ACUTE BACTERIAL PROSTATITIS -it is inflam. Refluxed from bladder or ascend from urethra -PRESENTATION :fever,constit. Symp.,urolog. Symp.,PR avoided,catheter avoided. -Dx :GUE,micrscopic exam. & culture of prostatic expressate,E.coli is common.,U/S,TRU/S. Rx :empiric therapy against G-ve bacteria indication of hospitalisation: 1-sepsis 2-immunecompromised 3-acute retention 4-significant medical comorbidities
CHRONIC BACTERIAL PROSTATITIS -INSIDOUS ONSET -CAUSED BY PERSISTENCE OF PATHOGEN IN PROSTATIC FLUID DESPITE OF ANTIBIOTIC. -PRESENTATION:asymp.,dysuria,frequency,low backpain,urgency,nocturia.,PR (normal,tendered,firm,stone) Ix :GUE,4 CUP TESTS,TRU/S -Rx : antibiotic for 3-4 m. alpha-blockers(reduce recurrence rate) cure is difficult suppressive therapy(not responding) TUR-P(refractory condition)
GRANULOMATOUS PROSTATITIS bacterial,viral,fungal,BCG,syste mic -eisinophilic or non eiosinophilic -fever,chills,obst/irrit. Symp. -GUE,PR(hard),prostatic biopsy -Rx : antibiotic steroid temperory emptying TUR-P(if not responding)
PROSTATIC ABSCESS -inadequate Rx of acute prostatitis -DM,pt. on dialysis,immuncompromised undergoing cath. -simillar to acute bact. Prostatitis -PR(tendered,swollen prostate) -TRU/S &pelvic CT -Rx : transrectal drainage under TRU/S or CT wth antib. if fail TUR drainage done
EPIDIDYMITIS -caused by ascending infection from LUT. -in males <35 yr caused by STD. -in children & old age caused by uropathogens.
PRESENTATION - scrotal pain radiating to groin &flank. -scrotal swelling due to infl. Or hydrocele. -symp. Of ureth.,cystitis,prostatitis. -O/E tendered red scrotal swelling.
epididymitis
investigations GUE : WBCS. Urethral discharge C/S. Doppler U/S &isotope scan. U/S :epididymal enlargement &hydrocele. Radiological evaluation in children.
ULTRASOUND
DOPPLER U/S
Doppler u/s of torsed lt. testicle
TREATMENT -ORAL ANTIBIOTIC. -SCROTAL ELEVATION, bed rest,&use of NSAID. -admission & IV drugs used. -in STD treat partner. -in chronic pain do epididymectomy.
URETHRITIS - NGU Rx by erythromycin or doxycyclin with follow up of pt. for 7 days. -treatment of persistent or recurrent urethritis is by metronidazole & erythromycin to act against both T.vaginalis &genital mycoplasma.
UTI IN PREGNANCY -anatomical changes :enlarged uterus specially in 2 nd &3 rd trimesters. -physiological changes :increase GFR &increase progesteron. -30% of pt. with BU develop PN. -INCIDENCE OF PN IN PREGNANT IS 1-4%.
UTI IN PREGNANCY -PN if untreated lead to prematurity &perinatal death. -evaluation at 1 st &16 th wk visit. -asympt. BU :URINE CULTURE > cfu/cc. -symp. BU :>1000cfu/cc -drugs used in pregnancy.
UTI IN CHILDREN - in 1 st yr boys >girls affected. -presentation :infant non specific.more localisation in older children. -diagnosis :urine C/S,GUE,blood tests(ESR,C-reactive prot. -classification ;1 st infection & recurrent infection. - recurrent infection :unresolved BU,b.persistence or reinfection.
UTI IN CHILDREN -E.coli is the most causative agent. -host factors -child is at greater risk of renal scarring by UTI. -incomplete immune & neurologic system. -delayed Dx due to non specific presentation.
UTI IN CHILDREN -renal scarrings may lead to HT & even ESRD. -TREATMENT :not severely ill child treated orally. Severly ill pt. treated by hospitalisation,IV drugs. -prophylactic antibiotics &radiological assessment is needed to prevent renal scarring.