Most UTIs can be treated by your gynecologist or family physician. If the diagnosis is difficult or the treatment fails, your doctor will refer you to a urologist.

First Doctor's Visit

You will be asked to provide a urine specimen that will either be analyzed in the doctor's office or sent to an outside laboratory. A large number of white blood cells indicates that your body has made an effort to fight some kind of infection. The presence of bacteria can also be directly confirmed. This is done quickly in a process called urinalysis.

If the doctor wants to find out exactly which bacteria have invaded, he or she will order a urine culture, which takes 24 to 72 hours. The laboratory may also be asked to determine which antibiotic will destroy those bacteria most effectively, so that your doctor can prescribe the most beneficial medication. (You will probably already have been given a small prescription for a broad-spectrum antibiotic—one that works against most bacteria—and for a painkilling medication to get started fighting the infection and discomfort right away.)

Other reasons for a urine culture are:

• Suspicion of a more serious infection, such as gonorrhea;

• Pregnancy or diabetes;

• An infection that returns within 3 weeks;

• Symptoms that continue for more than 7 days despite taking medication;

• Recent surgery of the genital or urinary tract or insertion or removal of a catheter.

If you could be pregnant or your doctor suspects an anatomical problem, such as a cystocele or a tumor, your doctor will also do a pelvic exam.

More Complex Tests

If your medication doesn't work or the doctor suspects a physical abnormality that cannot be seen, you will probably be referred to a urologist for more complex procedures. They may be performed at the doctor's office or a hospital.

A cystoscope allows the doctor to look directly into your urethra and bladder to check for irritation or a small tumor. First you will be given a local or general anesthetic. Then the scope will be passed through your urethra and into your bladder. Through the scope, the doctor can insert tiny instruments to collect small samples of urine and tissue for the laboratory to analyze. This procedure takes about 10 minutes once the cystoscope is in place.

With cystourethrography, a chemical is inserted into the bladder through the cystoscope. X-rays are taken as you urinate. The doctor watches to see if urine is backing up instead of flowing out.

Cystometry measures how well your bladder is functioning by gauging its ability to expand and contract. After introducing water or carbon dioxide into the bladder through a catheter, technicians note the amount you urinate each time you report the urge. The test takes about 30 to 60 minutes and is usually done in a hospital. Local anesthesia will prevent pain during the procedure.

An intravenous pyelogram (IVP) is performed by a radiologist and an x-ray technician in the outpatient department of a hospital. They will take a preliminary x-ray of your abdomen. Then you will lie down and a needle will be inserted into a vein in one arm. Special dye, called contrast material, is injected through the needle. Within a few minutes, the dye is carried by the blood to the kidneys and then through the urinary tract.

The goal is to find any blockage, such as kidney stones, or slight anatomic variations in the urinary tract, that might make it easier for an infection to take hold. X-rays are taken at regular intervals, such as after 1, 5, 10, and 15 minutes. After about an hour, the radiologist should have a good idea of what's going on in your urinary tract. This test is not suggested for women who are pregnant or those who have ever had an allergic reaction to x-ray contrast material.