B8.050 Male UTI Flashcards
what is a cremasteric reflex?
when you stroke the medial thigh, the testicle elevate
no cremasteric reflex + high riding testicle
testicular torsion
testicle will be fixed and hard
UA in the case of epididymitis
normal
epididymitis findings on scrotal US
increased blood flow (unlike torsion)
enlarged epididymal head
reactive hydrocele
do you need to do a scrotal US to evaluate epididymitis?
no
but if you’re unsure, you should do it
testicular torsion is an emergency, do not want to miss it
what is epididymitis
inflammation of the epididymis with or without infection
-can be due to chemical exposure
pathophys of epididymitis
retrograde ascent of pathogens along vas deferens to epididymis
2 most important factors in evaluating epididymitis
- patient age
2. patient sexual history
cause of epididymitis in individuals < 35 yrs
neisseria gonorrhea or chlamydia trachomatis
cause of epididymitis in individuals > 35 yrs
e.coli or other urinary tract pathogens
treatment of epididymitis in individuals < 35 yrs
ceftriaxone 250 mg IM & doxy 100 mg BID
10 days
OR
1 g azithromycin once
treatment of epididymitis in individuals > 35 yrs
levofloxacin 500 mg daily for 10 days
what questions should you always ask in a urological evaluation?
flank pain? hematuria? history of stones or UTIs? have you ever been unable to pee and had to get a catheter? urinary tract instrumentation?
what do you need in a diagnosis of acute bacterial prostatitis?
URINE CULTURE
should you order a PSA in the setting of prostatitis?
no
will be falsely elevated in 70% of men and may persist for 1-2 months
epidemiology of acute bacterial prostatitis
peak incidence in men 20-40 and >70
cause of acute bacterial prostatitis
ascending urethral infection or intraprostatic reflux
-the prostate is a sponge, ejaculate/urine can get into ducts and sit, there is a lot of stasis in the prostate
risk factors for acute bacterial prostatitis
BPH (number 1) GU infections high risk sexual behavior history of STIs immunocompromised phimosis prostate manipulation urethral stricture
common acute prostatitis pathogens
e.coli (>50%) pseudomonas klebsiella enterococcus enterobacter proteus serratia
presentation of ABP
irritative symptoms obstructive symptoms rectal and perineal pain painful ejaculation, hematospermia fevers, chills, nausea prostate boggy on rectal exam post-void residual may be elevated
ddx of ABP
BPH chronic BP chronic pelvic pains syndrome cystitis diverticulitis epididymitis orchitis proctitis prostate cancer
evaluation of ABP
midstream UA and urine culture
high risk men should be evaluated for G&C
when should you get imaging in a patient with ABP?
patients who remain febrile after 36 hours or whose symptoms do not improve with antibiotics
what imaging is obtained in ABP
CT
transrectal US
NOT a renal US
outpatient treatment of ABP
fluoroquinolone or TMP-SMX for 4 weeks
OR
if high risk sexual activity:
ceftriaxone 250 mg IM + doxy for 10 days
inpatient treatment of ABP
IV fluoro vs IV B-lactam (ceftriaxone) vs IV extended spectrum B-lactamases **treat for 24-48 hours with parenteral and transition to oral for 6 weeks
appearance of prostatic abscess on imaging
darker area within an enlarged prostate
characterize prostatic abscess
occur in 2.7% of patients with ABP
risk factors: urinary catheterization, urethral manipulation, immunocompromised state
how to evaluate recurrent male UTI
UA
post void residual
URINE CULTURE
start empiric antibiotics
ddx of recurrent UTIs in men
BPH
infected kidney stones
chronic bacterial prostatitis
urinary tract neoplasm
how to distinguish chronic bacterial prostatitis from urethral infection
four glass test
four glass test
midstream urine culture is negative
after prostatic massage, prostatic secretions and urine are both positive
characterize chronic bacterial prostatitis
usually presents as recurrent UTIs with the same strain
difficult to eradicate given limited diffusion of abx into the prostate gland
treatment of CBP
fluoroquinolone or TMP-SMX for 30 days
long term management of CBP
patients with urinary obstruction should be counseled on transurethral resection of the prostate to improve flow and potentially remove infected prostate tissue
suppressive antibiotics
self start antibiotics
