Still peeing blood after uti treatment

Our female Boston terrier was treated for a uti after being seen by our vet. He prescribed her antibiotics and it didn’t go away. He took X-rays and they didn’t show anything abnormal. He then put her on Piroxicam and nothing has helped. She is still peeing in the house and it sometimes has blood in it. What are the next steps and what could it be?

Hello!  And the answer is, as it so often is: It Depends.  We don't know enough about this case or your dog to say what the next step would be, only that this is a complex issue and that here are some of the things it might depend on.

Urinary tract infections need to be correctly diagnosed;  many things that look like urinary tract infections (blood, difficulty urinating and all that jazz) aren't.  Rather, they could be signs of lumps, bumps, inflammation or crystals in the bladder or tubes, protruding prostates in boys and so on.  Even when a urine sample is caught, it may carry down normal bacteria from the edge of the vulva or penis, which can then be interpreted as  a urinary infection.  Ideally therefore, a urinary infection would be diagnosed by inserting tubes into the bladder, and harvesting directly the contents.  They can be tested against different antibiotics to see what kind of antibiotics they respond to.   Antibiotic courses for UTIs often need to be long (up to four weeks), so specialists increasingly recommend culture and sensitivity.

(Culture and sensitivity is the processes of growing the microbes harvested and testing them with different antibiotics).

Furthermore, it depends on what sort of radiographs were taken.  These can range from 'lie-the-dog-on-the-plate-and-press-the-button' films, which would show obvious stones within the bladder, but not necessarily soft tissue lumps etc.  Then there is contrast radiography, where dye is put into the urine and radiographs taken which then show the path of the urine out of the kidneys.  However, this is now being superceded by much improved imaging, for example MRI and complex ultrasonography, which can give extremely helpful information and visualisation of the tract and problems within it.  So the next stage would very much depend on what is known already and what equipment was available.

It sounds to me as though the next step in you case would be to go back to the vet, and ask what possibilities have been ruled out so far and what is still 'on the list'.  This may then identify obvious testing that needs to be done, or even a referral to find out more, depending upon which stage the case is already at.

Diana has written an excellent article here in the Vet Help Direct blog about bladder stones and their diagnosis and treatment.  This is definately one of the possibilities signs similar to those that you have described:  https://vethelpdirect.com/vetblog/2021/04/02/what-causes-bladder-stones-in-dogs-and-how-are-they-treated/

However, someone who knows the case and the context will give you the best advice.