EPIDIDYMITIS

1

2
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

3
CHRONIC BACTERIAL PROSTATITIS

• -INSIDOUS ONSET
• -CAUSED BY PERSISTENCE OF PATHOGEN IN PROSTATIC
  FLUID DESPITE OF ANTIBIOTIC.
• -PRESENTATIONasymp.,dysuria,frequency,low
  backpain,urgency,nocturia.,PR (normal,tendered,fir
  m,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)

4
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)

5
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

6
EPIDIDYMITIS

• -caused by ascending infection from LUT.
• -in males lt35 yr caused by STD.
• -in children old age caused by uropathogens.

7
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.

8
epididymitis
9
investigations

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

10
ULTRASOUND
11
DOPPLER U/S
12
Doppler u/s of torsed lt. testicle
13
TREATMENT

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

14
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.

15
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.

16
UTI IN PREGNANCY

• -PN if untreated lead to prematurity perinatal
  death.
• -evaluation at 1st 16th wk visit.
• -asympt. BU URINE CULTURE gt100.000cfu/cc.
• -symp. BU gt1000cfu/cc
• -drugs used in pregnancy.

17
UTI IN CHILDREN

• -in 1st yr boys gtgirls 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.

18
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.

19
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.