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Dr. Arun Phophalia
Dr. Arun Phophalia, Urologist
Category: Urology
Satisfied Customers: 46889
Experience:  MBBS MS (Surgery) Vast experience and routinely perform all urology procedures including endoscopy.
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I have had 3 UTI’s in the last 6 months, and one 6 months

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Hello there,
I have had 3 UTI’s in the last 6 months, and one 6 months before that, 2 of which have resulted in kidney pain and A&E. Each time I get a UTI the antibiotics take no effect and we have tried lots of different types of AB, but the UTI comes straight back even if symptoms have improved. I am super vigilant with wiping, with urinating pre and post sexual intercourse but the pain really is now affecting our sex life. I am drinking so much water but to no avail. The symptoms have started worsening, especially at night and I’m not getting much sleep because of it. After several visits and phone calls where I’m prescribed more ABs everytime, my local GP has referred me for a bladder/urethra/kidney scan, but due to a Coronavirus they suspect I’ll be waiting a very long time. I really would love treatment, but with the current situation and being self employed, money is tricky, but I’d love to have a consultation with a urologist however much it costs and as quickly as possible. I wanted to know if you think a private urologist appt would be best And also if I need an NHS referral for an appointment?Thanks so much,Rebecca Fennelly
JA: Is the condition chronic, or acute?
Customer: Chronic
JA: Anything else in your medical history you think the Doctor should know?
Customer: No

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Customer: replied 5 days ago.
Thank you Dr. Really appreciate it x

Following approach for the chronic/recurrent urinary tract infection may be helpful;


1) Estimation of residual urine. This is done by an ultrasound examination. An ultrasound is done with a full bladder. Then you are asked to void and ultrasound is repeated. If there is a residual urine amount of more than 50 ml; that is considered as a significant amount. High residual urine in the bladder will not let the UTI eradicated. In high residual urine following investigations would be done;


a) CMG (cystometrogram)/video urodynamics; this tells about the bladder muscle and sphincter functions. A problem in these would not let the bladder empty properly and thus the recurrent UTI.

b) Pelvic floor EMG; tells about the pelvic muscle dysfunctions and help in the above.


These will need medications to improve bladder emptying.


2) Medications that alter urinary pH helps in eradicating the recurrent or chronic UTI with the antibiotics.


3) Culture for the mycobacterium; this if grown will need different kinds of medication regime specifically for the mycobacterium bacteria which do not respond to the antibiotics.


4) Gynecological examination; to see for the major cystocele (bladder prolapse). This also predisposes for the recurrent UTI.


5) If above do no help the other investigation contemplated are;


a) Cystoscopy; camera exam to look for bladder diverticulum or any other abnormality.

b) MR urography (magnetic resonance urography to look for infective nidus elsewhere in the urinary tract).

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Customer: replied 5 days ago.
Thank you so much Doctor. This is really helpful. I think my main question is how is best to get going with things, in order to get the relevant testing. Would it be quicker to go privately to get a consultation with a urologist, and would I need an NHS referral for that?
Thank you so much

You are very welcome, Rebecca.

If you want to go to private, you do not need a referral from the NHS.

If you want to see an NHS urologist, you may need a referral from them.

Please see this link;

Wishing you a speedy resolution and all the very best in life.




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