Infections of the Male GU System

Question 1

How to dx UTI?

Answer 1

dipstick
microscopic
culture

Question 2

+ nitrates on UA suggests presence of ________.

Answer 2

bacteria

Question 3

+ leuks on UA suggests presence of ________.

Answer 3

pyuria

Question 4

What test gets false-positive results when left exposed to air?

Answer 4

nitrite

Question 5

Signs of infection on urine microscopy

Answer 5

> 3-5 WBC/hpf

bacteria seen

Question 6

What dipstick test indicates presence of WBC in urine?

Answer 6

leukocyte esterase

Question 7

When should urine be sent for microscopy?

Answer 7

Any time there is high index of suspicion

Dipstick with positive nitrite, leuk, or hemoglobin

Question 8

When should urine be sent for culture?

Answer 8

Confirmed microscopy (WBC or bacteria)

Question 9

dysuria
frequency
urgency
suprapubic pain, hematuria, and cloudy/foul-smelling urine

Answer 9

Acute cystitis

Question 10

Why is acute cystitis rare in men?

Answer 10

long urethra

Question 11

Because acute cystitis is rare in men, what else should be looked for?

Answer 11

STIs
Prostatitis
Bladder outlet obstruction (BPH, urethral stricture)

Question 12

Bacterial cystitis treatment in men

Answer 12

all UTI’s in men considered complicated

Treat for minimum of 7 days
Trimethoprim
Bactrim DS one po bid
Fluoroquinolones 
Cipro 500mg one po bid

Question 13

acute vs chronic bacterial prostatitis: onset, sx’s, DRE, treatment?

Answer 13

acute: abrupt onset, painful DRE, can get septic, treatment x 4-6 wks
chronic: insidious onset with relapsing, recurrent UTI; +/- painful DRE; rarely septic or with fever; treatment 6 wks - 3 mon

Question 14

Age of bacterial prostatitis

Answer 14

uncommon pre-puberty boys

common in men < 50

Question 15

Signs of bacterial prostatitis

Answer 15

Irritative voiding sx (freq, urgency, dysuria)

Abrupt constitutional sx (fever, chills, malaise, arthralgia, rectal/perineal pain)

DRE: Tender, enlarged, boggy prostate

Question 16

How to determine post void residual?

Answer 16

bladder ultrasonography

Question 17

______ is most common causative organism in men with acute prostatitis.

Answer 17

E. coli

Question 18

Acute bacterial prostatitis treatment

Answer 18

ABX for 4–6 weeks

Trimethoprim = Bactrim DS one po bid
Fluoroquinolones = Cipro 500mg one po bid

Question 19

Empirical treatment of prostatitis should cover what?

Answer 19

G- bacteria and enterococci

Question 20

When to hospitalize or get urology consult for acute bacterial prostatitis?

Answer 20

sepsis, acute urinary retention or significant comorbidities

Question 21

Chronic Bacterial Prostatitis Management

Answer 21

ABX therapy similar to acute - Fluoroquinolones or Bactrim

Longer duration of therapy up to x 3-4 months

May add alpha-blocker and anti-inflammatory agents to reduce recurrences

Question 22

Most cases of epididymitis/orchitis in men < 35 yo due to _________. Most cases in children and elderly due to ________.

Answer 22

STI’s: Gonorrhea, Chlamydia

E. coli

Question 23

When not to do DRE?

Answer 23

painful acute prostatitis

Question 24

Severe scrotal pain radiating to groin or flank with enlargement and erythema.

Answer 24

Epididymitis/Orchitis

Question 25

PE test that is positive for Epididymitis/Orchitis

Answer 25

+ Prehn’s sign

Question 26

UA for any infection shows what?

Answer 26

WBCs and bacteria

Question 27

Epididymitis/Orchitis may have secondary _______ that can be seen on U/S.

Answer 27

reactive hydrocele

Question 28

Epididymitis/Orchitis management

Answer 28

- Oral abx x 14 days
 < 50 yo = doxy
 > 50 yo = fluoroquin
- Bed rest 
- Scrotal elevation 
- NSAIDs helpful to reduce duration of sx's

Question 29

Most common urologic dx in men younger than 50?

Answer 29

prostatitis

Question 30

Duration of therapy for uncomplicated cystitis, acute and chronic prostatitis, and epididymitis/orchitis?

Answer 30

Uncomplicated cystitis: 7 days

Epididymitis/orchitis: 14 days

Acute prostatitis: 4-6 wks
Chronic prostatitis: 6 wks - 3 months