長期尿道感染引起的腎水腫和尿路阻塞-泌尿科

長期尿道感染？

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醫師您好，自從4月底第一次小便有血先去一般診所就診發現有右側腎水腫（當時照了超音波及x光沒發現結石）、便讓我多喝水 之後的天天喝3000cc以上，但半個月後再度血尿，之後到大醫院就診照了超音波一樣右側腎臟水腫，x光也找不到石頭於是建議我做ivp檢查得到的是結論是：Intravenous pyelography using non-ionic IV-contrast medium study shows:＞ A vague small radiopaque nodule at right pelvic cavity noted in the plain film.＞ Mild dilatation of right pelvicalyceal system and ureter, with contrast medium stasis even in the post-voiding image.＞ Smooth contour of the luminal surface of the urinary bladder.＞ Mildly increased residual urine after voiding.Impression:1. Favor subtle right UVJ stone with mild obstructive uropathy.Clinical correlation and further management suggested.
（其實也沒看到石頭但右側輸尿管比較狹窄），因之前只讓我定期追蹤 8月初驗尿醫師說尿液也不乾淨（於是吃了兩週抗生素），同時超音波也認為腎臟還是有水腫
Size: Right 129 mm; Left 120 mm;Cortex Echogenicity: ■Gr1Surface: ■SmoothCentral Sinus: ■Hydronephrosis Right ■mod Left ■mildStone: ■Right,size 3 mm;Urinary Bladder: ■NegativeImp: bil. hydronephrosis, right＞ left.

但在這之前我有去婦科就診因為陰道也有點分泌物（也有吃抗生素）可是未見效果。
於是8月初醫師讓我照腹部電腦斷層掃描結果是：
Wgole Abdomen CT with ＆ without IV-contrast enhancement study plus CTU shows:＞ Slight dilatation of right pelvicalyceal system and partial ureter, no obvious hyperdense ureteral stone or soft tissue lesion identified.＞ Diffuse mild fatty liver.＞ No definite abnormal attenuation or enhancing mass lesion in the liver, spleen, pancreas, gallbladder, or kidneys. Few right renal cysts.＞ Within normal appearance of the appendix and bowel loops. ＞ Clear peritoneal fat without obvious ascites.＞ Maintained bony structure without definite fracture.＞ Degenerative change with spur formation at thoracolumbar spine.＞ No definite enlarged para-aortic or mesenteric LN.＞ No active pulmonary lesion at included lungs noted.Impression:1. Slight right hydroureteronephrosis, r/o occult stone or ureteral stricture in distal portion, or inflammation.2. Mild fatty liver.Clinical correlation and follow-up recommended.

一樣沒看到石頭，也是叫我追蹤就好不然就要從輸尿管進去看問題在哪。

實在不曉得該怎麼辦了，一直在吃抗生素可是尿液並沒有乾淨；亦找不到結石，雖然我並沒有太大的疼痛感，可是這樣的長期尿道感染深怕會影響腎臟，請問醫師我該怎麼辦呢？ 非常抱歉 問題較長，謝謝您！

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Mei，30~39歲女性，詢問日期：2022/08/24