​Urine test

You will need to give some of your urine for tests to exclude any current urinary tract infection and traces of blood in the urine.

Uroflowmetry

This is a simple test which electronically records the rate of urine flow. You will urinate into a container, called a uroflowmeter. This test helps your doctor to check whether there is any obstruction to the flow of urine.

Imaging of the bladder/kidneys

You may get an ultrasound of the bladder and kidneys, which uses high-frequency sounds to create an image of your bladder/kidneys. You may also need an x-ray/CT scan at the Diagnostic Imaging Centre to exclude any causes for persistent/recurrent infections (eg, stones in the urinary tract)

Cystoscopy

If you have blood in the urine or an abnormal ultrasound/x-ray/CT finding of the bladder, you may be asked to undergo a flexible cystoscopy in the clinic. This day procedure allows urologist to look into your bladder to assess if you have any other conditions.

Please refer to the flexible cystoscopy pamphlet for more information.

How to do a clean-catch specimen for females

It is often difficult to get an uncontaminated specimen for a female patient. A clean-catch specimen is very important for diagnosing UTI and blood in the urine. Please seek help from your doctor/nurse if you require advice to get a clean catch specimen.

For some patients, it may be necessary for us to obtain the urine specimen using a catheter (a thin tube which is inserted into the bladder via the urethra) to ensure accurate results.

Recurrent UTIs in males

• Male UTIs are considered complicated
• You should be investigated by a urologist because there may be an obstruction to your urination or there may be a bladder condition.
• We need to assess for common conditions such stones, benign prostatic enlargement and prostatitis (inflammation of prostate).
• You may present with lower urinary tract symptoms (e.g, pain during urination at the tip of penis), pain in the abdomen, blood in the urine, inability to urinate, infection of the kidneys or in the testes.
  

• ​Drink more fluids in the daytime.
• Urinate after sexual activities.
• Females using spermicides or vaginal diaphragms should try alternative forms of contraceptions.
• Avoid vaginal douching.
  
• Regular voiding. Avoid holding back urination for prolonged periods of time
• Get screening for conditions such as diabetes mellitus if suspected. If diabetic, good glucose control is essential for preventing recurrent infections.

​Medications may be required if self-management or lifestyle changes are inadequate to control the infections. Common medications are antibiotics, probiotics, cranberry extracts, topical estrogen 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 if any of the above strategy is suitable. You will be counselled on the benefits and risks of each strategy.

Probiotics, cranberry extracts

These are health supplements that may be useful in preventing UTIs in otherwise healthy individuals.

Topical estrogen cream

For postmenopausal females, we may recommend topical estrogen cream/pessary if you have dry or thin genitals. Topical estrogen therapy improves the tissue quality of the genitalia region and can prevent UTIs and relieve some symptoms such as pain on urination.

Intravesical therapy

For patients with severe, recurrent infections with previous failed treatments, we may suggest intravesical therapy of hyaluronic acid. You will usually require a few sessions, performed weekly, to see the benefits of the treatment.

Living with recurrent UTIs

Although UTIs are usually not life-threatening for healthy individuals, they may have a negative impact on the patients' quality of life. For older, immunocompromised patients, a severe episode of UTI can be life-threatening. Quality of life involves both physical and psychological health. It is important not only to feel healthy but also to feel free from the psychological pressure of living with UTI symptoms.

Seek help if the symptoms are bothering you. You can gain control of the condition simply by recognising and seeking treatment.