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    Urinary Retention, and recurrent Urinary Tract Infections
    An_245691 posted:
    Hi, I'm a 24-year old male, and totally new to this board. I've had a condition from as long as I remember where I am not able to void completely the bladder voluntarily. According to my parents, this was noticed at around the age of 3, due to having recurrent urinary tract infections. Being a male, this shouldn't be that common, and this enabled them to trigger some warnings. Due to this urinary retention, I was having urine reflux up the urethras, and as a side-problem, the kidneys enlarged (Kidney Hydronephrosis). Kidney size is currently roughly around 14 - 15cm in size, with the left kidney being bigger than the right. (as told by my ultrasound doctor). I'm currently performclean self-intermittent catheterization 3 - 4 times a day. This was just to give an overview of my condition, my two main issues being below.

    Lately, I'm having extremely recurrent urinary tract infections, almost twice a month. This is what is bothering me the most. I have no problem doing the intermittent catheterization, as I'm used to it and have incorporated it into my schedule - I would do anything to be able to get rid of it, but if I have to live with it, it's not such a huge problem. However, having such common urinary tract infections is making me very frustrated, as it leaves me quite weak, with fever, and pain in urination. I then do a urine test to get an idea of sensitivity, and then take a course of antibiotics, normally for 5 - 7 days. The problem is that as soon as I stop antibiotics, most of the time 1 - 4 days after another UTI starts. I've always had UTIs from time to time, but lately they're very common. I had periods in my life when I didn't have a single one for about 8 - 12 months. As far as I know, no lifestyle changes were done. To add to my frustration, I was much less healthy before (smoked regularly, binge drinked a lot, ate loads of fast food, ...) than I am today, and used to get much less UTIs! I've done a good deal of research on the internet to try and find if there is anything I can do to stop these UTIs. Some of these are:

    - Stopped smoking about 2 years ago, as I read that it can irritate the bladder. Nothing really changed. Nowadays just smoke the occasional cigarette when I'm having a drink, but never more than 3 - 4 cigaretters per week.

    - I go out regularly every weekend (Fri, Sat, Sun), and drink alcohol as well. When I was younger, I used to binge drink almost every weekend, which I've now reduced to having around 4 - 6 alcohol units per night out. Nothing has changed from the UTIs. I've even tried a period of 5 weeks not even touching a single alcoholic drink. I noticed it took a bit longer to get a UTI, but I think this could have been a coincidence, as sometimes I do go for 3 - 4 weeks without a UTI, though rarely. I intend to do another bout of non-drinking to re-test this, as lately they're extremely frequent again.

    - Added more exercise, as I read it could help.

    - Take 2x cranberry tablets twice a day - This seems to have reduced the intensity of UTIs, but not remove them.

    - Take cranberry juice: No difference

    - Take grapefruit seed extract: No difference

    - Take Uva Ursi as a possible herbal treatment, rather than antibiotics - Didn't seem to work

    - Take fish oil supplements: No difference

    Whenever I used to talk with my doctor about these frequent UTIs, I never found them to take it very seriously. On the books, when doing test results, everything looks stable.

    Another frustrating issue is that they never actually gave me a 'label' to my condition. They told me they can't properly diagnose the condition.

    I would like to know if there is any possible thing I could do in such a situation. Sorry for the long post, but I couldn't know how to summarize this in any less!
    counterso responded:
    First thought is that the brand of cranberry supplements you are taking contain an inadequate amount of PACs to actually affect the e.coli. The fact you said they are tablets also probably means they have a cellulose binder that binds to the PACs in the cranberry before they ever get used in your body, rendering them ineffective. Cranberry juice should be effective if you drink enough, but you need to drink it twice per day since PACs only stay active in the body for about 12 hours before they bind to the blood and stop working.

    If you're going to take a cranberry supplement, you should take one that is certified for PAC content to provide the amount that is needed for benefit, like TheraCran.

    You're correct about the abnormality of UTIs in men, and since you've identified the problem, the issue that remains is a useful solution.

    Clearly the most likely cause of infections that are now occurring because of the frequent catheterization which pushes bacteria into your bladder where it colonizes. The number one solution is hygiene, and that's making sure that your penis is disinfected before inserting the catheter, as well as the catheter (and your hands) being disinfected.

    The second thing is to strengthen your immune system. With the regular use of antibiotics, your immune system is all messed up. A long course of probiotics will help (more than a month). And if you are still taking antibiotics, you'll need to adjust the timing of your probiotics so you don't waste them.

    Frequent infections are serious mainly because of the damage they do to your immune system after taking antibiotics. That plus the fact that a male UTI can very quickly become life-threatening means anything you can to to reduce the chance of getting one is a good idea.

    GSE, Fish Oil, and Uva Ursi have nothing to do with UTIs and are not a solution. There is nothing that can get rid of an existing one other than antibiotics, and none of the three of those will do anything to prevent them.

    For as much stress as your urinary system is under it seems ill-advised that you stress it further with things like heavy drinking (by which is meant more than 1 alcoholic beverage in a day). There's nothing wrong with exercise, but it's not going to change your infection rate.

    And as far as a long-term solution, the physical abnormality that is causing the urine retention is something to discuss with a urologist to determine if there is a surgical correction that could alleviate the need to catheterize. The need to catheterize doubles the risk of infection already caused by the urine retention.

    If your urologist is so laisse faire about your circumstances, I'd say it's time to replace the urologist and look for a permanent solution where your risk is reduced, not increased.
    An_245691 replied to counterso's response:
    I am taking Seven Seas Cranberry tablets, which contain 200mg of cranberry active ingredient (that is what is listed on the container). Personally I think i found tablets more effective than juice, as I find the taste of cranberry juice too sweet.

    Regarding catherterization - I use a new cathether every time, and use Instillagel as a lubricant, which I use to place some on the tip of the urethra (externally), as well as about 7-10 inches from the catheter tip. I wash my hands using antibacterial & disinfectant (Dermophardi), as well as the head of the penis / tip of urethra.

    Regarding probiotics - I tried taking them for a very short period, maybe 5 days but stopped as I didn't see any real effect. Do you think it would be better for a longer term? And what type of probiotics would you suggest? The ones which only contain lacidophillus bacillus, or the ones with more strains? And how should one take probiotics, especially when I'm also taking antibiotics at the same time. Most of the time antibiotics are Augmentin 625mg 1 tablet 3 times day, or Ciprox 500mg 1 table, twice daily.

    As a side note, most of the latest infections are of the E.Coli or Klebsiella Pneumonia type, and sometimes although a bit rare, Serratia Marcescens.

    Recently (last Monday), I went to see a different doctor specialised in Urology, and he said that the reason is that my exact condition / reason for not voiding bladder completely is current unknown. Personally I don't think that they will be doing anything else to try to identify the cause, or treat the root problem. I've done loads of DTPAs, Urodynamics, Ultrasounds, Xrays, a CT-scan (once), as well as Uroflow. They said that in such cases, it would normally be something related to the nerves, but in that case there would other complications like spinal cord injury, spina bifida etc. In my case, apart from this i'm pretty much fine. They said there is nothing they could do to allieave the cause, and the intermittent catheterization is the treatment.

    Regarding the frequent UTIs, he suggested being placed under proper care of a bacteriologist to see exactly what type of bacteria. He also mentioned that general antibiotics I take kill around 80% of the bacteria. The assumption is that the remaining 20% die off or are killed by the body. In my case, he said that the 20% may be living off, and re-multiplicating to cause another infection. He suggested an option where I would be hospitalised for 5 days and given intravenous antibiotics, as well as an indwelling cathether for 4 - 5 weeks. I have no problem regarding the hospitalisation, but I find the indwelling cathether a bit problematic, given that it leaves you quite limited in what you can do, and reduces quite significantly the quality of life.
    counterso replied to An_245691's response:
    Seven Seas is not helping. First, there is no such thing as a one-a-day cranberry solution. The PACs (proanthocyanidins) only remain active in the body for about 12 hours. Second, the weight of cranberry has NOTHING to do with the amount of PACs in the product. Third it has cellulose which binds to the PACs rendering them much less effective. Most cranberry supplements are about 1% PACs and it takes about 33mg PACs per day to be effective. At 200mg of cranberry material, you're probably getting 2mg PACs. Ineffective.

    Please check out the reliable product that I recommended. It is the one used in research studies by universities and the NIH because it is that much better.

    If you don't like cranberry juice cocktail because it's sweet, then you can go to the health food store and get 100% cranberry juice. Cranberry juice cocktail is about 27% cranberry juice, so if you take the much more bitter 100% juice you would only need about 3oz twice per day for the same amount of PACs. The other small downside of juice (other than not liking the taste) is that the longer it sits on the shelf, more of the PACs settle out of the juice as long-chain (less useful) PACs. In the case of juice, freshness counts. That's why many people find the cranberry supplements to be a highly effective substitute for juice (don't like taste, not subject to aging).

    Cranberry can only address the e.coli bacteria. It attaches to the p-fimbria of the e.coli and prevents these fimbria from being able to attach to the bladder wall, colonizing into an infection. Since regular voiding is usually what washes these bacteria from your bladder, when you retain urine, the bacteria have a moist environment in which to live and aren't all flushed out. The other substance that attaches to the Type-1-fimbria of the e.coli is d-Mannose, however taking mannose orally does not reach your bladder. This substance is only effective as a bladder wash.

    There is no natural product (other than your immune system) that is currently known to address the likelihood of infection from other bacteria types like Klebs or Serratia.

    The study of your infection using something like a 7-day broth culture is likely to give you a more complete picture of the bacteria that you are encountering. What is SUPPOSED to happen when the doctor does a UTI test is that they first find out if there is an infection, and second (most importantly) they test the bacteria they found against a panel of many antibiotics to see which antibiotics are effective against the strain(s) that were found. This is meant to prevent super-infections where resistant bacteria remain because the antibiotics prescribed are no longer capable of clearing the infection.

    Probiotics do not work in a week. You need to take them for no less than a month. That's like expecting your lawn to be lush and full after throwing seed down 5 days prior. It doesn't happen that way. It is a longer term maintenance program that builds your good flora over time. It is not a treatment. Every time you get an infection your immune system is weakened and every time you take an antibiotic your immune system is damaged. It takes a lot longer to restore the natural balance in your gut than it does to wreck it.

    If your doctor is already thinking that you have resistant bacteria, they are completely negligent in not insisting on the test that determines the effectiveness of an antibiotic treatment before giving it to you. A broad-based antibiotic infusion is a horrible thing to do to your body and I agree with you that you should avoid it. That doesn't mean you can't get effective treatment.

    I'm glad to hear that you are following a very high standard of caution with your catheters.

    It sounds like three things can help:
    1) proper testing/assignment of effective antibiotic
    2) long-term probiotics use to restore immune function
    3) different cranberry product to reduce e.coli risk
    An_245691 replied to counterso's response:
    Regarding cranberry tablets - I take 2 tablets, twice daily (every 12 hours). I'll look into that product, hopefully being able to find it for purchase in Malta, as not all stuff can be easily found here.

    Currently whenever I have an infection, I take the urine to be tested for the type of bacteria. Results come out within 2 - 3 days, and they tell me what type of bacteria they are and which antibiotics are effective. Most of the time, if the bacteria is E.Coli or Klebsiella (90% of the times), then it is sensitive to Augmentin and Ciprofloxacin (Siprox). Doctors never prescribe antibiotics without the urine test results first.

    Regarding probiotics, when and how much should I take, especially when taking them side by side with another course of antibiotics? I would like to give this probiotic thing another try.

    Thanks again!
    counterso replied to An_245691's response:
    Unfortunately TheraCran will not likely be available to you outside of the United States. You can refer to this product comparison chart and choose an alternate that is free of cellulose, and take the number of pills indicated as an equivalent dosage based on PAC content.

    Probiotics should be taken at least 2 hours AFTER antibiotics, and continued for at least a month beyond the course of antibiotics. While taking antibiotics, the most effective variety is probably sacchromices boullardi. After your antibiotics have finished, a more complete probiotic formula would be appropriate, particularly one that features lactobactillus varieties.
    An_245691 replied to counterso's response:
    Unfortunately one doesn't find a lot of varieties here, but I will check when I go to the local health store.

    Regarding probiotics, I take Prebio 9 Forte ( ). Do you think this would be good for a long term ( 1month ) period?
    counterso replied to An_245691's response:
    Prebio 9 Forte sounds pretty good. 1 month is not long term, a year would be long(er) term for probiotics, but there's nothing wrong with or risky taking them every day for years.

    When you look for cranberry, if you're taking a pill product, avoid all tablets (almost all of them have cellulose), and estimate that most have about 1% PAC content, so you need to take enough to provide around 16 or 17 mg PACs twice a day. That means for every 100mg of cranberry material, you get about 1mg PACs.

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