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ACUTE BACTERIAL PROSTATITIS

ACUTE BACTERIAL PROSTATITIS. -it is inflam. Refluxed from bladder or ascend from urethra -PRESENTATION :fever,constit. Symp.,urolog. Symp.,PR avoided,catheter avoided. -Dx :GUE,micrscopic exam. & culture of prostatic expressate,E.coli is common.,U/S,TRU/S.

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ACUTE BACTERIAL PROSTATITIS

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  1. ACUTE BACTERIAL PROSTATITIS • -it is inflam. Refluxed from bladder or ascend from urethra • -PRESENTATION :fever,constit. Symp.,urolog. Symp.,PR avoided,catheter avoided. • -Dx :GUE,micrscopic exam. & culture of prostatic expressate,E.coli is common.,U/S,TRU/S. • Rx :empiric therapy against G-ve bacteria • indication of hospitalisation: • 1-sepsis • 2-immunecompromised • 3-acute retention • 4-significant medical comorbidities

  2. CHRONIC BACTERIAL PROSTATITIS • -INSIDOUS ONSET • -CAUSED BY PERSISTENCE OF PATHOGEN IN PROSTATIC FLUID DESPITE OF ANTIBIOTIC. • -PRESENTATION:asymp.,dysuria,frequency,low backpain,urgency,nocturia.,PR (normal,tendered,firm,stone) • Ix :GUE,4 CUP TESTS,TRU/S • -Rx : antibiotic for 3-4 m. • alpha-blockers(reduce recurrence rate) • cure is difficult • suppressive therapy(not responding) • TUR-P(refractory condition)

  3. GRANULOMATOUS PROSTATITIS • bacterial,viral,fungal,BCG,systemic • -eisinophilic or non eiosinophilic • -fever,chills,obst/irrit. Symp. • -GUE,PR(hard),prostatic biopsy • -Rx : antibiotic • steroid • temperory emptying • TUR-P(if not responding)

  4. PROSTATIC ABSCESS • -inadequate Rx of acute prostatitis • -DM,pt. on dialysis,immuncompromised undergoing cath. • -simillar to acute bact. Prostatitis • -PR(tendered ,swollen prostate) • -TRU/S &pelvic CT • -Rx :transrectal drainage under TRU/S or CT wth antib. • if fail TUR drainage done

  5. EPIDIDYMITIS -caused by ascending infection from LUT. -in males <35 yr caused by STD. -in children & old age caused by uropathogens.

  6. PRESENTATION • -scrotal pain radiating to groin &flank. • -scrotal swelling due to infl. Or hydrocele. • -symp. Of ureth.,cystitis,prostatitis. • -O/E tendered red scrotal swelling.

  7. epididymitis

  8. investigations • GUE : WBCS. • Urethral discharge C/S. • Doppler U/S &isotope scan. • U/S :epididymal enlargement &hydrocele. • Radiological evaluation in children.

  9. ULTRASOUND

  10. DOPPLER U/S

  11. Doppler u/s of torsed lt. testicle

  12. TREATMENT • -ORAL ANTIBIOTIC. • -SCROTAL ELEVATION, bed rest,&use of NSAID. • -admission & IV drugs used. • -in STD treat partner. • -in chronic pain do epididymectomy.

  13. URETHRITIS • -NGU Rx by erythromycin or doxycyclin with follow up of pt. for 7 days. • -treatment of persistent or recurrent urethritis is by metronidazole & erythromycin to act against both T.vaginalis &genital mycoplasma.

  14. UTI IN PREGNANCY • -anatomical changes :enlarged uterus specially in 2nd &3rd trimesters. • -physiological changes :increase GFR &increase progesteron. • -30% of pt. with BU develop PN. • -INCIDENCE OF PN IN PREGNANT IS 1-4%.

  15. UTI IN PREGNANCY • -PN if untreated lead to prematurity &perinatal death. • -evaluation at 1st &16th wk visit. • -asympt. BU :URINE CULTURE >100.000cfu/cc. • -symp. BU :>1000cfu/cc • -drugs used in pregnancy.

  16. UTI IN CHILDREN • -in 1st yr boys >girls affected. • -presentation :infant non specific.more localisation in older children. • -diagnosis :urine C/S ,GUE,blood tests(ESR,C-reactive prot. • -classification ;1st infection & recurrent infection. • - recurrent infection :unresolved BU ,b.persistence or reinfection.

  17. UTI IN CHILDREN • -E.coli is the most causative agent. • -host factors • -child is at greater risk of renal scarring by UTI. • -incomplete immune & neurologic system. • -delayed Dx due to non specific presentation.

  18. UTI IN CHILDREN • -renal scarrings may lead to HT & even ESRD. • -TREATMENT :not severely ill child treated orally. • Severly ill pt. treated by hospitalisation ,IV drugs. • -prophylactic antibiotics &radiological assessment is needed to prevent renal scarring.

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