Top Docs: Understanding urinary tract infection
Urinary tract infections are the bane of womankind.
One in five women will get at least one in her lifetime, according to the National Kidney Foundation. And, though less common, men get them, too.
Only 25¢ for 5 months
Urinary tract infections are the bane of womankind.
One in five women will get at least one in her lifetime, according to the National Kidney Foundation. And, though less common, men get them, too.
An infection typically occurs when bacteria enter the urinary tract through the urethra, the tube that carries urine out of the body, and begin to multiply. Most urinary tract infections, or UTIs, stay in the bladder, where urine is stored. Without prompt treatment, bacteria can travel upward, infecting the kidneys.
However, the past two to three decades of research have yet to yield a breakthrough preventive therapy.
"We are still very much reliant on antibiotics to deal with infections," said Dr. Robert Moldwin, director of the Pelvic Pain Center at the Smith Institute for Urology in New Hyde Park and an associate professor of urology at the Hofstra North Shore-LIJ School of Medicine in Hempstead, which will enroll its first class next summer.
SYMPTOMS
Not everyone with a urinary tract infection has symptoms, reports the National Kidney and Urologic Diseases Information Clearinghouse. But most people experience one or more symptoms, such as:
- Urgent need to urinate, but often little urine passes.
- A burning feeling during or after urination
- Pressure or pain in the lower abdomen.
- Urine that looks cloudy or reddish if blood is present.
- A tired, shaky feeling.
- Urine with a strong odor.
Still, without a full work-up, it can be risky to assume that a UTI is responsible for discomfort. "The symptoms of urinary tract infections are nonspecific, and the same symptoms may be related to, let us say, many other diseases," said Dr. Zelik Frischer, a urology professor at Stony Brook University Medical Center and a member of its urology practice in East Setauket. It's important to rule out bladder tumors, for instance, he said.
Another possibility to eliminate is interstitial cystitis, a painful bladder condition, Moldwin added. He said he has seen a number of patients with this condition who, over the years, had been improperly treated with either antibiotics for UTI or medications to control an overactive bladder. "A lot of clinicians haven't even heard the term," he said of interstitial cystitis, "and if they don't know about it, they don't think about it."
RISK FACTORS
Women are particularly UTI-prone because they have a shorter urethra than do men, and that makes it easier for bacteria to reach the bladder, according to the kidney foundation. Women who engage in frequent sexual intercourse are also at risk, says the American College of Obstetricians and Gynecologists.
Other risk factors include:
- Having diabetes, which changes the immune system.
- Having an obstructed urine flow, such as a kidney stone or enlarged prostate gland.
- Using a catheter, or tube, to urinate.
CURRENT THINKING
Infrequent sufferers are usually treated on a case-by-case basis. Often, UTIs clear up within a day or two with antibiotics, but sometimes a longer course of medication is needed.
For women prone to recurrent infections, one option is what's called "self therapy." The woman is given a prescription to fill for an antibiotic, a cup for a urine sample and a prescription for the laboratory's bacteria culture. The next time she thinks she has a UTI, she urinates in the cup, refrigerates it, takes an antibiotic and takes the urine sample and prescription to the lab.
"This is a quick way for that patient to do well, to do well rapidly, to be empowered, and I think it works out really, really well - and patients love it," Moldwin said.
Another option for people with frequent, recurrent infections is to take low doses of antibiotics over an extended period of time. This helps suppress the growth of bacteria.
To prevent UTIs linked to sexual intercourse, some people take an antibiotic right after having sex.
In the future, a vaccine might be the best strategy to protect the urinary tract against bacterial infection, Frischer and Moldwin said.
THE LONG ISLAND SCENE
The American Urological Association Foundation maintains an online directory of urologists. To find a doctor near you, go to urologyhealth.org/find_urologist.
This is the 18th installment of a 26-week series in which Newsday presents Castle Connolly's list of top L.I. doctors. Today: nephrologists and urologists
Who's who
NEPHROLOGY
Dr. Alessandro Bellucci
North Shore Univ. Hosp., Dept. Nephrology, 300 Community Dr., Great Neck, 516-562-4312
Dr. Steven Bourla
789 Old Country Rd., Plainview, 516-433-3600
Dr. Steven Fishbane
200 Old Country Rd., Mineola, 516-663-2169
Dr. Lionel Mailloux
50 Seaview Blvd., Port Washington, 516-484-6093
Dr. Joseph Mattana
100 Community Dr., Great Neck, 516-465-3010
Dr. Richard Schwarz
325 Park Ave., Huntington, 631-351-3784
Dr. Pravin Singhal
100 Community Dr., Great Neck, 516-465-3010
Dr. John Wagner
410 Lakeville Rd., New Hyde Park, 516-465-3010
UROLOGY
Dr. Roman Alyskewycz
10 Medical Plaza, Glen Cove, 516-676-4328
Dr. Richard Ashley
233 Seventh St., Garden City, 516-294-7666
Dr. David Beccia
332 E. Main St., Bay Shore, 631-665-3737
Dr. Anthony Bruno
1305 Franklin Ave., Garden City, 516-746-5550
Dr. Mitchell Buchbinder
2001 Marcus Ave., Lake Success, 516-437-4228
Dr. Zelik Frischer
24 Research Way, East Setauket, 631-444-3887
Dr. Sarah Girardi
535 Plandome Rd., Manhasset, 516-627-6188
Dr. Moneer Hanna
935 Northern Blvd., Great Neck, 516-466-6950
Dr. Steven Harris
309 W. Park Ave., Long Beach, 516-431-9800
Dr. Louis Kavoussi
450 Lakeville Rd., New Hyde Park, 516-734-8558
Dr. Jeffrey Layne
1181 Old Country Rd., Plainview, 516-933-6060
Dr. Arnold Leventhal
1800 Rockaway Ave., Hewlett, 516-593-1838
Dr. Elliott Lieberman
875 Old Country Rd., Plainview, 516-931-1710
Dr. Brett Mellinger
Mellinger Urology, 100 Garden City Plaza, Garden City, 516-873-5353
Dr. Carl Mills
250 Yaphank Rd., East Patchogue, 631-475-5051
Dr. Robert Moldwin
450 Lakeville Rd., New Hyde Park, 516-734-8500
Dr. Barry Shepard
601 Franklin Ave., Garden City, 516-742-3200
Dr. Robert Sunshine
4230 Hempstead Tpke., Bethpage, 516-796-2222
Dr. Robert Wasnick
Stony Brook Medical Park, 24 Research Way, East Setauket, 631-444-6270
Dr. Michael Ziegelbaum
2001 Marcus Ave., Lake Success, 516-437-4228
How they were picked
Castle Connolly Medical Ltd. is a health care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.
Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Newsday is not part of the selection process.
Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.
To see the whole list . . .
Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The soft-cover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.
Have a whirlwind weekend in Saratoga with Newsday travel reporter Scott Vogel