Q: My 68 years old father has recurrent urinary tract infection (UTI) problem along with prostatitis. But as per the doctor prostate enlargement (75 g in weight) does not contribute to UTI but the problem is still there. His prostate specific antigen (PSA) test was 26 during the severe UTI. His urine test report showed plenty of pus cells 10-12 RBC and albumin was ++. The UTI gets cured when we give treatment but recurs when we stop it with the symptom of high fever. His abdomen ultrasonography (USG) showed prostate enlargement, mild hydronephrosis and hydroureter. The doctor said it is not due to the prostate enlargement. What should we do? He had undergone trochanter surgery and now he has no mobility at all. Can this immobility be the reason for his problem? Please advise.

A:There is no doubt about your father suffering with urinary tract infection (UTI), as evident with symptoms, urine findings, as well as PSA. Such episodes are not uncommon with major illnesses like inter-trochanteric fracture when urethral catheterisation is done for a short term. Intractability and recurrent nature of UTI suggests co-existing pathology with ineffective bladder emptying, as also suggested by the fullness of the upper tract. Limited mobility does not make a person prone to UTI, though it may exacerbate borderline co-existing pathology due to any reason, as it is more difficult to empty the bladder lying down than either sitting or standing. Many patients with limited mobility may be on indwelling catheters too, making it practically impossible to sterilise their urine. Most common pathology making UTI intractable in such age is prostatic obstruction, though other pathologies like diabetic bladders and stricture of urethra may be the reason.