Prostatitis, Pyelonephritis, Varicocele Flashcards
Prostatitis: Acute Bacterial presentation
- Fever
- Irritative/obstructive voiding
- warm boggy tender prostate**
- E. coli
Acute Prostatitis: Treatment
<35 years: Ceftriaxone + (Doxycycline or Azithromycin)
>35 years: Fluoroquinolones or TMP-SMX for 4 weeks
Hospitalized: IV fluoroquinolone + (aminoglycoside or ampicillin)
If a patient has been receiving treatment for prostatitis but continues to have a fever what test needs to be done? why?
CT pelvis to rule out prostatic abscess
Chronic Bacterial Prostatitis: presentation/pain
- pain in the genitals, urinary tract, perineum, low back
- dysuria, urgency, frequency, pain with ejaculation
- E. coli!
Chronic versus acute prostatitis: which affects young men and which older?
Older men –> chronic prostatitis
Younger men –> acute prostatitis
For which type of prostatitis is expressed prostatic secretion with post massage urine culture done?
Chronic bacterial prostatitis
Chronic Bacterial Prostatitis: TX
- Antibiotics (8-16 wks)
- NSAIDs
- Alpha blockers to relax stroma and capsule smooth muscle
- Sitz baths (warm tub soaking for 30 mins)
If a patient has history of “UTI” but negative cultures, WBC present, and tender prostate what might they have?
Inflammatory Chronic Pelvic Pain Syndrome
Inflammatory Chronic Pelvic Pain Syndrome: treatment
Fluoroquinolone
or
TMP-SMX for 6-8 weeks**
What is it called when patient is having prostatic pain, but no bacteria grow in culture and no WBCs are in the prostatic fluid?
Non-inflammatory Chronic Pelvic Pain syndrome
aka prostadynia
Pyelonephritis: Presentation
- Abdominal Pain
- Flank Pain
- Nausea/Vomiting
- Fever/Chills
What labs would you expect to see in pyelonephritis?
UA: WBCs, WBC casts
CBC: Leukocytosis with left shift
What can be seen on US in pyelonephritis?
- Kidney enlargement
- abnormal kidney echogenicity
Pyelonephritis: mildly ill treatment
- outpatient
- Fluoroquinolone x7 days*
Pyelonephritis moderately ill to severely ill (high fever, dehydration, high WBC): treatment
- Admit
- IV antibiotics (switch to PO once afebrile for 24-48 hours)
- Oral antibiotics for 2 weeks at home
What is on the same spectrum as pyelonephritis?
Pyelonephritis < Acute bacterial nephritis < Renal abscess
Renal Abcess
- purulent fluid collection
- Often in DM, and immunocompromised
- Gram negative**
Chronic Pyelonephritis: cause and characteristics
- From prior infections
- Scarred, atrophic kidney that functions poorly, low flow, HIGH renin
Chronic Pyelonephritis: clinical presentation
- HTN
- proteinuria
- Renal insufficiency
- Recurrent UTIs
What is a characteristic radiographic finding of chronic pyelonephritis?
caliceal blunting**
Prostatic massage: Acute versus Chronic Prostatitis
Don’t do it in acute because you risk bacteremia
Do in chronic prostatitis to increase bacterial yield for culture
Chronic Prostatitis: treatment
- Fluoroquinolone or TMP-SMX for 6-12 weeks
2. TURP (if refractory)
