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“Experience is one thing you can't get for nothing.”  Oscar Wilde
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ANNOUNCING OUR SCHEDULE THROUGH THE END OF 2015!
Everyone is trying to get things done before the new year. To help meet your needs, please note:
  1. Our office will be completely closed for the week of Thanksgiving (Nov. 20th at noon until Nov 30th at 7am.)  The practice will be covered for ER visits ONLY by another Urologist.   PLEASE plan ahead if you will need prescription refills as he will only be seeing patients in the ER with true emergencies. 
  2. Our office will also be closed for the following holidays Dec. 24 & 25 and Dec 31 at noon, and Jan 1, 2016.   
RECURRENT UTI
This summary came mostly from the work of the American Urologic Association Update Series by Drs. Hickling and Nitti.
Urinary Tract Infections (UTIs) are the most common bacterial infection! HOW VEXING! UTI’s accounts for 8 million doctor visits, more than 200,000 hospitalizations and $3.5 billion health care dollars per year!  In most women, the bladder is a “sterile” organ; it has NO bacteria in it. There are some women who have bacteria living in the bladder but they do not have an inflammatory response.  This condition does not need to be treated.  The definition of a RECURRENT UTI is:  2 CULTURE PROVEN UTIs in 6 months OR three CULTURE PROVEN UTI’s IN 12 MONTHS. 10% of women report reoccurring UTI. 60% will have one UTI, at least once, in their lives.

Where do the bacteria come from?
1.GI tract (anus)
2. Vagina
3. Invasion of urothelial cells (burrows into bladder cells and hide there to be released later)
 
What is the evaluation for a patient with UTI?
If you have only had a couple of UTI's, a detailed history and physical examination are all that is needed. If you have recurrent UTI, we recommend a pelvic ultrasound for post void residual urine, a renal ultrasound and a cystoscopy. If you have residual blood in your urine after the infection has cleared, we recommend a CAT scan of your kidneys, too.

Treatment:
DO NOT TREAT ASYMPTOMATIC UTI. If the patient has NO symptoms, leave it alone!
In patients with symptoms, treat with antibiotics, get a culture before starting the antibiotic (whenever possible), and recheck the urine with a culture 1-2 weeks after the last antibiotic pill.   For the compliant, motivated patient, who has been worked up by the urologist, SELF START therapy can be instituted. Three day therapy is recommended in this circumstance.   Several studies have indicated that the patient can self diagnose 90% of the time, correctly, when educated. This practice has led to fewer adverse events and less utilization of antibiotic.   You must always keep your prescription filled and with you while traveling. Starting the drug quickly is KEY! 
Sacral Neuromodulation Test Stimulation Days
Friday December 4th will be our next test days in the office. 
We have some samples and coupons for Premarin and Aquoral
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