Patient: Description of condition (onset, main symptoms, hospital visited, etc.): Patient female, 60 years old. onset in July, urinary tract infection in hot and muggy weather, burning pain in urine, with a feeling of abdominal cramping. She was diagnosed with pelvic inflammatory disease after a gynecological examination and routine urine examination at a local informal hospital; later she went to a regular hospital for examination and had no gynecological problems. Yesterday, the symptoms of urinary tract infection appeared again, and the patient felt cramping in the abdomen and needed hot water to relieve it. The urine routine examination leukocytes +++75, microscopic examination leukocytes of 20-25. Due to recurrent attacks for two consecutive months, the patient had a heavy burden of thought. Due to the initial onset of the disease, a gynecological consultation at a local private hospital was sought, and chronic pelvic inflammatory disease was diagnosed. After three days, the situation improved and was changed to oral medication. She relapsed one week after stopping the medication. She was given oral triple gold tablets and other antibiotics on her own. The situation improved and then relapsed after one week. Went to the nearest regular hospital and was diagnosed with urinary tract infection and prescribed oral medication. The situation improved and relapsed a week later. Yesterday the patient felt the symptoms again and reported burning pain in the urine and discomfort in the abdomen at night, which could only be relieved after applying warm compresses with a warm water bag. But the symptoms were lighter than before. I went to Dongzhimen Hospital of Traditional Chinese Medicine and the doctor prescribed oral fluoxacin. I hope to cure it as soon as possible and reduce the number of recurrences, can you give some advice? Also, is there any direct relationship between lower abdominal cramping and urinary tract infection? Yang Yong, Department of Urology, Beijing University Cancer Hospital
Yang Yong, Department of Urology, Beijing Chaoyang Hospital: It should be a recurrent urinary tract infection or cystitis. The key is to find the cause of recurrent episodes. Usually there are three reasons: 1. Bacterial virulence or drug-resistant bacterial infection, which needs to be confirmed by bacteriological culture. If positive culture can be obtained, sensitive antibiotics need to be selected for two consecutive weeks orally according to the results, and intravenous drip antibiotics are not recommended because they can easily lead to mycobacterial infection. If high fever occurs during the attack, intravenous drip control of bacteremia is required followed by two weeks of oral antibiotics; 2. Decreased resistance. The most common cause in the elderly is due to poor control of diabetes mellitus, other causes are long-term oral steroid hormones or taking some kind of immunosuppressant for other diseases; 3. Urinary dysfunction. It is not uncommon in the elderly, and careful history taking can reveal that most of these patients have difficulty in urination. When encountering such symptoms, urinary flow rate and residual urine volume determination tests are required, or further urodynamic tests are done. Recurrent urinary tract infections in patients with dyspareunia can only be prevented from recurring if the dyspareunia is relieved. Intravenous drip antibiotics and long-term oral antibiotics alone are only temporarily effective in this group of patients, and relapse will soon occur.