Complicated UTI
59
F.S. is a 68-year-old Hispanic male new patient with 4 years of waxing/waning dysuria and severe urethral irritation with intermittent fatigue/malaise. He denies fevers, chills, flank pain, GI symptoms, abdominal/pelvic pressure, or rectal pain, and has no urinary catheter. Multiple prior antibiotic courses (nitrofurantoin, ciprofloxacin, cefuroxime) provided only temporary relief; he is not currently on antibiotics and has no reported antibiotic allergies. He reports hospitalization ~14 months ago for an obstructing kidney stone with infection treated with lithotripsy and temporary ureteral stenting. He travels frequently between Nevada and Mexico, has missed follow-ups, has not returned to urology since discharge, and has no PCP.