#434: Ur-INe for Recurrent UTI?! with Dr. Kellen Choi, DO AKA The Bladder Teacher
Apr 8, 2024
auto_awesome
Dr. Kellen Choi, The Bladder Teacher from the University of Kentucky, discusses the complexities of urinary tract infections (UTIs), the importance of hydration, non-antibiotic prophylaxis, vaginal estrogen, and pelvic floor physical therapy. She explores managing UTIs in post-menopausal patients with breast cancer and immunocompromised patients. The conversation also covers differential diagnoses for UTI-like symptoms and the role of pelvic floor dysfunction in genitourinary health.
Proper diagnosis crucial for recurrent UTIs, requiring urine analysis and culture confirmation.
Lifestyle changes like hydration, bowel habits, and vaginal health help manage UTIs.
Personalized approach needed for complex cases, considering individual factors, treatments, and responses.
Deep dives
Importance of Proper Diagnosis and Follow-up for Recurrent UTIs
Proper diagnosis and follow-up are essential for patients experiencing recurrent UTIs. Guidelines recommend careful assessment, including urine analysis and culture to confirm UTI episodes. Differentiating between uncomplicated and complicated UTIs helps determine appropriate treatment plans based on patient characteristics, previous UTI history, and potential underlying conditions.
Management Beyond Antibiotics: Lifestyle Changes and Supplements
In addition to antibiotics, lifestyle modifications play a significant role in managing UTIs. Encouraging adequate hydration, regular bowel movements, and maintaining proper vaginal health with options like vaginal estrogen cream for postmenopausal women can help prevent UTIs. Supplements like cranberry and D-mannose may assist in inhibiting bacterial adherence to the urinary tract, providing alternative preventive measures.
Challenges with Recurrent UTIs and Patient-specific Approach
Dealing with recurrent UTIs in complex cases requires a patient-specific approach. Considering factors like immunocompromised states, ongoing treatments or conditions like breast cancer, and varied responses to standard treatments, necessitates collaboration among healthcare providers. Tailoring management plans to individual patient needs, addressing concerns about hormone-based therapies, and discussing risk-benefit ratios are crucial for effective UTI management in challenging scenarios.
Preventative Measures for Patients on Immunocompromising Treatments
Patients undergoing immunosuppressant treatments for conditions like MS are prone to UTIs. Prophylactic antibiotics are sometimes administered to reduce UTI risk, especially when starting immunosuppressants. Studies, like one on vaginal estrogen for postmenopausal women with breast cancer history, influence treatment decisions to avoid increased recurrence risk.
Evaluating Imaging Needs for Patients with Recurrent UTIs
Patient history and symptoms guide imaging decisions for recurring UTIs. Renal ultrasound may be appropriate for past kidney stone history, while CT urogram suits cases like gross hematuria in smokers. Consulting specialists or ordering imaging based on individual history and physical findings optimizes diagnostic accuracy to address potential causes beyond infections.
Sounds like another UTI but it could be more than that! Time to explore the entire pelvic floor and see what more you can treat. School’s in session with the Bladder Teacher, Kellen Choi, DO from the University of Louisville @KellenChoi
You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month.
Sponsor: Locumstory