8.1 UTI & Scrotal Swelling

Question 1

Risk factors for UTI

Answer 1

• female
• prior UTI
• sexual activity
• spermicide use
• vaginal infection
• diabetes
• obesity
• familial tendency (uroepithelial cells susceptibility; vaginal mucus properties)
• organisms (E. coli)

Question 2

What are the routes of infection?

Answer 2

• ascends urethra to bladder (sometimes kidneys)
• bloodstream (kidneys)

Question 3

By what pathogens are UTI caused?

Answer 3

• mostly bacteria
• virus, fungi, parasites

Common bacterium:
- ➖E. coli (gram negative, LOP O, Fimbriae)
Cell membrane covered by lipoprotein O
- ➖K. Pneumonia (hospital)
- ➖Proteus spp
- ➕Enterococcus. Spp

Question 4

Normal protective functions of UT system:

Answer 4

• complete bladder emptying during micturition
• acid pH (kill most bacteria)
• ⬆️ urea concetration
• uromodulim & uroepithelium mucous secretion (bind to bac, easily secreted)
• utererovesical junction competence
• urethral sphincter competence
• protective uroepithelial immune response

Question 5

Classification of UTI

Answer 5

1. Pyuria - >10WC
2. Bacteriuria - urinary pathogen with colony forming units
3. Asym bacteriuria - not genitourinary signs/sym
4. Sym UTI - bacteriuria in presence of genitourinary signs/sym
5. Uncomplicated UTI - signs/sym with pyuria = bacteriuria in anatomic + functional normal UT
6. Complicated UTI - UTI in structurally or functionally abnormal UT

Question 6

List causes and anatomical changes related to benign scrotal swelling

Answer 6

• Hydrocele
• Epididymitis
• Testis torsion
• Varicocele
• Testis trauma
• Inguinal hernia
• Epidydimal cyst
• Spermatocele

Question 7

Hydrocele

Answer 7

• ⬆️ fluid between viceral and parietal layers of tunica albuginea
• idiopathic (primary)
• Sec: infec (parasite, bac); lymphatic obstruction; trauma

Question 8

Epididymitis

Answer 8

• infalm with swelling of epididymis
• related to UTI or STD

Question 9

Testis torsion

Answer 9

• high insertion of tunica vaginalis on testis
• allows twisting of testis (along puberty)
• transverse testis
• long spermatic cord
• pt often infertile

Question 10

Varicocele
Classification

Answer 10

• primary: spermatic vein(left) obstructed by backpressure from left renal vein pinched between SMA (sup messenteric) and Ao
  veins are dilated
• secondary: retroperitoneal process blocks spermatic vein by external pressure

Question 11

Testis trauma -> haematocele

Answer 11

• rupture with bleeding into same space where hydrocele fluid accumulate
• takes very long time to resolve
• causes haematocele

Question 12

Inguinal hernia

Answer 12

• defect in abdominal musculature with abdom content (bowel) herniating into scrotum
• direct or indirect

Question 13

Epididymal cyst

Answer 13

Embryological remnants in head or tail of epididymis accumulate fluid and forms around cyst

Question 14

Spermatocele

Answer 14

• after vasectomy
• spermatozoa leak from proximal vasal end
• cause accumulation of fluid just above testis

Question 15

How to classify benign scrotal swellings?

Answer 15

Painful:
- Tesitis tortion
- Epiddidmitis
- Trauma

Painless:
- Hydrocele
- Varicocele
- Cancer (benign)