• Inflammation of the renal parenchyma & renal pelvis.
• Causes: Obstruction, foreign body & trauma.
• Symptoms: Loin pain, fever, frequency & dysuria.
• Investigations: Urinanalysis, C/S, RFT, U/S& KUB.
• Treatment: IV fluids & antibiotics.
A. Acute cystitis
• Acute inflammation of the bladder.
• In men it is usually bacterial infection.
• The urothelium become congested.
• Urine may look cloudy due to pus, and smell fishy due to bacterial conversion of urea to ammonia.
• Symptoms: Suprapubic pain, frequency, urgency, dysuria & heamaturia.
• Signs : suprapubic tenderness.
• Investigations: Urinalysis, Urine & C/S .
− 1st line antibiotics are Trimethoprim(Septrin), or Nitrofurantoin . Then according to culture result, for 3-5 days. Increase fluid intake.
− In recurrent cases, cystoscopy to R/O malignancy.
B. Chronic Cystitis
• Repeated acute attacks.
• Bladder stays clean if emptied regularly and natural bactericidal action of urothelium will deal with what is left. This is impaired in diabetic & cancer cases.
• Investigations: Urine C/S,U/S, IVU, Cytology, Cystoscopy & Bladder biopsy.
• Treatment: Long term antibiotics
A. Acute Prostatitis
• Source: Blood-born infection, UTI and urinary outflow obstruction below the bladder neck forcing urine into its ducts.
• Symptoms: Fever, painful micturition, weak urine stream & perineal pain.
• Signs: enlarged tender prostate at digital rectal examination (DRE).
• Treatment: Antibiotic e.g. trimethoprim or quinolones (e.g. short course of quinolones for acute infection followed by 4-6 wks of low dose trimethoprim).
• In most cases resolve completely.
• Rarely it suppurate Þ abscessÞ drained transurethrally, otherwise it may open into rectum.
• It may relapse without warning.
B. Chronic Prostatitis
• Symptoms: Persistent suprapubic perineal discomfort &painful micturition.
• Investigations: 2 urine samples(1&2), collect prostatic fluid by expressed prostatic massage (3), finally a 3rd urine sample collected (4).
• Diagnosis confirmed if bacterial count in (3)&(4) > (1&2).
• Treatment: Long term antibiotics.
• Painful urethra & micturition, urethral discharge and frequency. Causes inflammation of paraurethral glands.
• Causes: Neisseria gonorrhea ,Chlamydia trachomatis & Mycobacterium.
• Diagnosis: gram stain of pus for N.G. (intracellular diploccoci) & culture. Special culture for Chlamydia and Mycobacterium.
• Complications: urethral strictures.
• Treatment: Tetracycline & Ceftriaxone.
A. Acute Epididymoorchitis:
a) Acute orchitis
• Mostly caused by viruses (Mumps or Coxsachie). Mumps occur only after puberty.
• Bilateral Þ Odema & pressure causes pressure necrosis Þ atrophy of testis.
• When unilateral Þ R/O torsion testis that may need exploration.
b) Acute epididymitis:
• Bacterial infection spread from urinary bladder via vas deferens especially after prolonged use of catheter. Organisms are usually E.Coli & Chlamydia trachomatis.
• Treatment: Broad spectrum then specific antibiotics according to semen C/S.
B. Chronic Epididymoorchitis
• Causes: repeated UTI, STD & blood born infections.
• Needs long term antibiotics .
• Requires epididymioorchiectomy if medical treatment fails.
Sexually Transmitted Diseases
• Diseases transmitted by sexual contact.
a) Gonorrhea: as mentioned before.
b) Syphilis: Rare. Due to Treponema pallidum. Causes ulceration of the glans penis. Treated :long penicillin course.
c) Condylomata acuminata (Genital warts): caused by human papilloma virus. Itchy genital skin tags.
– Treatment: Local Podophyllin, freezing & diathermy. Cystoscopy to R/O bladder warts.
d) AIDS: (Acquired Immune Deficiency Syndrome)
• Cause: Human Immunodeficiency Virus (HIV ).
• Route of transmission:
− Extramarital relations & homosexuality.
− Blood born: From mother to fetus.
− Blood transfusion.
− Drug addicts: Contaminated syringes.
− Symptoms: Non-specific.
− Treatment combination of anti-retroviral therapy.