As a means of diagnosing upper tract disease, a CT (computerized tomography) scan may show anatomical abnormalities in the kidney itself, or perhaps obstruction or dilation of the ureters, kidney stones, or evidence of scarring from previous disease. If the technology for a CT scan is not available to you, another test called an IVP (intravenous pyelogram) may give the same information.

An IVP is an x-ray test in which dye is injected through a needle inserted into a vein of one arm. The dye, which shows up in strong contrast on an x-ray, circulates through the bloodstream to the kidneys and then is excreted through the urinary tract. X-rays are taken at regular intervals for about an hour after the dye is introduced, to show what is happening in the urinary tract. The test can be performed in the outpatient department of a hospital or at a radiology center.

Another test, a backflow test, in which dye is introduced into the bladder with a catheter, will show whether urine is flowing backward up the ureters.

What is the next step if these diagnostic tests turn up a kidney stone or some abnormality?

Many anatomical defects can be corrected surgically. Kidney stones can be removed surgically or dissolved by bombarding them with sound waves, a procedure called lithotripsy, which my patients have told me is somewhat uncomfortable and performed with the use of pain medications.

Which medications work for urinary tract infections?

Most urinary tract infections respond to antibiotics. The course of treatment depends on the severity of the infection. One antibiotic favored nowadays is Macrodantin (generic name nitrofurantoin), because it remains concentrated in the bladder. Since it does not appear in high levels throughout the body, Macrodantin is unlikely to destroy the helpful vaginal organisms that fight yeast infections. Other antibiotics include sulfa drugs, trimethoprim, or quinolones. Some physicians use amoxicillin or ampicillin.

Pyridium, a urinary analgesic, is available without a prescription as Uristat. While it does not kill the bacteria that cause the infection, it does relieve the discomfort. (Don’t be surprised when it turns your urine orange!) Pyridium does not alter a urine culture, so you can still be tested to determine the exact cause of your urinary tract infection even when you are taking pyridium.

Common everyday infections, the kind caused by increased sexual activity, can be treated by short courses of antibiotics, between one and seven days. Repeat infections involve longer courses, sometimes three months or more, to make sure that all the offending bacteria have been killed. After a course of antibiotics, your caregiver may ask for another urine culture to be certain that the infection is gone. Sometimes antibiotics make the symptoms disappear, but the infection can still be detected in the urine sample.

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