1 / 41

BLADDER INFECTION

BLADDER INFECTION. Acute Cystitis. Definition: refers to urinary infection of the lower urinary tract, particularly the bladder. Sex Predilection: F>M 1 ° Mode of infection: ascending from the periurethral /vaginal and fecal flora D iagnosis is made clinically.

karlyn
Download Presentation

BLADDER INFECTION

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. BLADDER INFECTION

  2. Acute Cystitis • Definition: refers to urinary infection of the lower urinary tract, particularly the bladder. • Sex Predilection: F>M • 1° Mode of infection: ascending from the periurethral/vaginal and fecal flora • Diagnosis is made clinically

  3. Acute Cystits: Presentation and Findings • Frequent Findings: Irritative voiding symptoms (dysuria, frequency, urgency) • Other common symptoms: low back and suprapubic pain, hematuria, cloudy/foul-smelling urine • Fever and systemic symptoms: rare • Urinalysis: (+) WBC, (+) Hematuria • Urine Culture: confirm the diagnosis • E. coli – most common • Others: G(-) Klebsiella and Proteus; G(+) S. saprophyticus and Enterococcus.

  4. Management Pharmacologic • Short course oral antibiotics • Trimethoprim-sulfamethoxazole, Nitrofurantoin, and Fluoroquinolones • Duration: 3-5 days • fluoroquinolones with long half-lives (fleroxacin, pefloxacin, and rufloxacin) may be suitable for single-dose therapy

  5. Recurrent Cystitis/UTI • Presentation and Findings: • Cause: bacterial persistence or reinfection with another organism • Note: it’s important to identify the cause • Bacterial Persistence – remove the infected source • Reinfection – Preventive therapy

  6. Bacterial Persistence Radiologic imaging is indicated US – provide a screening evaluation of the GUT IVP, Cystoscopy, CT may sometimes be necessary Frequent, recurrent UTI – bacterial localization studies Bacterial Reinfection Evaluate for evidence of vesicovaginal or vesicoenteric fistula Otherwise, radiologic examination is not necessary Radiographic Imaging

  7. Management • Depends on the cause: • Surgical removal of the infected source, i.e. urinary calculi – treat persistence • Reinfection: Surgical repair of fistulas, prophylactic antibiotics • Recurrent UTI/cystitis related to sexual activity: • Frequent emptying of the bladder and a single dose of antibiotic taken after intercourse • Alternative Tx for recurrent cystits/UTI • Intravaginal estriol, lactobacillus vaginal suppositories, cranberry juice

  8. Malacoplakia • Uncommon inflammatory disease of the bladder • manifesting as plaques or nodules made up of large histiocytes (von Hansenmann cells) and laminar inclusion bodies (Michaelis-Gutmann bodies) • Can also affect ureters, kidneys

  9. Presentation and Findings • Patients • F>M with history of UTI • With chronic illness or immunosuppressed • Signs and Symptoms • Bladder: Irritative voiding symptoms – urgency and frequency; and hematuria • Ureter and Kidney: fever, flank pain, flank mass • Both kidneys: s/sx of azotemia and renal failure

  10. Radiologic Findings • US/CT • May demonstrate a mass in the bladder and and evidence of obstruction. • KIDNEY: focal, diffuse, hypodense parenchymal masses on CT • Biopsy • Differentiates malakoplakia from malignancy

  11. Management Pharmacologic • Primarily consists of antibiotic therapy with high intracellular levels: • TMP-SMX and fluoroquinolones • Bethanecol and Ascorbic Acid – enhance phagolysosomal activity • Lower urinary tract involvement: • Antibiotic alone Non-pharmacologic • Involvement of ureter or kidney: • surgical excision • Prognosis is poor and mortality is high in patients who have bilateral renal involvement regardless of treatment

  12. Prostate Infections

  13. ANATOMY Chestnut-shaped fibromuscular and glandular organ Inferior to bladder 20g; 3cm diameter produces prostate fluid

  14. PROSTATE INFECTIONS I. Acute Bacterial Prostatitis II. Chronic Bacterial Prostatitis III. GranulomatousProstatitis IV. Prostate Abscess

  15. I. Acute Bacterial Prostatis • Inflammation of the prostate associated w/ a UTI • From urethral infection or reflux of infected urine • Luekocytes are seen within the surrounding acini of the prostate in response to infection • Edema and hyperemia developed • Prolong infection – necrosis and abscess

  16. Presentation and Findings • More common in adults esp. <50 (Collins et al, 1998) • abrupt onset • fever, chills, malaise, arthralgia, myalgia, lower back/rectal/perineal pain • urinary symptoms (frequency,urgency, dysuria) • Urinary retention • DRE - tender, enlarged glands that are irregular and warm

  17. ACUTE BACTERIAL PROSTITIS LABS • Urinalysis -WBCs and occasionally hematuria • Serum Blood Analysis– leukocytosis • Prostate-specific antigen DEFINITIVE DX • microscopic examination and culture of the prostatic expressate • culture of urine obtained before and after prostate massage – single organism • E. coli – most causative agent • OTHERS: Proteus, Klebsiella, Enterobacter,Pseudomonas, and Serratia spp.

  18. ACUTE BACTERIAL PROSTITIS RADIOLOGIC IMAGING • Rarely indicated • Bladder ultrasonography – useful in determining the amount of residual urine MANAGEMENT • Pharmacologic • Trimethoprim and Fluoroquinolones (4–6 weeks) • Ampicillin and an aminoglycoside for gram-negative bacteria and enterococci • Non-pharmacologic • Patients w/ urinary retention 2nd to acute prostatis - suprapubiccatheter

  19. II. Chronic Bacterial Prostatis CLINICAL PRESENTATION • more insidious onset • characterized by relapsing, recurrent UTI caused by the persistence of pathogen in the prostatic fluid despite antibiotic therapy • dysuria, urgency, frequency, nocturia, and low back/perinealpain • DRE: often normal; occasionally, tenderness, firmness, or prostatic calculi

  20. Chronic Bacterial Prostatis LABS • Urinalysis - a variable degree of WBCs and bacteria • Serum Blood Analysis– no leukocytosis • Prostate-specific antigen DEFINITIVE DX • microscopic examination and culture of the prostatic expressate using the 4-cup test • E. coli – most causative agent

  21. The 4-cup Test • Preparation: • Require Px to have a full bladder • Retract foreskin of uncircumcised men • Clean glans with soap/water or povidone-iodine • Collection: • -Collect first 10ml of voided urine (VB1) • -Discard next 100ml • -Collect next 10ml of voided urine (VB2) • -Massage prostate and collect prostate expressate (EPS) • -Collect first 10ml of voided urine after massage (VB3) • -Immediately culture and microscopically examine all specimens • Interpretation: • -All specimens <103 CFU/ml = not bacterial prostatitis • -VB3 or EPS >10 x CFU of VB1 = chronic bacterial prostatitis • -VB1 > other specimens = urethritis or specimen contamination • -All specimens >103 CFU/ml = treat for UTI and repeat test

  22. ACUTE BACTERIAL PROSTITIS RADIOLOGIC IMAGING • Rarely indicated • Transrectalultrasonography – if prostatic abscess MANAGEMENT • Pharmacologic • Antibiotic similar to acute bacterial prostatis but for 3-4 months • TMP-SMX 1 single-strength tablet daily, nitrofurantoin 100 mg daily, or ciprofloxacin 250 mg daily • Non-pharmacologic • Transurethral resection of the prostate - refractory disease

  23. III. GranulomatousProstatis Etiology: • bacterial, viral, or fungal infection, • the use of bacillus Calmette-Guerin therapy • malacoplakia, or systemic granulomatous diseases affecting the prostate • 2/3 of cases have no specific cause 2 types of Non-specific granulomatousprostatitis: • Non-eosinophilic – abnormal tissue response to extravasated prostatic fluid • Eosinophilic – more severe, allergic response of prostate to some unknown antigen

  24. GranulomatousProstatis CLINICAL PRESENTATION • fever, chills, and obstructive/irritative voiding symptoms • urinary retention • eosinophilicgranulomatousprostatitis - severely ill and have high fevers • DRE - hard, indurated, and fixed prostate, difficult to distinguish from prostate carcinoma

  25. GranulomatousProstatis LABS • Urinalysis – no evidence of bacterial infection • CBC – leukocytosis; marked eosinophilia DEFINITIVE DX: biopsy of prostate MANAGEMENT • Pharmacologic • Antibiotic therapy and corticosteroids • Non-pharmacologic • Transurethral resection of the prostate - patients who do not respond to treatment and have significant outlet obstruction.

  26. IV. Prostate Abscess • result from complications of acute bacterial prostatitis • High risk: • Diabetes • those receiving chronic dialysis • immunocompromised patients, undergoing urethral instrumentation, who have chronic indwelling catheters • Clinical Presentation • Similar Symptoms as acute bacterial prostatitis • History of acute bacterial prostatitis with good initial response to antibiotics but recurrence of symptoms during Tratment • DRE: tender and swollen prostate; fluctuance 16% px

  27. Prostate Abscess RADIOLOGIC IMAGING • transrectalultrasonography or pelvic CT scan is crucial for diagnosis and treatment MANAGEMENT • Pharmacologic • Antibiotic therapy • Non-pharmacologic • Transrectal drainage • Transurethral resection and drainage

  28. URETHRITIS

  29. Urethritis • Infection / inflammation of the urethra • Categorized into: • Neisseriagonorrhea • Other organisms • Chlamydia trachomatis, Ureaplasmaurealyticum, Trichomonasvaginalis, and Herpes Simplex Virus • Acquired through sexual intercourse

  30. URETHRITIS PRESENTATION AND FINDINGS • urethral discharge and dysuria • Obstructive voiding symptoms - patients with recurrent infection • 40% of patients with gonococcalurethritis are asymptomatic DIAGNOSIS • examination and culture of the urethra

  31. URETHRITIS RADIOLOGIC IMAGING • Retrograde urethrogram - indicated in patients with recurrent infection and obstructive voiding symptoms MANAGEMENT • Pharmacologic • Gonococcal: ceftriaxone (250 mg intramuscularly); fluoroquinolones (ciprofloxacin 250 mg or norfloxacin 800mg) • Non-gonococcal: tetracycline or erythromycin (500 mg 4 times daily) or doxycycline (100 mg twice daily) for 7–14 days • Non-pharmacologic • Prevention! • Protective sexual practices

  32. URETHRITIS Female: urethral discharge Male: urethral discharge

  33. EPIDIDYMITIS

  34. Epididymitis • Infection / inflammation of the epididymis • ascending infection of the lower urinary tract • Men <35 y/o  STDs (N. gonorrhoeaeand C. trachomatis) • Children & older men  urinary patogens (E. coli) • Homosexual men  E. coli • may spread to involve the testis

  35. Epididymitis • Presentation & Findings • Severe scrotal pain that may radiate to the groin or flank • Scrotal enlargement or reactive hydrocele • Urethritis, cystitis or prostatitis • PE: • enlarged and red scrotum • Thickened spermatic cord

  36. Epididymitis • Presentation and Findings • Urinalysis: WBCs and bacteria in the urine or urethral discharge • Serum blood analysis: leukocytosis • Radiologic Imaging • Scrotal Doppler UTZ or radionuclide scanning • Epididymitis: enlarged epididymis with increased blood flow

  37. Epididymitis Management • Pharmacologic • Oral Antibiotics and NSAIDS • Treatment of sexual partners in STD • Non-pharmacologic • Bed rest, scrotal elevation & NSAIDS – helpful in reducing the duration of symptoms • Sepsis or severe infection  hospitalization & parenteral antibiotic therapy • Abscess  open drainage • Chronic, relapsing epididymitis & scrotal pain  epididymectomy

  38. Epididymitis

  39. EPIDIDYMITIS & URETHRITIS IN HIV PATIENTS • caused by N. gonorrhoeae and C. trachomatis • E. coli is more common • HIV-infected patients with suppurative or antibiotic-resistant epididymitis - infection with fungi or mycobacteria should be considered • it is recommended that HIV-infected patients abstain from sexual intercourse until 7 days after treatment is completed.

  40. REFERENCE: • Smith’s General Urology 17th Edition • Images from http://images.google.com.ph

More Related