A urinary tract infection (UTI) is a common bacterial infection affecting any part of the urinary system, most frequently the bladder (cystitis). Standard, uncomplicated UTIs usually occur in otherwise healthy individuals and are treated effectively with a short course of oral antibiotics prescribed by a primary care provider. These infections typically present with symptoms like painful urination, urgency, and frequency. However, certain circumstances demand specialized evaluation by a urologist, who focuses on the health and structure of the urinary tract.
When Initial Treatment Fails or Recurrence Occurs
A UTI transitions to a complicated or recurrent issue when initial antibiotic treatment fails or when infections happen too frequently. Treatment failure is signaled by symptoms that persist or return shortly after finishing the prescribed medication. This often means the infection is caused by a drug-resistant bacterium, requiring specialized testing to determine the correct antibiotic. Recurrent UTIs are defined as two or more separate, symptomatic episodes within six months, or three or more episodes within a year. For these chronic issues, a urologist explores long-term management strategies, such as continuous low-dose antibiotics or a “self-start” regimen the patient initiates at the first sign of symptoms.
Severe Symptoms Warranting Immediate Referral
Immediate attention from a specialist or emergency care is necessary when the infection has spread beyond the bladder to the kidneys (pyelonephritis). These cases are complicated UTIs that carry a risk of serious systemic illness. Severe symptoms act as “red flags” signaling the need for urgent urological consultation.
Symptoms suggesting a kidney infection include a high fever, often above 100.4°F, accompanied by shaking chills. Severe, persistent pain in the flank or back, located just beneath the ribs, indicates kidney inflammation. Persistent nausea and vomiting are also concerning, as they can lead to dehydration and prevent effective oral antibiotic use. Gross hematuria (visible blood in the urine) or a sudden, severe inability to urinate also require immediate evaluation.
Identifying Underlying Causes of Complex UTIs
When UTIs are chronic or complicated, the urologist shifts focus from treating the infection to identifying underlying structural, functional, or systemic issues. This comprehensive approach involves specialized diagnostics to investigate the anatomy and function of the urinary tract.
Imaging Tests
The urologist may order imaging tests, such as an ultrasound, CT scan, or MRI, to visualize the urinary tract and look for structural abnormalities. These studies can reveal conditions like kidney stones, which obstruct urine flow and create a breeding ground for bacteria. They also help detect vesicoureteral reflux (urine flowing backward toward the kidneys) or bladder diverticula (small pouches that do not drain completely). In men, the urologist investigates an enlarged prostate (benign prostatic hyperplasia), which causes poor bladder emptying and recurrent infections.
Cystoscopy and Other Evaluations
A common procedure is a cystoscopy, where a thin, lighted tube is inserted through the urethra to investigate the bladder directly. During this procedure, the urologist visually inspects the bladder lining for signs of chronic inflammation, tumors, bladder stones, or urethral strictures. For post-menopausal women, the urologist may also assess for urogenital changes, such as atrophic vaginitis, which predispose them to recurrent UTIs due to changes in the natural vaginal flora.