The association of lower abdominal tenderness with increased pus cells in the urine points towards an infection in the urinary bladder. This can be followed up in two ways. The first is a course of antibiotics followed by a routine urine examination and a culture to confirm that the infection is gone. This is referred to as empirical treatment. The second course of action is a urine culture and a vaginal examination followed by appropriate medication and a urine culture. It is very important to follow up with a urine culture after the treatment course is complete to ensure that no residual infection is present as this may cause kidney damage or general poor health. The absence of any residual urine after passing out urine is reassuring and the kidney cysts are inconsequential.