Introduction:

Hello, I am Saswati Chakraborty. I want consultation of an Urologist for my mother Mrs. Kumkum Chakraborty.

History of the Patient:

Mrs, Chakraborty had a recurrent senile UTI first in the year 2006, with symptoms of Dysuria and micturition. At that time the patient consulted Dr. K Pradhan (Kolkata) and under his advice, she conducted an USG of whole abdomen and ECG with Urine culture. The infection was caused mainly by E.coli organism. Dr. Pradhan conducted cyctoscopic urethral dilation under GA and day stay. After that she was given Conjugase (0.625 mg) and Evalon cream to apply daily. Post operation, the patient got fully cured with no discomfort in urine passage.

However, in the year 2011, again recurrent UTI occurred and this time, it was quite serious, with fever and almost same symptoms like the first (difficulty in urine passage, discomfort and dysuria and presence of blood in the urine). She was then admitted in Zenith Hospital (Kolkata) under Dr. Narayan Banerjee and under the combined treatment of Gynac (Sutapa Banerjee), Urologist (Dr. Arindam Dutta) and Dr. Banerjee himself, the patient underwent conservative treatment, with no surgical procedures. She remained admitted from 14.12.2011 to 20.12.2011. In this phase, the patient was given Tablet Urispas (200), for 5 days, to continue with Pan 40 for 2 weeks, Antibiotic (Tablet Glevo 500 mg) for 5 days, Urilizer to be continued and Evalon cream to be applied, Tablet Trika (0.5) for 10 days, Liquid Duphalac 15 mil (for 1 month) and Niftas (100) for 1 month. She had no surgical procedures this time however, the doctor (Urologist-Dr. Arindam Dutta) advised to continue take Veltum 0.2. Upon his advice, the patient took Veltum (0.2) for 1 month and the condition was fine. Since the condition of patient was fine, hence doctor further did not go for cystoscopic dilation.

Present Problem: In the present year 2015, from the month of february, the patient is complaining of discomfort while passing urine and burning sensation in the vaginal area, stomach area and back area. There is no difficulty in urine passage though as patient was taking Veltam 0.2 and there were no traces of blood in urine or fever. In this period, the patient consulted Dr. Anil Chomal (Consultant Urologist-Kolkata) and he gave Tablet Duonem (200) mg-antibiotics for 6 days. After taking the antibiotics, still the discomfort did not pacify and hence the patient reported back to Dr. Arindum Dutta (who treated her in the year 2011). with his consultation, the patient took Zanocein (antibiotic 200 mg) and Urispas tablet. But still there was no improvement. Then the patient went for urine culture after 2 weeks of antibiotic course completion from Roy and Tribedi. I am attaching the reports of Roy and Tribedi (Urine Culture and Urinanalysis). Please have a look. The culture report is normal with no suspicious findings and normal pus cells count. Then she consulted Dr. Manoj Sharma (General Medicine) for her burning sensation as she was confused, since no medicines were working in her case. Dr. Manoj Sharma also gave her an Antibiotic (percin 600) for 10 days. After taking this antibiotic, also the condition did not improve, then  Dr.Arindum Dutta advised for Cystoscopic Dilation. She underwent the second cystoscopic dilation on 28.04.2015. The urinal passage was narrow as per cystoscopic reports and was extended upto 26 Vr. other wise there were no suspicious findings from the cystoscopic dilation report (I am attaching the report herewith of cystoscopic dilation).After the cystoscpic procedure, the patient is complaining of increased burning sensation in the vaginal, pelvic and stomach region. A gynaecological consultation has also been followed up after cystoscopy to see if there are any redness and swelling in the vulvo-vaginal area. However, the gynaecologist has confirmed from local observation that no abnormalities has been found in the uterus. However, she has given a lactic acid wash (Lactacyd) followed by premarin ointment application with application of surfaz sn to avoid any chances of vaginitis. Now she is complaining of terrible burning feeling particularly after urinating and after fecal procedures. In the afternoon from 3.30 p.m to 5.30 p.m the condition worsens and she cant rest her body as she is saying that her chest area, stomach area, lower back and legs are constantly burning in that particular time. There are no blood with urine. Urination flow is alright. Upon advice of consultant family physician she is now taking K-Mac for relief. However there are no signs of relief yet.Present Problem: She is complaining of severe burning sensations in the stomach, pelvic area, vaginal region after urine discharge and anus region. Burning worsens in the afternoon.

Present Medications: She is now presently taking these medications:1. K-Mac: 2 tspns after dinner with Urispass,2. Atorva after lunch3. Febutaz 40 after lunch4. Pantocid DSR in the morning5. Losarbeta in the morning6. Durajoint after dinner (1 tablet daily)7. From 2011 she was consuming Veltam 0.2 but considering the side effects of tamsulosine, the drug has been recently stopped for past 2 days.8. Ativan (Clonazepam) 1 tablet after dinner.She has no history of adverse reactions to any sulfa drugs or any other allergies.I have described the whole condition of the patient. The patient has a history of hypertension, where she suffers from high blood pressure, for which she is taking beta blocker (LosarBeta). The drug has controlled her BP to 130/80 with no fluctuations (several times measured). The reports of sugar shows that she is not diabetic and for cholesterol, she is now taking atorva, however, her level is normal <124. She had no previous surgeries except two time dilation (2006, 2015) and one surgical procedure during the birth of her first child. She has no allergies.


My Questions are:

1. What is causing such irritating and burning sensation in the stomach, pelvic and vaginal region, specially after urinal and fecal procedure?

2. How long this will sustain?

3. Is this something to do with cystoscopic procedures?

4. Does this condition indicate interstitial bladder cystitis? or Renal Tubular Acidosis?

5. How to get relief from such condition?

6. After reading the whole case, and studying the reports, do you think that the patient is suffering from any other serious complications?

7. Can there be any GERD problems going on?8. The patient is consuming Veltum 0.2 from 2011 to 2015. Can this may cause side effects?

I am attaching the following reports1. USG Report2. Report of Blood Sugar (Fasting and PP) and Serum Cholesterol3. Report of Cystoscopic Findings (Recent 28.04.2015)4. Urine Culture Report5. Urinanalysis Report

Please help.

Saswati Chakraborty

 

 

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