0071643192.pdf

RENAL AND GENITOURINARY

EMERGENCIES

ACUTE BACTERIAL PROSTATITIS

ETIOLOGY

■ Patients <35 years: Sexually transmitted pathogens C. trachomatis and/or

N. gonorrhoeae (GC)predominate.

■ Patients ≥35 years:Most often caused by Gram-negative organisms, pre-

dominantly E. coli. Mixed bacterial infections are uncommon. Suspect

anacute exacerbation of chronic prostatitisif there is a history of recur-

rent UTIs.

■ Tuberculosis should be considered in the presence of renal TB.

SYMPTOMS/EXAM

■ Fever/chills.

■ Perineal or low back pain.

■ Urgency, dysuria, frequency, urinary retention.

■ Tender swollen prostate that is firm and warm to the touch (avoid prostatic

massage as it may precipitate bacteremia).

DIAGNOSIS

■ Clinical examination is key to diagnosis.

■ Urine culture may help isolate organism.

TREATMENT

■ Supportive care with analgesia, antipyretics, hydration.

■ Antibiotics:

■ Age <35 years: Ceftriaxone (IM ×1) or ofloxacin (×10 days) and doxy-

cycline (×10 days)

■ Age≥35 years: Fluoroquinolone or trimethoprim/sulfamethoxazole for

2–4 weeks

■ Chronic bacterial: Fluoroquinolone × 4 weeks or trimethoprim/

sulfamethoxazole for 1–3 months

■ Avoidurethral catheterization, use suprapubic catheter if urinary retention

occurs.

■ Parenteral antibiotics and admission if patient appears toxic

PENILE ULCERS

Sexually transmitted diseases are the likely cause of isolated penile

ulcers. Table 18.9 outlines the organisms, diagnosis, and treatment. See

Figures 18.1–4.

DIFFERENTIAL

■ In the setting of genital ulceration andoral ulcerations consider Behçet dis-

ease, Stevens-Johnson syndrome, Reiter syndrome, pemphigus vulgaris.

■ Others causes of isolated genital unceration include lymphoma, carci-

noma, vasculitis, fixed drug eruption, trauma.

DIAGNOSIS

■ Diagnosis is often clinical.

■ Syphilis is diagnosed by dark-field examination, direct fluorescent antibody

testing, and serology.

Prostatitis

<35 years: Think STD.

≥35 years: Think E. coli;

needs prolonged antibiotic

therapy.