Date:
Patient:
Reason for Visit:
Follow-up for recurrent UTI
Evaluation of symptoms and frequency of UTIs
Discussion of risk factors and preventive strategies
History:
Presenting Illness:
Number and frequency of UTIs in the past year
Symptoms during UTI episodes (e.g., dysuria, urgency, frequency, hematuria)
Duration of symptoms before seeking treatment
Treatment received for previous UTIs (antibiotics, duration)
Response to previous treatments (improvement in symptoms)
Past Medical History (PMH):
Underlying medical conditions (diabetes, kidney stones)
Prior surgeries (urological procedures)
History of sexually transmitted infections (STIs)
Use of urinary catheters
Social History:
Sexual activity and practices (frequency, spermicide use)
Fluid intake habits
Voiding habits (frequency, incomplete emptying)
Use of birth control pills or diaphragms
Physical Exam:
General: Assess for signs of fever or systemic illness.
Abdominal: Palpate for bladder distention or tenderness.
Genitourinary: Evaluate for external signs of inflammation or irritation.
Diagnostic Tests (may be ordered depending on clinical presentation):
Urinalysis and urine culture: Confirm UTI diagnosis, identify causative organism, and assess for antibiotic susceptibility.
Midstream clean catch technique: Ensures accurate urine sample collection for culture.
Imaging studies (may be considered in some cases):
Renal ultrasound – to rule out structural abnormalities of the urinary tract.
Cystoscopy – to visualize the bladder and urethra for abnormalities (less common).
Assessment:
Confirmation of recurrent UTI: Defined as two or more documented UTIs within 6 months or three or more within a year.
Severity of symptoms and impact on quality of life.
Identification of potential risk factors: Anatomical abnormalities, incomplete bladder emptying, urinary stasis, behavioral factors, hormonal changes (postmenopause), frequent UTIs during pregnancy.
Antibiotic resistance testing: To guide appropriate antibiotic selection for future treatment.
Plan:
Acute UTI treatment: Antibiotics based on culture results and susceptibility testing. The duration of treatment may be adjusted based on severity and frequency of UTIs.
Preventive strategies:
Increased fluid intake (water is best) to promote urination and flush bacteria.
Double voiding (urinating twice consecutively) to ensure complete bladder emptying.
Wiping from front to back after urination to prevent bacteria from entering the urethra.
Cranberry products (limited evidence, but may be considered).
Low-dose antibiotic prophylaxis (may be recommended for high-risk patients).
Consider topical estrogen therapy for postmenopausal women with recurrent UTIs.
Address modifiable risk factors (e.g., spermicide use, incomplete emptying).
Referral to a urologist (may be considered): For complex cases, suspected anatomical abnormalities, or recurrent UTIs despite appropriate preventive measures.
Patient education: Provide information about UTIs, risk factors, importance of complete antibiotic courses, and preventive strategies.
Discuss signs and symptoms of UTI and importance of seeking prompt treatment.
Encourage open communication about sexual health and practices.
Follow-up:
Schedule for follow-up appointments based on severity:
More frequent visits for patients with frequent UTIs or those on long-term antibiotic prophylaxis.
Less frequent visits for patients with well-controlled symptoms and no recent UTIs.
Monitor response to treatment, adjust preventive plan as needed, and address any ongoing concerns.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of recurrent urinary tract infections