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.

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.