Hello Doctor,
For the first 3 months of having a suprapubic (SP) catheter with a valve (not a bag), I had NO UTIs! It was changed in a room with good air control to keep it as germ-free as possible. But when it was changed in the wards or nurses’ room, I got a UTI. I took pills to prevent UTIs, then a nurse painfully removed the catheter, and I had blood in the urine and from my abdomen for a week. There was NO UTI because of the pills. Now, 3 weeks later, I keep getting UTIs. Seven days of pills clear it up, but 3 days later, the UTI returns repeatedly. Could damage to the bladder cause this? The doctors here have no idea.
Hello,
Thank you for reaching out to Dr. Galen. Please find the below response to your query.
Based on the details you provided, there are a few potential factors that could be contributing to your recurrent urinary tract infections (UTIs) after suprapubic catheter removal:
1. Bladder Damage
Damage to the bladder from the catheter insertion or removal process may be causing recurring UTIs. The blood in your urine and from your abdomen for a week after the painful catheter removal suggests there could have been trauma or injury to the bladder or surrounding tissues. This damage may make you more susceptible to infections.
2. Incomplete Bladder Emptying
If the catheter insertion or removal caused scarring or inflammation that obstructs the urethra or bladder neck, it could lead to incomplete emptying of the bladder. Residual urine in the bladder provides an ideal environment for bacteria to grow and cause recurrent UTIs.
3. Antibiotic Resistance
The repeated short courses of antibiotics to treat each UTI may be selecting for antibiotic-resistant bacteria. Taking antibiotics for only a few days may not fully eradicate the infection, allowing resistant bacteria to persist and cause recurrent UTIs.
4. Irritation and Inflammation
The catheter and repeated UTIs may have caused chronic inflammation and irritation of the bladder lining (interstitial cystitis). This can make the bladder more sensitive and prone to infection.
5. Underlying Condition
There could be an underlying condition predisposing you to UTIs, such as an anatomical abnormality, neurogenic bladder, or immunodeficiency. These would need to be evaluated and treated.
Recommendations
I would suggest the following:
- Discuss the possibility of bladder damage with your urologist and consider cystoscopy to evaluate the bladder.
- Ensure you are completely emptying your bladder after catheter removal.
- Discuss antibiotic prophylaxis with your doctor to prevent recurrent UTIs while the bladder heals.
- Treat each UTI with a full course of targeted antibiotics based on urine culture results.
- Consider bladder instillations with dimethyl sulfoxide (DMSO) or pentosan polysulfate sodium if interstitial cystitis is suspected.
- Undergo further urological evaluation to rule out any underlying anatomical or functional abnormalities.
Recurrent UTIs can be challenging, but with a thorough evaluation and multimodal treatment approach, the infections can often be brought under control. I would recommend following up with your urologist to determine the underlying cause and develop an appropriate management plan.
Let me know if you have any other questions!
Thanks
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