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 2nd &3rd
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 1st &16th wk visit.
• -asympt. BU :URINE CULTURE
>100.000cfu/cc.
• -symp. BU :>1000cfu/cc
• -drugs used in pregnancy.
UTI IN CHILDREN
• -in 1st 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 ;1st 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.