Prostatitis, Pyelonephritis, Varicocele

Question 1

Prostatitis: Acute Bacterial presentation

Answer 1

• Fever
• Irritative/obstructive voiding
• warm boggy tender prostate**
• E. coli

Question 2

Acute Prostatitis: Treatment

Answer 2

<35 years: Ceftriaxone + (Doxycycline or Azithromycin)
>35 years: Fluoroquinolones or TMP-SMX for 4 weeks

Hospitalized: IV fluoroquinolone + (aminoglycoside or ampicillin)

Question 3

If a patient has been receiving treatment for prostatitis but continues to have a fever what test needs to be done? why?

Answer 3

CT pelvis to rule out prostatic abscess

Question 4

Chronic Bacterial Prostatitis: presentation/pain

Answer 4

• pain in the genitals, urinary tract, perineum, low back
• dysuria, urgency, frequency, pain with ejaculation
• E. coli!

Question 5

Chronic versus acute prostatitis: which affects young men and which older?

Answer 5

Older men –> chronic prostatitis

Younger men –> acute prostatitis

Question 6

For which type of prostatitis is expressed prostatic secretion with post massage urine culture done?

Answer 6

Chronic bacterial prostatitis

Question 7

Chronic Bacterial Prostatitis: TX

Answer 7

1. Antibiotics (8-16 wks)
2. NSAIDs
3. Alpha blockers to relax stroma and capsule smooth muscle
4. Sitz baths (warm tub soaking for 30 mins)

Question 8

If a patient has history of “UTI” but negative cultures, WBC present, and tender prostate what might they have?

Answer 8

Inflammatory Chronic Pelvic Pain Syndrome

Question 9

Inflammatory Chronic Pelvic Pain Syndrome: treatment

Answer 9

Fluoroquinolone
or
TMP-SMX for 6-8 weeks**

Question 10

What is it called when patient is having prostatic pain, but no bacteria grow in culture and no WBCs are in the prostatic fluid?

Answer 10

Non-inflammatory Chronic Pelvic Pain syndrome

aka prostadynia

Question 11

Pyelonephritis: Presentation

Answer 11

• Abdominal Pain
• Flank Pain
• Nausea/Vomiting
• Fever/Chills

Question 12

What labs would you expect to see in pyelonephritis?

Answer 12

UA: WBCs, WBC casts

CBC: Leukocytosis with left shift

Question 13

What can be seen on US in pyelonephritis?

Answer 13

• Kidney enlargement

- abnormal kidney echogenicity

Question 14

Pyelonephritis: mildly ill treatment

Answer 14

• outpatient

- Fluoroquinolone x7 days*

Question 15

Pyelonephritis moderately ill to severely ill (high fever, dehydration, high WBC): treatment

Answer 15

• Admit
• IV antibiotics (switch to PO once afebrile for 24-48 hours)
• Oral antibiotics for 2 weeks at home

Question 16

What is on the same spectrum as pyelonephritis?

Answer 16

Pyelonephritis < Acute bacterial nephritis < Renal abscess

Question 17

Renal Abcess

Answer 17

• purulent fluid collection
• Often in DM, and immunocompromised
• Gram negative**

Question 18

Chronic Pyelonephritis: cause and characteristics

Answer 18

• From prior infections

- Scarred, atrophic kidney that functions poorly, low flow, HIGH renin

Question 19

Chronic Pyelonephritis: clinical presentation

Answer 19

• HTN
• proteinuria
• Renal insufficiency
• Recurrent UTIs

Question 20

What is a characteristic radiographic finding of chronic pyelonephritis?

Answer 20

caliceal blunting**

Question 21

Prostatic massage: Acute versus Chronic Prostatitis

Answer 21

Don’t do it in acute because you risk bacteremia

Do in chronic prostatitis to increase bacterial yield for culture

Question 22

Chronic Prostatitis: treatment

Answer 22

1. Fluoroquinolone or TMP-SMX for 6-12 weeks

2. TURP (if refractory)