Inflammatory Disorders of the Genitourinary System


Acute pyelonephritis

• 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 .

• Ultrasound.

• KUB.



• Treatment:

− 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.

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