 
  • Urinate after sexual activities. 
  • Consider alternative contraceptives using spermicides or vaginal diaphragms. 
  • Avoid vaginal douching. 
  • Practice regular voiding and avoid holding back urination for prolonged periods. 
  • Undergo screening for conditions such as diabetes mellitus if suspected. If diabetic, good glucose control is essential for preventing recurrent infections. 
Drug Treatment for Females

Medications may be required if self-management or lifestyle changes are inadequate. Common medications include antibiotics, probiotics, cranberry extracts, topical oestrogen cream/pessary for postmenopausal females. 

Antibiotic strategies: 

  • Self-diagnosis and self-treatment (self-start treatment). 
  • Post-coital prophylaxis if UTI is brought on by sexual intercourse. 
  • Continuous low-dose antimicrobial prophylaxis. 

Your Urologist will advise you on the suitability of the strategies, providing information on their benefits and risks. 

Probiotics and cranberry extracts 
These health supplements that may beneficial in preventing UTIs in otherwise healthy individuals. 

Topical oestrogen cream 
For postmenopausal females, topical oestrogen cream/pessary may be recommended to address dry or thin genitals. This therapy improves tissue quality of the genitalia region,  preventing UTIs and alleviating some symptoms such as pain during urination. 

Intravesical therapy 
For patients with severe, recurrent infections with previous failed treatments, intravesical therapy with hyaluronic acid may be suggested. Multiple sessions, usually performed weekly, may be required to experience the benefits.  

Living with recurrent UTIs 
Although UTIs are usually not life-threatening for healthy individuals, they can  negatively impact on the quality of life. For older or immunocompromised patients, severe UTI can pose life-threatening risks. Quality of life involves both physical and psychological health. Seeking help and treatment is important to gaining control over the condition and relieving associated symptoms. 

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