Q: My 56 years old father has been suffering from urine infection since long. Even after the course of antibiotics, pus cells have been found in large number in his latest urine test. Will this have any harmful affect on his kidneys?

A:Urine infection (UTI) is uncommon in men between 3 to 50 years of age, but incidence increases dramatically after this age. Urine infection is a cause of significant morbidity and mortality in elderly men and has to be taken seriously. On other hand, diagnosis of UTI and its treatment on the basis of presence of pus cells in urine, or growth of bacteria on urine culture, over treats many such men. First, presence of pus cells in urine (pyuria) does not mean infection. A person can have pyuria even in absence of infection in presence of a foreign body like catheter and stones, as well as during healing phase after any urinary surgery. Second, presence of bacteria on a urine culture test does not always mean infection. Bacteria may be present in urine even in absence of infection if urine has not been collected properly or the sample has been stored at room temperature for more than half hour before it was processed, as happens to tests on samples collected at home and delivered to the lab later. A person can even grow bacteria in bladder without infection as in catheterised patients called asymptomatic bacteria and does no require treatment. Commonest causes of persistent infection in elderly men is urinary obstruction due to prostatic enlargement in 50 to 80% cases, other causes being stone disease, anatomical abnormalities of the urinary tract like bladder diverticula and genitourinary tuberculosis. Your physician is right. There is more to pus cells and bacteria in urine than what meets the eye, and would confuse many primary physicians and the patients alike. Your dad would certainly be helped by a specialist.