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Dr. Chip
Dr. Chip, General Practice
Category: Urology
Satisfied Customers: 32187
Experience:  Years of experience with general surgery and urgent care
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My 86 mother currently living in Ghana, West Africa has been

Customer Question

My 86 mother currently living in Ghana, West Africa has been asked to have a urethrocytoscopy and I would like to know how safe the procedure is and if there are less invasive options for my Mum. She has had recurrent infections, about one every 6 weeks started after my Dad passed away in March 2013 when she got Shigella. She was put on Nitrofurantoin in Oct 2013 50 mg twice daily and was infection free till April. The dose was reduced to 50 mg daily perhaps because of her liver complaining but unfortunately, the infections started coming more frequently. She has had 3 in the last 5 months. Citrobacter Kloseri and E. Coli being the latest two. There is sometimes blood in the urine samples, but not always. The scan of the bladder in April 2014 was normal, no mass or calculi seen. The consultants did think of applying estrogen cream to the carbuncle or cutting it off. But they just wanted to make sure there was nothing else hiding in the bladder. The gynaecologist said there was only a tiny amount of urine pooling behind the carbuncle. The urologist said that the urethrocytoscopy in elderly women also opens up the urethra and most often free flow of urine results. The GP was worried that one of the infections might travel up to the kidneys, which is why he encouraged Mum to have the urethrcytoscopy and biopsy. The symptoms are lower pelvic pain, urine flow is reduced during the day, but copious at night, often causing bed wetting. I notice that she gets confused and forgetful whenever she has an infection.
The latest antibiotic she took was Zinnat (cefuroxime) 500 mg twice daily for 10 days, course finished on Friday 2nd Janu 2015. For the previous infection, she took Doxycycline 200mg twice a day for 10 days ( managed only 8.5 days due to stomach irritation). Currently taking Atacand (Candesartan) 4 mg daily; Isosorbide Denigrate 2.5 mg. 3x a day and Warfarin 1.5mg/2.5mg alternating. INR has been around 1.6 for about 18 months. Now 2.9 due to antibiotics.
Can you advise if urethrocytoscopy is advisable and if so how safe the procedure is, given my Mum's age and history. Thank you.
Submitted: 2 years ago.
Category: Urology
Expert:  Dr. Chip replied 2 years ago.
Hi--just to start with--how's your Mum's heart and lungs and does she have any other medical conditions?
Customer: replied 2 years ago.
Hi, my Mum has angina and has chronic asthma. She has deep vein thrombosis and is on warfarin as well as other meds for angina and hypertension.
Expert:  Dr. Chip replied 2 years ago.
OK Peter. Just one other question--did your Mum have a post voiding residual bladder ultrasound to see if she's retaining any urine in her bladder after she pees?
Customer: replied 2 years ago.
Hi Dr Chip my Mum has not had that ultrasound. But I understand she recently had a scan as part of a gynae examination. This took place after Mum had peed and she was told there was only a small amount of urine. Also with regards ***** ***** previous question she has a number of EKGs done and I assume they were okay. I don't actually live with Mum in Ghana so having to rely on information being sent from over there. Thanks.
Expert:  Dr. Chip replied 2 years ago.
Sorry for the delay Peter and we can continue after this if you'd like. I can only give you my thoughts here and I don't want to look like I'm trying to take over her care. Without a significant postvoiding residual which might indicate a bladder sphincter problem that might be treated with cystoscopy, I see no reason for the procedure because it isn't likely to reveal anything that can be treated here as with bladder polyps, cancer, etc. And given her cardiac and pulmonary problems I would think the risk of the anesthesia and the procedure itself would be very high with little chance of any progress with her problem so I think she doesn't need to have the procedure
Customer: replied 2 years ago.
Hi Dr Chip thank you for your response. Please bear with me as I have just forwarded your response to my sister in Ghana who is mum's primary carer to see if she has any further questions and will let you know either way. Thank you.
Expert:  Dr. Chip replied 2 years ago.
I'm here Peter
Customer: replied 2 years ago.
Hi Dr Chip can you please clarify what you mean by the procedure isn't likely to reveal anything that can be treated here?
Expert:  Dr. Chip replied 2 years ago.
Sure. Really, first off, I think her bladder is normal--that looking in there won't find anything. The only reason for scoping is to look for polyps or cancer or perhaps something called interstitial cystitis which I am sure she doesn't have. The only thing that might be a cause for recurring UTI's that could be treated with a scope would be a urethral stricture which is causing a fair amount of residual urine to be left behind after she voids and would be a greenhouse for bacterial growth. But since she doesn't have much in the way of a post-void urine residual left in her bladder this isn't a problem with urine retention. So basically I'm saying that in my opinion there is no need for a cystoscopy in her case and there would be a high risk for the procedure itself considering her cardiac and pulmonary conditions
Dr. Chip and other Urology Specialists are ready to help you
Expert:  Dr. Chip replied 2 years ago.
Is there any more information I can afford you about this Peter?
Customer: replied 2 years ago.
Hi Dr Chip thank you this is really helpful. Best wishes
Peter.
Expert:  Dr. Chip replied 2 years ago.
My pleasure Peter--call on me any time