MINISTRY OF HEALTH OF UZBEKISTAN
DEVELOPMENT CENTRE OF MEDICAL EDUCATION
Tashkent Medical Academy
"Approved"
Prorector for educational proceedings of TMA
Prof. Teshaev O.R.
«_____»_________________ 2012
Department: UROLOGY
Subject: Urology
SUBJECT: Lower urinary tract infections
Educational-methodical course book
(For teachers and students of medical institutes)
Tashkent-2012
Compiled by:
Mirkhamidov D.H. - docent of Urology department, TMA
Zakirov H.K. - Assistant of Urology department, TMA
Nuraliyev T.Yu. - Assistant of Urology department, TMA
Reviewers:
Gaybullaev A.A. - Head of the Department of Urology and Nephrology
operational Tashkent Institute of Postgraduate Education, PhD.
Fakirov A.Z. - Docent of Pediatric Surgery, Tashkent Medical Academy,
Candidate of Medical Sciences.
Methodical development approved:
- At a meeting of ICC TMA, protocol № __ "___"_______ of 2012.
- The Academic Council of TMA, protocol № ___ of "___"____ 2012.
Pedagogic technology
Topic 5
Amount of students: 10
Form of the practical
occupation
Plan of the practical
occupation
Lower urinary tract infections
Occupation duration: 6 hours
Practical class in a topic
History of problem. Concept, aetiology, pathogenesis,
classification. Acute and chronic cystitis, prostatitis, urethritis,
orchitis, epididymitis(complicated, complicated). Epidemiology.
Most often registered originators in patients with UTI,
pathogenic factors, which lead to development of UTI.
Pathogenesis. Classification of cystitis, prostatitis, urethritis,
orchitis, epididymitis.
Clinical symptoms of an acute and chronic cystitis, prostatitis,
urethritis, orchitis, epididymitis. Diagnostics. Localization
assays. Topical and differential diagnostics of various forms of
lower urinary tract infections. Treatment. Principles of
appointment of antibacterial therapy.
Purpose of educational
occupation
To generate general idea about lower urinary tract
infections(prostatitis, urethritis, orchitis, epididymitis).
To teach students to reveal the basic symptoms of lower urinary
tract infections
Acquisition and strengthening of the received theoretical
knowledge.
Acquisition of practical skills.
Application acquisition of knowledge and skills in practice.
Development of logical thinking of students.
Formation structural thinking of students.
Formation of own thinking of students
The Pedagogical problems:
Acquaint the reason and
mechanism of the origin
symptoms of lower urinary
tract infections
Results:
The student has to be able correctly and purposefully
to study a observation and clinical analysis of urological patients,
to collect the anamnesis, to carry out objective survey of
patients.
The student should know an etiology, a pathogenesis, clinic,
diagnostics, differential diagnostics, treatment and preventive
maintenance of following diseases: cystitis, prostatitis, urethritis,
orchitis, epididymitis; to palpate of male external genitals; to
perform digital rectal examination, to interpret laboratory,
urodynamic, ultrasonic, X-ray, instrumental and other methods
research results of this diseases; to evaluate the effectiveness of
treatment, criteria for cure; to carry out reabilitational and
prophylactic medical examination
Facilities of the education
Practical employment, demonstration, work in small groups –
interactive business game “a round table”.
Uniform methodical system on a topic of education, slides,
Forms of the education
Conditions of the education
Monitoring and estimation
banners, a distributing material, situational problems,
examination of patients in department of urology, the case
record.
Face-to-face, collective and individual work.
The educational room equip with means of training where
probably to apply methods of training, “Urinary tract infection”
room
Oral, written, the decision of situational problems and computer
test problems, analysis of supervised patients, demonstration of
the master practical skills.
Urology. Theme N2
Technological card of practical occupation
“Lower urinary tract infections”
Maintenance of activity:
Activity of teacher
Activity of the student
1 stage. Introduction (15 minutes)
1.1. Stated the name of a theme of practical employment, the
Listened and wrote down.
purpose, the maintenance and expect results are more its.
Wrote down the name of a
1.2. Gave the short information on a theme of practical
theme.
employment. Acquainted students the plan of carrying out of
Answered questions.
employment.
1.3. Acquainted the list of the basic and additional literature.
1.4. For attraction of students to the vigorous activity asked
questions.
2 stage. Basic process (150 minutes)
2.1. Showed visual materials on all questions of the plan of practical Listened, studied, wrote
employment. By use of banners and razdaptochnogo of a material down, defined, asked
interviewed on a theme of employment. Asked to write down high questions.
lights of a theme of employment. Checked knowledge and degree of Wrote down high lights.
development of a material students by use of stands in a thematic Answered questions.
office.
Actively participated in
For definition of base knowledge interviewed. Popravalyaet and interactive games.
rezumiruyet answers.
Participated on kuratsiya of
2.2. In small groups spent interactive games us methods «a round patients, studied case records.
table».
Solved test problems.
2.3. In common with students spent kuratsiya of patients in
stationary branch (poll of patients, objective survey) and acquainted
a material the case record.
2.4. Spent computer test poll in an educational room.
3 stage. Final stage (15 minutes)
3.1. Did the general conclusion on a theme.
Listened, active students was
3.2. Otseniyevayet of knowledge and skills of actively participat estimat. Wrote down the task
students.
for independent work. Wrote
3.3. Declared the questions stud on the next employment and it down a theme of the
asked to be prepar independently.
following employment,
3.4. Gave the task for the following employment:
prepared.
1) To draw an organizer "Pyramid" on prostatitis.
2) Declared a theme of the following topic «Varicocele, Peyroni
desease, erectile dysfunction and man's infertility» and it asked to
be prepar for practical employment.
3) Acquainted questions on control of the knowledge.
4) Acquainted the list of the necessary literature.
Subject: Lower urinary tract infections
1. Venue lessons, equipment
- Department of Urology;
- A set of posters, computer slides, tables;
- Computer.
2. The duration of the study subjects
Number of hours - 5
3. Session Purpose:
To create a general idea about semiotics of urological diseases.
To teach students to identify basic symptoms in diseases of the genitourinary system.
Objectives:
The student should know:
1. Location and nature of pain in urological syndromes.
2. Quantitative changes in the urine.
3. Qualitative changes in the urine.
4. Abnormal discharge from the urethra
5. Pathological changes in the sperm.
6. Types of disorders of urination.
The student should be able to:
1. Differentiate manifestations of pain in urological diseases from those with diseases of other organs.
2. Differentiate from renal colic pain of other origin.
3. Properly gather history, highlight features inherent violation of urination.
4. Assess the severity of the patient with disorders of urination.
5. To assess the impact of urination disorders in the physical condition of the patient.
6. Make an objective examination of the patient, examine the external genitalia.
Motivation
Knowing the symptoms of urological diseases is the basis for the understanding of pathological
processes occurring in the body of patients. Acquired knowledge of symptoms of urological diseases
will allow general practitioners to correctly diagnose urological diseases, acute conditions to identify
and assign an effective treatment.
5. Interdisciplinary communication and inside subject connections
Teaching this topic is based on the knowledge bases of students of biochemistry, normal and
abnormal anatomy, and topographic anatomy with operative surgery, histology, normal and
pathological physiology of the genitourinary system.
Obtained in the course of training, knowledge will facilitate students to understand the
aetiopathogenesis and clinic of urology, to carry out a differential diagnosis, to determine the tactics
and treatment of urological patients.
The content of lessons
6.1. Theoretical part
Urinary tract infection.
Acute urethritis.
(Category 1).
Concept.
Bacterial urethritis - infection is a nonspecific inflammatory disease of the urethra.
Diagnosis. Symptoms and signs.
The diagnosis of acute bacterial urethritis is established on the basis of patient
complaints at discharge from the urethra, burning and pain along the urethra at the
beginning of urination, frequent urination. On examination, determined by the
discharge from the urethra, urethral sponge becomes bright red, puffy. On palpation of
the urethra is sore and swollen.
Laboratory data.
In the analysis of blood leukocytosis with a shift of leukocyte left. Microscopy urethral
discharge revealed white blood cells, epithelial cells and mucus in large quantities.
With the help of color (using the Gram Romanowsky-Giemsa), urethral discharge
revealed bacteria and protozoa. For the detection of trichomonads, in addition to
coloring applied study of native drugs. If you notice white blood cells and bacteria
need to take the selection into a sterile container and place in refrigerator (the material
can be stored up to 8 hours at +4 - +6 °C), and send for culture in a bacteriological
laboratory in a special cold box.
Instrumental research.
Transurethral research and bladder catheterization for acute urethritis contraindicated.
If a patient has acute urinary retention occurred, it is better to do suprapubic bladder
puncture.
Differential diagnosis.
1. Urethritis caused by mycoplasma (urogenital mycoplasmosis) differs total lack of
any specificity, the search for mycoplasmas should be done in many long proceeding,
torpid urethritis, which is found in, for example, Trichomonas and other alleged
agents. Detection of mycoplasmas in the urine of one partner is a signal for the second
survey.
2. Herpetic urethritis caused by pathogen belonging to the group of DNA viruses can
be transmitted sexually. Initial symptoms include burning sensation, discomfort during
urination. Often seen cutaneous manifestations - a group of intense small
hemispherical bubble on the site of opening of which remain painful erosions.
3. Condylomatosis urethra caused by a viral infection. Genital warts - growths
papillomatosis size from point to 0.8 x 0.3 cm or more - appears at the head of the
penis into the vagina in women. Warts appear on the mucous membrane of the inner
layer of the foreskin on the glans penis, coronal sulcus, on the moist areas of the skin
in the scaphoid fossa of the urethra. Persistent disease course.
4. Chlamydial urethritis and Reiter's disease. The causative agent of his is Chlamydia
trachomatis. It is found in sexual partners. The disease often begins urethritis flowing
torpidly, discharge from the urethra, scanty, sometimes have a whitish hue. Multifocal
lesions characterized by the genitourinary system (sluggishly flowing prostatitis,
vesiculitis, epididymitis, etc.).
Treatment.
Outpatient treatment (with the exclusion of a specific inflammatory process:
gonorrhea, trichomoniasis, and others) are assigned doksatsiklin or azithromycin.
Evaluating the effectiveness of treatment.
Based on the reduction of clinical symptoms (cessation of discharge from the urethra,
reducing the pain during the urethra, bladder improvement). Treatment is considered
effective if within 48 hours after the appointment of antibacterial agents decreased
clinical signs of disease and ceased discharge from the urethra.
Tactics.
With the ineffectiveness of conservative treatment for 7 days the patient should be
referred to a urologist or invite a specialist for advice.
Criteria for cure.
The complete disappearance of clinical signs, persistent normalization of urine tests.
Analysis of urine for the presence of bacteriuria leukocyturia and must be repeated up
to 1 month 1 time per week.
Prevention at the level of the patient (an individual).
Effective prevention of acute bacterial urethritis is to prevent the penetration of
ascending urinary tract infection. In men, the risk of acute urethritis is high in the
performance of instrumental studies and manipulation of the urethra. In this connection
it is necessary to study and manipulation of the urethra to hold on strict indications and
in aseptic conditions.
Prevention at the family level.
The family should be conducted outreach on hygiene for men and women, and sexual
health.
Prevention at the community level.
Promoting healthy lifestyles, standards (requirements), personal hygiene, sexual
health, disease prevention, sexually transmitted diseases.
Standard protocol
Urinary tract infection.
Acute cystitis.
(Category 1).
Concept.
Acute cystitis - a non-specific infectious inflammatory disease of the bladder.
Diagnosis. Symptoms and signs.
Diagnosis is based on the specific patient's complaints of frequent urination without
delay, nocturia, burning during urination and dysuria. Pain and suprapubic region, and
discomfort. On palpation often reveals suprapubic tenderness.
Laboratory data.
In the analysis of blood there is no change or there is a slight leukocytosis. In the
analysis of urine sediment microscopy revealed leykotsituriya more than 400 in the
field of view, more than 100,000 bacteriuria in 1 ml of urine, sometimes reveals
macro-or microhematuria. If you find leukocyturia and bacteriuria must take urine in a
sterile container, placed in a refrigerator (where the urine can be stored up to 8 hours at
+4 - +6  C), and send for culture in a bacteriological laboratory in a special cold box.
Instrumental research.
Ultrasound. Send the patient to the US kidneys, ureters and bladder to prevent urinary
tract obstruction, stones, tumors and the presence of residual urine. If you find
obstruction, tumors, stones, and residual urine the patient referred to a specialist
urologist.
Differential diagnosis.
1. Acute cystitis should be differentiated from acute urethral syndrome in women.
When urethral syndrome observed frequent urination and dysuria, and urine culture
shows few or no growth of bacteria.
2. Vulvovaginitis may show symptoms of cystitis. It can be diagnosed accurately by
physical examination with proper research on the content of vaginal pathogens.
3. Acute pyelonephritis may cause instability of the bladder. A typical low back pain,
fever, and ultrasound can differentiate acute pyelonephritis from acute cystitis.
4. In men, acute bacterial cystitis must be differentiated from infection of urethra, the
prostate. Appropriate physical examination and laboratory tests usually allow the
doctor to make a correct diagnosis.
5. Acute cystitis should be distinguished from the stone on the bottom third of the
ureter. Appropriate physical, ultrasonic and X-ray studies allow the correct diagnosis.
Treatment.
According to results of urine culture. In identifying genital infection in women,
treatment agree with the gynecologist.
Outpatient treatment: trimethoprim / sulfometoksazol (biseptol) inside or
fluoroquinolones.
Reserve: cephalosporin or nitrofurantoin inside or doksatsiklin, amoxicillin /
clavulanate.
Criteria for cure.
The complete disappearance of clinical signs, persistent normalization of urine tests.
Analysis of urine for the presence of bacteriuria leukocyturia and must be repeated up
to 1 month 1 time per week.
Prevention at the level of the patient (an individual).
Effective prevention of acute bacterial urethritis is to prevent the penetration of
ascending urinary tract infection. In men, the risk of acute urethritis is high in the
performance of instrumental examinations and manipulation of the urethra. In this
connection it is necessary to investigate and manipulation of the urethra to hold on
strict indications and in aseptic conditions.
Prevention at the family level.
The family should be conducted outreach on hygiene for men and women, and sexual
health.
Prevention at the community level.
Promoting healthy lifestyles, standards (requirements), personal hygiene, sexual
health, disease prevention, sexually transmitted diseases.
Standard protocol
Urinary tract infection.
Chronic cystitis.
(Category 1).
Concept.
Chronic bacterial cystitis - a non-specific infectious inflammatory disease of the
bladder, bladder infection when there is 3 or more times within a year.
Diagnosis. Symptoms and signs.
Chronic cystitis may be asymptomatic or have various symptoms of irritation of the
bladder. In patients observed frequent urination, dysuria, nocturia. Isolation of air in
the urine makes you think about the possible presence of enteric-vesical fistula, or
infection with gas-forming pathogens. On physical examination are often not available.
Laboratory data.
If no chronic cystitis complicated by severe urinary tract disorders, blood will be
normal. In the analysis of urine sediment microscopy revealed bacteriuria more than
100,000 in 1 ml of urine, and small Pyuria. Women need to smear from the cervix and
vestibule.
If you find bacteriuria and leukocyturia necessary to take urine and swab from the
cervix and vestibule in a sterile container, placed in a refrigerator (where the urine can
be stored up to 8 hours at +4 ° +6 ° C), and send for culture in a bacteriological
laboratory in special cold box.
Instrumental research.
Ultrasound. Send the patient to the US kidneys, ureters and bladder to prevent urinary
tract obstruction, stones, tumors and the presence of residual urine. If you find
obstruction, tumors, stones, and residual urine the patient referred to a specialist
urologist.
Differential diagnosis.
1. Chronic cystitis must be differentiated from other infectious diseases: vaginitis,
prostatitis, urethritis and kidney infection. The typical clinical symptoms, physical
examination and other techniques allow a correct diagnosis.
2. Tuberculosis is a kidney or bladder is differentiated from chronic cystitis the
presence of "sterile" pyuria.
3. Chronic cystitis should be differentiated from non-infectious conditions, such as
prussic vaginitis, urethritis associated with hormone deficiency, non-communicable
diseases urethra abacterial prostatitis, interstitial cystitis, allergic cystitis, radiation
cystitis, cystitis after chemotherapy and others.
Treatment.
The most important aspect of treatment is to identify the causes of the causes and
appropriate correction of predisposing factors, if possible. In identifying infectious and
inflammatory diseases of the genitalia agree with the treatment of a gynecologist.
Treatment: Trimethoprim / sulfometoksazol (biseptol) inside or fluoroquinolones.
Reserve: cephalosporins by mouth, or nitrofurantoin, or doksatsiklin, or sulfonamides,
or amoxicillin / clavulanate.
Evaluating the effectiveness of treatment.
Based on the reduction of clinical symptoms (dysuria decrease pain, improve wellbeing). Counts the number of leukocytes in 1 ml of urine (or in the field of view of the
microscope) after 48 hours after the appointment of antibacterial drugs. Treatment is
effective if this date number of leukocytes in 1 ml of urine (or in the field of view) is
decreased significantly (multiple), disappears bacteriuria.
Tactics.
If you find the stones, tumors or other diseases of the bladder, or the effectiveness of
conservative treatment, after 48 hours the patient should be referred to a urologist or
invite a specialist for advice.
Criteria for cure.
The complete disappearance of clinical signs of disease. Sustained normalization of
urine and blood. Analysis of urine for the presence of bacteriuria and leukocyturia
must be repeated up to 2 months, 1 every 15 days.
Prevention at the level of the patient (an individual).
Prevention of chronic cystitis is to identify causes and contributing factors, as well as
their removal and treatment.
In children with suspected anomalies and / or vesicoureteral reflux complete urological
examination.
Prophylactic treatment with antibiotics and antiseptics should be prolonged until full
rehabilitation. The women - sites of infection of the genitals. Patients should observe
personal hygiene (regular bathing, change of underwear) and sexual health
Prevention at the family level.
The family must be carried out advocacy work on women's personal hygiene,
especially for girls, because asymptomatic bacteriuria is more common in patients
poorly or improperly exercising it. It is important to respect sexual health.
Prevention at the community level.
Promoting healthy lifestyles, standards (requirements), personal hygiene, sexual
health, disease prevention, sexually transmitted diseases. Early identification of risk
groups (congenital kidney and urinary tract diseases, persons with latent bacteriuria
and others).
Rehabilitation of patients and clinical examination of patients with chronic cystitis.
Patients with chronic cystitis, after elimination of the causes of disease, antibiotic
therapy should be continued according to the sensitivity of microorganisms according
to urine culture and bacteriological smear seeding of the vagina and cervix in women.
Prophylactic treatment with antibiotics and antiseptics should be prolonged, to
complete rehabilitation, and a prophylactic treatment with antibiotics and antiseptics
should be prolonged, to complete rehabilitation, and systematic control of urine.
Efficacy of treatment should be assessed on the dynamics of the results of urine and
smears of the vestibule and the cervix in women.
Control urine (smear of vestibule in females) - Counting the number of leukocytes in
1 ml of urine and the presence of bacteria in the sediment should be repeated in the
period up to 1 month 1 every 10 days to 3 months - 1 time per month, then up to 1 year
- 1 every 3 months.
When complete disappearance of clinical symptoms and the absence of bacteriuria
leukocyturia and the patient must be under medical supervision for 1 year.
In the case of treatment failure, presence or growth leukocyturia bacteriuria and patient
should be referred to a urologist or invite a specialist for advice.
In patients with chronic cystitis, it is necessary readjustment of foci of any location, in
women, especially sanitation foci of infection from the genitals. Patients should
observe personal hygiene (regular patients with chronic cystitis, it is necessary
readjustment of foci of any location, in women, especially sanitation foci of infection
from the genitals. Patients should observe personal hygiene (regular bathing, change of
underwear) and sexual health .
If you have a drainage tube (tsistostomichesky, urethral catheter, etc.) need care for
drainage.
Sanatorium treatment of patients with chronic cystitis, recommended after a course
of antibiotic therapy and complete rehabilitation of the urinary tract.
Standard protocol
Genital infection in men.
Acute uncomplicated prostatitis.
(Category 1).
Concept.
Acute bacterial prostatitis - an infectious disease is a nonspecific inflammatory
disorder of the prostate gland. May cover part or all of the share of the prostate.
Diagnosis. Symptoms and signs.
Diagnosis is based on specific patient complaints on rise in body temperature to 39 40 ° C, pain in the rump and perineum, frequent and strong urge to urinate, nocturia,
can be observed and myalgia arthralgia.
At rectal palpation the prostate there is a strong pain, swelling, pastose and local
hyperthermia. Prostate massage is contraindicated in acute prostatitis, because the can
cause bacteremia or complaints of pain. Acute prostatitis is usually accompanied by
acute cystitis and urine in this case is murky, can be detected by gross hematuria.
Laboratory data.
In the analysis of blood leukocytosis with a shift of leukocyte left. When smear (if
discharge from the urethra) are found in large quantities leukocytes and bacteria. In the
analysis of urine revealed Pyuria, more than 400 in the field of view, bacteriuria, more
than 100,000 in 1 ml of urine, fresh red blood cells.
In prostatic fluid can also be detected in a large number of white blood cells and
bacteria. If you find leukocyturia and bacteriuria must take urine (if there is prostatic
fluid) in a sterile container and place in refrigerator (urine or prostatic fluid can be
stored up to 8 hours at +4 ° - +6 ° C), and send for culture in a bacteriological
laboratory In the secret in the prostate also can be detected in a large number of white
blood cells and bacteria. If you find leukocyturia and bacteriuria must take urine (if
there is prostatic fluid) in a sterile container and place in refrigerator (urine or prostatic
fluid can be stored up to 8 hours at +4 ° - +6 ° C), and send for culture in a
bacteriological laboratory in a special cold box.
Instrumental research.
Transurethral catheterization studies and research and Transurethral bladder
catheterization for acute prostatitis are contraindicated.
If a patient has acute urinary retention occurred, it is better to do suprapubic bladder
puncture.
Ultrasound. Send the patient to the US of the bladder, prostate. If you find an abscess,
or urinary retention prostate patient referred to a specialist urologist.
Differential diagnosis.
Acute pyelonephritis can be accompanied by strong stimulation of the bladder.
Prostatitis pain localized in the sacral region, whereas pyelonephritis lumbar pain. The
changes found during rectal examination the prostate for acute prostatitis, make it easy
to differentiate acute pyelonephritis may be associated with acute severe irritation of
the bladder. Prostatitis pain localized in the sacral region, whereas pyelonephritis
lumbar pain. The changes found during rectal examination the prostate for acute
prostatitis can be easily differentiated from acute prostatitis acute infection of the
upper urinary tract.
Acute diverticulitis be differentiated from acute prostatitis. Carefully collected history
and physical examination usually differentiate these two states.
Acute granulomatous prostatitis should be differentiated from acute bacterial
prostatitis. Acute eosinophilic granulomatous prostatitis variant in people with a
history of allergic or bronchial asthma. This condition is usually accompanied by
severe manifestations of generalized vasculitis. The diagnosis in this case is made by
histological examination of biopsy the prostate.
Treatment.
According to results of urine culture and prostatic secretions. Outpatient treatment: (to
the exclusion of a specific inflammatory process: gonorrhea, trichomoniasis, and
others) fluoroquinolones.
Reserve: trimethoprim / sulfometoksazol (biseptol).
Evaluating the effectiveness of treatment.
Based on the reduction of clinical signs (decreased body temperature, decrease pain,
dysuria, micturition improvement). Reduce pain, swelling and pastosity by rectal
examination of prostate. Counts the number of leukocytes in 1 ml of urine (or prostate
secretion) at 48 hours after the appointment of antibacterial drugs. Treatment is
effective if this date fell clinical signs of disease, there is reduction in the number of
leukocytes in 1 ml based on the reduction of clinical signs of disease (decreased body
temperature, decrease pain, dysuria, micturition improvement). Reduce pain, swelling
and pastosity by rectal examination of prostate. Counts the number of leukocytes in 1
ml of urine (or prostate secretion) at 48 hours after the appointment of antibacterial
drugs. Treatment is effective if this date fell clinical signs of disease, there is reduction
in the number of leukocytes in 1 ml of urine (or prostate secretion) and the
disappearance of bacteriuria.
Tactics.
In the event of acute urinary retention, prostatic abscess formation, with the
development of epididymitis, bacteriological shock the patient immediately referred to
a urologist. With the ineffectiveness of conservative treatment of uncomplicated
prostatitis in 48 hours, the patient should be sent to a urologist or invite a specialist for
advice.
Criteria for cure.
The complete disappearance of clinical signs of disease. Sustained normalization of
urine, blood and prostatic secretions. Analysis of urine and prostatic secretions for the
presence of bacteriuria leukocyturia and must be repeated up to 1 month 1 every 10
days, then up to 3 months - 1 time per month.
Prevention at the level of the patient (an individual).
Effective prevention of acute bacterial prostatitis is to prevent the penetration of
ascending urinary tract infection. In the case of infection of the urinary tract using the
instrumental manipulation of the urethra and reduce to the strict aseptic conditions.
In patients with acute bacterial prostatitis requires readjustment of foci of infection of
any location. Patients should observe good personal hygiene and sexual health.
Prevention at the family level.
The family should be conducted outreach on hygiene for men and sexual health.
Prevention at the community level.
Promoting healthy lifestyles, standards (requirements), personal hygiene, sexual
health, disease prevention, sexually transmitted diseases.
Standard protocol
Genital infection in men.
Acute orchitis.
(Category 1).
Concept.
Acute orchitis - a non-specific infectious inflammatory disease of the testicle. In 2035% of cases, orchitis occurs after mumps.
Diagnosis. Symptoms and signs.
Diagnosis is based on specific patient complaints and an increase in pain in the
scrotum, increased body temperature to 40 ° C.
Objectively, one or both testicles grow and become very painful. Often, it is
impossible to distinguish by palpation of the appendix testis. Scrotum skin hyperemic.
With transillumination can be detected acute hydrops shell eggs.
Laboratory data.
A blood test usually shows leukocytosis.
Urine tests, smear microscopy are needed to determine urinary tract infections. When
orchitis, urinalysis, often without pathology. If you find leukocyturia and bacteriuria
must take urine in a sterile container and place in refrigerator (urine can be stored up to
8 hours at +4 ° - +6 ° C), and send for culture in a bacteriological laboratory in a
special cold box.
Instrumental research.
Transurethral examination and bladder catheterization for acute orchitis
contraindicated.
Ultrasound. Send the patient to the US of the scrotum. If you notice an abscess testicle,
the patient referred to a specialist - a urologist.
Differential diagnosis.
1. Acute epididymitis can be easily distinguished from acute orchitis by palpation. The
presence of urethral discharge and pyuria, and ultrasound data of the scrotum can
differentiate epididymitis.
2. Testicular torsion the spermatic cord and is more common in boys and adolescents.
At the beginning of the disease testicular torsion, appendix testis can be felt from the
top. Ultrasound scanning can confirm or exclude the diagnosis of orchitis.
3. Post-traumatic testicular rupture and severe bleeding in the testis observed in injury
scrotum. Ultrasonography can differentiate rupture of testicular orchitis.
4. Testicular tumors should be differentiated from acute orchitis. Careful palpation of
the scrotum reveals a painless education in compressed testicular tumors. Testicular
ultrasound examination allows us to differentiate the diagnosis of these conditions.
Treatment.
When orchitis caused by bacterial infection, antimicrobial agents are appointed doksatsiklin or azithromycin.
General measures: bed rest, useful to the local heat and wear jockstrap.
Evaluating the effectiveness of treatment.
Based on the reduction of clinical signs (decreased body temperature, reducing pain
and swelling of the testicle), feeling better.
Tactics.
With the ineffectiveness of conservative treatment for 7 days or when an abscess the
patient should be referred to a urologist.
Criteria for cure.
The complete disappearance of clinical signs of disease. Sustained normalization of
blood and urine tests. Restoration of normal size and consistency of the testicle.
Prevention at the level of the patient (an individual).
Fat-soluble protivoparotitnaya virus vaccine is very effective in the prevention of
mumps and its complications, such as orchitis. In the presence of urinary tract
infections or other infections of the body needed treatment and rehabilitation sites of
infection. Patients with a history of orchitis should observe good personal hygiene and
sexual health.
Prevention at the family level.
The family must be carried out advocacy work on men's personal hygiene, prevention
of sexually transmitted infections and urinary tract infections.
Prevention at the community level.
Promoting healthy lifestyles, standards (requirements), personal hygiene, sexual
health, disease prevention, sexually transmitted diseases.
Standard protocol
Genital infection in men
Acute epididymitis.
(Category 1).
Concept.
Acute epididymitis - an infection is a nonspecific inflammatory disease of the
epididymis.
Diagnosis. Symptoms and signs.
Diagnosis is based on specific patient complaints of pain in the scrotum, and which
may radiate along the spermatic cord, epididymis increase within 3-4 hours, increased
body temperature to 40 ° degrees. There may be mucous-purulent discharge from the
urethra, the symptoms of cystitis or prostatitis.
OBJECTIVE: scrotum usually increases and becomes hyperemic. In the early stages
of acute epididymitis increased, uplotenny, painful appendage can be distinguished
from the testicle, but after several hours of becoming an appendage of the testicle and
one common mass. Spermatic cord may increase due to swelling.
Laboratory data.
In the analysis of blood leukocytosis with a shift of leukocyte left. Urine tests, smear
microscopy (with a discharge from the urethra) are needed to determine the urinary
tract infection. If you find leukocyturia and bacteriuria must take urine in a sterile
container and place in refrigerator (urine or discharge from the urethra can be stored up
to 8 hours at +4 ° - +6 ° C), and send for culture in a bacteriological laboratory in a
special cold box.
Instrumental research..
Transurethral research and bladder catheterization in acute epididymitis are
contraindicated.
Ultrasound. Send the patient to the US of the scrotum. If you notice an abscess
appendage patient referred to a specialist urologist.
Differential diagnosis.
1. Tuberculous epididymitis - rarely seen severe pain and fever. On palpation the
appendage is distinguishable from the testis, there may be a symptom of "beads". At
rectal examination the prostate is determined by the compaction and an increase in the
seminal vesicles, located on the side of epididymitis. The diagnosis is the detection of
tubercle bacilli in cultures of urine or prostatic secretions.
2. Testicular tumors should be differentiated from acute epididymitis. Careful
palpation reveals isolated from normal appendage formation, coming from the testicle.
Informative ultrasound of the scrotum.
3. Torsion of the spermatic cord is more common in boys and adolescents, but can
occasionally occur in adults. At the beginning of the disease twisting of the spermatic
cord, an appendage can be felt above the testicle. Later, the egg and the appendage
increased sharply painful, their texture becomes dense. The use of ultrasound scan can
confirm or exclude the diagnosis of epididymitis.
4. Testicular trauma can mimic acute epididymitis. In the history of corruption and the
lack of pyuria or urethral discharge helps in the differential diagnosis.
5. Orchitis - inflammation of the testicles should be differentiated from acute
epididymitis. Orchitis is usually accompanied by parotitis (inflammation of the parotid
gland). In the differential diagnosis is of great importance ultrasound sonography
scrotum.
Treatment.
With the exclusion of a specific inflammatory process (gonorrhea, tuberculosis),
testicular tumors and abscesses appointed doksatsiklin or azithromycin in combination
with protivotrihomonadnyh drugs.
Evaluating the effectiveness of treatment.
Based on the reduction of clinical signs (decreased body temperature, reducing pain
and swelling in the scrotum), feeling better.
Tactics.
With the ineffectiveness of conservative treatment for 7 days, and abscess detection of
the tumor, the patient should be sent to a urologist.
Criteria for cure.
The complete disappearance of clinical signs of disease. Sustained normalization of
urine and blood. Appendage return of normal size and consistency.
Prevention at (individual).
Prevention of sexually transmitted infections, the identification and treatment of the
major causes of urinary tract infections and prostatitis. Patients with a history of
epididymitis should observe good personal hygiene and sexual health.
Prevention at the family level.
The family must be carried out advocacy work on men's personal hygiene, prevention
of sexually transmitted infections and urinary tract infections.
Prevention at the community level.
Promoting healthy lifestyles, standards (requirements), personal hygiene, sexual
health, disease prevention, sexually transmitted diseases.
Rehabilitation of patients and clinical examination of patients with epididymitis.
Patients with nonspecific epididymitis, after clinical improvement, should be in the
presence of a urinary tract infection continue prophylactic treatment with antibiotics
and antiseptics.
Evaluate the effectiveness of treatment must be under the control of urine: counting the
number of leukocytes in 1 ml of urine and detect bacteria in the sediment.
When complete disappearance of clinical symptoms and the absence of bacteriuria
leukocyturia and the patient must be under medical observation for 6 months.
In the case of treatment failure, and recurrence of the disease or not the disappearance
of bacteriuria and leukocyturia patient should be referred to a urologist or invite a
specialist for advice.
Patients who have had epididymitis, shows the reorganization of foci of any location.
Patients should observe good personal hygiene and sexual health.
Used in this lesson, new teaching technologies, "Round Table".
USING "Round Table".
The method provides for joint activities and active participation in the classroom each student, the
teacher works with the entire group.
Embarks on a circle piece of paper with the job. Each student writes his answer sheet and passes the
other. All write down their answers, followed by discussion: crossed out the wrong answers, the
number of correct - evaluate the student's knowledge.
To think about each answer the student is given 3 minutes. Then, the answers are discussed. At the
end of the method of teacher comments on your answer is correct, its validity, the activity level of
students.
This methodology promotes student speech, forming the foundations of critical thinking as In this
case, the student learns to assert his view, analyze responses band members - participants of the
contest.
6.2. Analitical part
Situational task:
Task 1. A man 52 years ago there was an acute night pain in the lumbar region to the right, which
was accompanied by gross hematuria at first. Pain radiating into the right groin. Fever, chills and
joint pain no. Patient notes frequent urination, pain while urinating or reduce the amount of urine is
not. He suffers from gout, during an exacerbation which takes colchicine and NSAIDs. Last
exacerbation of gout was about 9 months ago. Currently, no symptoms of gout. Family history of
kidney disease and bladder is not burdened. Prior to that, back pain or hematuria was not.
1. Your preliminary diagnosis?
2. Possible changes in the overall results of urine analysis.
3. Possible changes in the results of the US kidneys.
Answers:
1. Urolithiasis. Stone of the right ureter.
2. In the analysis of urine - increase the number of red blood cells, white blood cells.
3. US on the bladder - Kidney enlargement of cavities
Task 2. A man in '71 went to the emergency department at the lack of self-urination in the past 24
hours. It was found that for the last 6 months. He observed the deterioration of symptoms, including
frequent urination, nocturia, urgency to urinate and a sluggish stream of urine. In the last 2 weeks
notes incontinence. He suffers from mild hypertension and BPH.
Rectal examination: a prostate spherical shape, the median furrow is not determined, nodules are not
palpable. Ultrasound of the kidneys: two-way ureterohydronefrosis. Ultrasound bladder volume
800ml.
Questions.
1. What causes urinary tract obstruction in a patient?
2. What medical tactics?
Answers:
1. BPH.
2. Bladder catheterization or PC cystostomy.
Task 3. The patient complained of blood in the urine, urine color "meat slops."
Questions:
1. How is this symptom?
2. Where localised pathological focus?
Answers:
1. Hematuria (total).
2. Kidneys, pelvis, ureter, bladder.
Task 3. A woman 67 years with hypertension over the past 2 months was noted two episodes of
painless gross hematuria total. Urolithiasis, trauma and coagulopathy lumbar region it was not. The
patient smoked a pack of cigarettes a day for 40 years.
Questions:
1. What is the presumptive diagnosis?
2. What research is needed to make?
6.3. Practical part
The interview with the patient in the urology department, conducting physical examination,
determination of the nature of pain, its location, and intensity of irradiation, urinary disorders, as well
as changes in quality and quantity of urine in patients with urological diseases, the causes and
mechanisms of the onset of symptoms in patients with urological diseases.
7. Forms of control knowledge, skills and abilities
- Viva voice examination;
- Writing;
- Solution of tasks;
- Tests.
8. Criteria for evaluating the current control
Achievement
as a
№
percentage (%) and
scoring the student's
knowledge
level
rating
1
86-100
Achievement as a Achievement as a percentage (%) and scoring
percentage (%) and the student's knowledge level rating
scoring the student's
knowledge
level
rating
Excellent "5"
Independently analyses
Uses in practice
.
Shows high activity, a creative approach to the
conduct of interactive games
Correctly solves the case studies with full
justification for the answer
Understands the subject matter
Knows, says confident
Has a faithful representation
2
.
71-85
Good "4"
Uses in practice
Shows high activity during the interactive
games
Correctly solve situational problems, but the
rationale for the answer not full enough
Understands the subject matter
Knows, says confident
Has a faithful representation
3
55-71
.
4
54 and less
.
Satisfactorily
"3"
Knows, says not sure
Unsatisfactorily
"2"
It does not accurately represent
Has a partial view
Do not know
9. Chronological map of classes
№
Stages of training
1.
2.
Lead-in tutor (study subjects).
Discussion topics practical training, assessment
of baseline knowledge of students with new
educational technologies (round table, case
studies, slides), as well as checking the source of
students' knowledge, the use of visual aids
(slides, models, phantoms, ultrasound, x-ray,
etc.).
Summing up the discussion.
Giving students tasks to perform the practical
part of training. Cottage explanations and notes
for the task. Self-Supervision.
The assimilation of skills a student with a teacher
(Supervision thematic patient)
3.
4.
5.
6.
7.
8.
Forms
employment
The
survey,
explanation
of Continued
a
resident
of
Property in the
minutes. 225
10
an 50
15
30
Medical
history, 40
clinical role-playing
case studies
Analysis of the results of laboratory and work
with
the 30
instrumental
studies
thematic
patient, clinical laboratory
differential diagnosis, treatment plan and instruments
rehabilitation, prescriptions, etc.
Talk degree goal classes on the basis of developed Oral
questioning, 30
theoretical knowledge and practical experience test,
debate,
on the results of the student, and with this in discussion of the
mind, evaluation of the group.
practical work
Conclusion of the teacher on this lesson. Information,
20
Assessment of the students on a 100 point system questions for selfand its publication. Cottage set students the next training.
class (a set of questions)
10. Questions
1. The causes of renal colic.
2. Types and causes of anuria.
3. Hematuria and its difference from urethremorrhagia.
4. Total hematuria and its cause factors.
5. Reasons postrenal anuria.
6. The difference between anuria and ischuria.
7. Chyluria and its causes.
11. Recommended Reading
1. Учебник «Урология». М. Медицина, 2004г
2. Руководство по урологии в 3-х томах. Под ред. Акад. Н.А. Лопаткина М, 1998г.
3. Неотложная урология. Ю.А.Пытель, И.И. Золотарев. М. Медицина, 1985г.
More:
1.
Мартин И. Резник. Секреты урологии. 1998г.
2.
Справочник врача общей практики. Дж. Мёрт. М. Практика. 1998г.
3.
Пытель Ю. А., Борисов В.В. Физиология человека. Мочевые пути. М.1992г.
4.
Урология и андрология в вопросах и ответах. Под ред. О.А.Тиктинского, В.В. Михайличенко.
«Питер». Санкт-Петербург, 1998. – 377с.
5.
Урология по Дональду Смиту. Под ред. Э.Танаго и Дж.Маканинча. Перевод с англ. «Практика».
М. 2005. – 819с.
6.
Интернет:
(www.uroweb.ru;
www.uro.ru;
www.medscape.com;
www.uroweb.org; www.bju.org; www.europeanurology.com).
www.medicalstudents.com;