3-82
Primary:
- Treat initially with a course of antibiotics, with or without alpha-blockers.
Levaquin 500 mg po qd has broad coverage for both C. trachomatis and urinary pathogens. Treat for
30 days.
Alpha blockers include the following:
Hytrin (terazosin) 1-5 mg po q hs (start at low dose and titrate up over several weeks)
Cardura (doxazosin) 1-4 mg po q hs (start at low dose and titrate up over several weeks)
Flomax (tamsulosin) 1 po q d (No titration necessary)
Minipress 1-5 mg PO q hs - Patients who complain of frequency should be given bladder antispasmodics with caution since they can
cause urinary retention. Hyoscyamine 1 po bid prn, Ditropan 5 mg po TID prn, Elavil 10-25 mg po qd,
or Flavoxate 1 po bid can all be used.
Primitive: Sitz baths or sitting in a tub of warm water can relax the bladder and decrease pain.
Empiric: If the patient has had multiple sexual contacts and initial symptoms of urethritis (discharge) after
finishing Levaquin, a trial of erythromycin 500 mg po qid for 30 days can be given. If symptoms persist,
try metronidazole (Flagyl) 250 mg po tid for 30 days. The empiric usage of Levaquin, erythromycin and
metronidazole covers most sexually transmitted diseases that would affect the lower urinary tract. Without
urethral discharge or abnormalities on urinalysis or physical exam (no genital ulcers, lymphadenopathy, etc)
STDs are very unlikely.
Patient Education
Activity: Bedrest for septic patients with close monitoring of vital signs.
Medications: Alpha-blockers may make sinus conditions worse. Likewise, sinus medications may make
voiding more difficult.
Prevention and Hygiene: Use condoms. Most cases are not associated with any underlying abnormality,
however elective evaluation by a urologist may prevent recurrences.
No Improvement/Deterioration: If fever persists beyond 48-72 hours, return promptly. Some prostatitis is
slow to resolve.
Follow-up Actions
Return evaluation: Fever can be expected to last 1-3 days.
Evacuation/Consultation Criteria: Aggressively rehydrate unstable patients in shock and evacuate
immediately. If urinary frequency and urgency persist after initial 30 days, continue treatment for another 30
days. Stable patients should eventually follow-up with a urologist electively to assess the need for further
evaluation.
Symptom: Male Genital Problems: Testis Torsion
CAPT Leo Kusuda, MC, USNIntroduction: Rapid identification and treatment of torsion is necessary to preserve testis function. Such
patients require tacking or fixation of the opposite testis to the scrotal skin since it is also at risk. Loss of both
testes not only results in sterility but loss of testosterone, which requires lifelong supplementation for normal
body function. Salvage of the affected testis can be achieved if reduced in 4 hours. Some salvage of testis
function can occur with reduction of the torsion 2 days out, but this is unusual.
Subjective: Symptoms
Acute (< 2 hr): Severe scrotal pain, onset can be at night while asleep, may have prior history of scrotal
pain lasting less than 1 day, may have nausea/vomiting, testis is extremely painful, spermatic cord may be
tender
Sub-acute (2-48 hr): Scrotal pain increases over several hours. After 24 hours, some of the pain may start to