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84 Cards in this Set
- Front
- Back
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What is the offending agent of Acute prostatitis?
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Ususally gram negative rods such as E coli or Pseudomonas species
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What are the most likely routes of infection?
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Ascent up urethra and reflux of infected urine into the prostatic ducts
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What may be the result of this route of infection (ascent and reflux)?
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A concomitant infection in the bladder or epedidymis
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When examining a patient with acute prostatitis, what must you NOT do?
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Massage prostate. Urosepsis may be very possible
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What might the pt complain of?
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An abrupt onset of perineal, sacral, or suprapubic pain. He also may complain of fever/chills, malaise, irritative voiding, +/- myalgias . He also may have obstructive sxs and urinary retention
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What will the exam reveal?
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A high fever and warm and very tender prostate (remember not to massage prostate, be gentle)
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What will the urinalysis show?
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Pyuria, bacteruria, and varying degrees of hematuria (just like Acutie pyelonephritis)
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What will the urine culture show?
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It will be positive with the offending pathogen
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What will the CBC show?
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leukocytosis
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What is the treatment for Acute Bacterial Prostatitis?
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Treat 4-6 wks with Levaquin (It was two weeks for severe Acute pyelonephritis) . It has the highest cure rate
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Besides Levaquin (which has the highest cure rate), what else could you also consider treating with?
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Septra
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How should you treat if Hospitalization is required?
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IV Levaquin or Amp&an aminoglycoside until fever free (normally about 24hrs), then switch to oral levaquin
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How should you treat if the patient develops urinary retention?
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Suprapubic aspiration (a catheter would be contraindicated, due to spreading of infection)
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If the patient needs suprapubic aspiration, who should perform this?
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Call Urology
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Why is it critical that the patient gets adequate treatment?
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Inadequate treatment can lead to prostate abscess or chronic bacterial prostatitis
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How would you confirm the adequacy of treatment?
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A negative urine culture would confirm adequate treatment
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Should you ever draw a PSA if the patient has Acute bacterial prostatitis?
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No, the PSA would add no value. It would be elevated due to inflammation, but would give no definitive diagnosis in the detection of cancer.
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If the pt is of age for PSA screening, what would you do if the patient had acute bacterial prostatitis?
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Wait at least two weeks, then do a PSA screen
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Where does Chronic bacterial prostatitis evolve from?
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It may evolve from acute bacterial prostatis
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What are the pt's complaints?
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May be asymptomatic or complain of lower back pain, perineal pain, and irrative voiding sxs (onsidious onset). Also may have ejaculatory pain
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What will be in the pt's medical history?
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Recurrent UTI's (chronic bacterial prostatitis is the most common cause of recurrent UTI's in males)
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What might the PE reveal?
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a normal sized prostate that is boggy, indurated, or tender to palpation (no fever or warmth mentioned in the lesson). And may also palpate prostatic calculi
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What will the urinalysis show?
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It may be normal or show leukocytosis
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What will expressed prostatic secretions demonstrate?
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increased numbers of leukocytosis
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What is necessary to make the dosage of chronic bacterial prostatitis?
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A culture of secretions, or of the postprostatic massage urine specimen
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What will the CBC show in Chronic bacterial prostatitis?
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No leukocytosis
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How are prostatic secretions extracted?
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The physician has the guy bend over a table or something with his penis hanging down. The physician sticks his finger up the guy's butt, and massages the guy's prostate from the lateral side toward the middle (both sides). The physician should be able to extract at least 4 drops of free-flowing prostatic fluid.
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How do you treat Chronic bacterial prostatitis?
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levaquin for at least 4 weeks (500mg or 750mg) - it provides good gram - and gram + coverage. Or Cipro for 4 weeks. If you want, you can use Septra, but the tx is 12 weeks.
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What can the guy use for pain?
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NSAIDS or Sitz bath
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What would you do for a guy with recurrent dz, which is common?
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A longer course of abx, then a lower dose for suppressive therapy of Levaquin or Septra for 6 months, then re-evaluate/refer.
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What is another name for Chronic Non-bacterial prostatitis?
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Chronic pelvic pain syndrome : inflammatory
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How common is Chronic Non-bacterial prostatitis?
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It is the most common prostatitis, and the cause is unknown
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How is Chronic Non-bacterial prostatitis diagnosed?
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There is no infection, so it is a diagnosis of exclusion (r/o ABP and CBP)
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What is the clinical presentation?
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Similar to Chronic bacterial prostatitis, but no hx of UTI's
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What will the labs show?
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Increased leukocytes can be seen on expressed secretions, but all cultures are negative (no bacteria)
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How do you treat Chronic Non-bacterial prostatitis?
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It's uncertain due to it's uknown etiology, but abx trial directed against ureaplasma, mycoplasma, or chlamydia is warranted. Erythromycin (CMDT), or Levaquin/Septra (Pocket Guide to Urology). You can also use an alpha blocker if needed.
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What do you use for pain?
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NSAIDS or Sitz baths.
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How do you monitor treatment?
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Follow up with urine samples
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"This is Travis, who always holds his pee because he's too busy playing video games. It is a dz known as ""chronic pelvic pain syndrome: noninflammatory""… What is this dz?"
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Prostadynia
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What is Prostadynia characterized by, and who does it affect?
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prostate/pelvic pain without inflammation or infection that affects younger men.
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What are the causes of Prostadynia?
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Various causes… related to dysfunctional voiding and pelvic floor musculature dysfunction.
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What were Travis' complaints when he went to the doctor?
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irrative voiding sxs (same as CBP), but no fever.
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What were Travis' exam and lab findings?
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No fever, normal exam, a negative urinalysis, and an normal culture.
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What was did the Doctor give Travis?
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A perscription for an Alpha blocker (Terazosin, doxazosin) for his bladder neck spasms.
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The doctor suggested therapy that he could do at home… What was it?
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Sitz baths
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There was one more possible prescription that the doctor suggested that might help his pelvic floor muscle dysfunction. What was that?
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Biofeedback or Diazepam for pelvic floor muscle dysfunction
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What is the source of an Acute Epididymitis infection?
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Normally the result of an ascending infection from the lower urinary tract
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In which population do you find the most cases of Acute epididymitis infections? And what is the cause?
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Mostly men under the age of 35, and it is mostly from STD
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Are they found in other populations?
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Yes, children and older men due to E. Coli
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Who else is at risk of infection from E. Coli and other enteric bacteria?
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Men who practice anal intercourse
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When are symptoms likely to occur?
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After acute physical strain, trauma, or sexual activity
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Does this pain radiate? If so, where?
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Yes, it may radiate laterally and posteriorly along the spermatic cord or to flank.
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What other associated symptoms may the patient have?
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Associated symptoms of urethritis and cystitis
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What exam findings will there be?
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fever and scrotal swelling, a tender prostate, a positive Phren's sign (pain relief with scrotal elevation above the pubic symphysis)
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What will the CBC show?
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Leukocytosis
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What will the urethral gram stain show?
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If it is indeed gonnorhea, the offending pathogen will be present.
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If all that is detected is WBC's, what might this idicate?
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Chlamydia
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In a non-STD varieties, what will the urinalysis show?
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pyuria, bacteriuria, and varying degrees of hematuria
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What will the urine culture indicate?
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The offending pathogen
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If needed, what imaging could you use for a diagnosis?
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If needed, you may get an ultrasound (rule out cysts, tumors, etc.)
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What kind of patient education treatment would you give?
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Bed rest if needed. Scrotal elevation (wear briefs instead of boxers) in the acute phase.
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What medication therapy would you give?
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For GC/Chlamydia: Ceftriaxone 250mg IM and Doxycycline 100mg BID X 10 days OR Zithromycin. For Coliforms: you can use Cipro XR or Levaquin 750mg X 10-14 days
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What will delayed treatment result in?
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Epididymo-orchitis, decreased fertility, or abscess formation
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What is the name for inflammation of the testis?
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Orchitis
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What is the most common cause of Orchitis?
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bacterial infection (viral infections also occur in the form of mumps orchitis)
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In what population is 30% of orchitis cases observed?
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Postpubertal males who contract parotitis (mumps)
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What are the signs and sxs of Orchitis?
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Testes that atrophy, and infertility is a significant and frequent result of viral orchitis, but less common with bacterial infection
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Instructor did not discuss TX in the reading material, but I imagine if it is viral that you would take some type of antiviral med, and if it is bacterial, perhaps levaquin, Cipro, or Septra
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Is testicular torsion an infection, per se?
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No
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What is the main associated finding in testicular torsion?
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Acute testalgia
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What is the secondary injury in testicular torsion?
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ischemic injury to the testes secondary to twisting of testis on the spermatic cord
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What are the pre-disposing factors?
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"Cryptorchidism; ""bell clapper deformity""
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Is this urgent or non-urgent?
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This is a TRUE EMERGENCY!
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In what population is testicular torsion more common?
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In neonates and adolescents
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What all might the patient complain of?
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a Hyperacute onset of pain and swelling within the testis, and N&V
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How might the patient describe the pain?
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constant and severe, along with abdominal pain
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What does the physical exam reveal?
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"a ""high lie"" testis with transverse lie and absent ipsilateral cremasteric reflex (if you stroke the inner thigh, the scrotum will shrivel up. The presence of cremasteric reflex means testicular torsion is unlikely)"
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What do you do for the patient?
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Contact the duty urologist asap. (if situation permits… get a dopplar ultrasound, but contacting the urologist takes priority)
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What would the Doppler differentiate?
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Testicular torsion from Epididymitis. If it were torsion, there would be less blood on the painful side. If it were epididymitis, there would be an increase in blood flow on the painful side.
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What would the surgical treatment for testicular torsion be?
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Surgical would be an orchiopexy if the testis was still viable. If not viable, then an orchiectomy is needed.
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How long does a patient have before loosing viability in his testis before requiring an orchiectomy?
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When diagnosed and corrected surgically within 6 hours of occurrence, the testis is usually saved.
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"If there is no urologist on board, what might you attempt as ""non-surgical"" treatment?"
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"Manual detorsion or ""opening the book"", as it is also known as"
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What is the worst outcome of testicular torsion?
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It could lead to infertility
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May not be testable, but… what is done during surgery to assure no future episodes of torsion?
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The testes are both surgically affixed to the scrotum to prevent future episodes.
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