Specific Infections of the Genitourinary System

1. Specific Infections of the Genitourinary System

2. Tuberculosis of the genitourinary tract

3. TB of GU tract is caused by mycobacterium bovis it predominantly affect Asian male more than female Rt kidney more than left Pathogenesis TB Primary TB Affected lung Post primary TB Re activation of primary one trigger by immune system Kidney : Haematogenous spread causing granuloma with caesous necrosis of cortex and papillary deformity and heeling by fibrosis and calcification(autonephrectomy)

4. Ureter: directly from kidney causing ureteric stricture and uretertis cystica Bladder : ether from 1\Renal infection 2\ iatrogenic from interavesical BCG Bladder wall became oedmatous ,red, with ulceration and tubercle then disease progress to fibrosis contraction small capacity( thimble bladder) Epididymis and vas :gate beaded cord Kidney and prostate is properly gat primary TB

5. Presentation • GU TB should be suspected in present of • A history of present and past history of TB with • chronic cystitis resistant to treatment • Sterial pyuria • Gross or microscopic haematuria • Non tender enlarge epididmis with beaded or thinking vas • Chronic scrotal sinus • Indurations or nodulation of prostate and thinking of one or both seminal vesicles • Investigation

6. Urine :at least 3 early morning urine samples • Sating by Ziehal Neelsen stainging • Culture media for TB is jensen medium • CXR and sputum • Tuberculin skin test • PCR • IVP :ether normal or show calcification infundibular stenosis, cavitations ,bladder cacification • CT • Cystoscopy and biopsy • Treatment : for 6 months • Inculd isoniazid,rifampicin,ethambutol,streptomycin and pyrizinamide • , • .

7. Ureteric stricture treated by stenting, nephrostomy or reimplantion Bladder may required augmentation or reconstruction, or diversion Any surgical intrvension .need at least 6 week medical Rx The site most commonly affected is the ureterovesical junction (UVJ)

8. CT has replaced IVU for the diagnosis and evaluation of genitourinary TB *It is at least the equal of IVU in identifying -calyceal abnormalities, -hydronephrosis or hydroureter, -autonephrectomy, amputated infundibulum, -urinary tract calcifications, and -renal parenchymal cavities *However,these findings are not specific

9. Urinary Schistosomiasis

10. Is caused by atrematode or (fluke) called Schistoma haematobuim that present in egypt ,africa and middle east a fresh water snail release the infective form of parasite (cercariae) that penetrate the skin and migrate to liver as (schistosomules) where they mature ,adult warm couple migrate to the vesical veins and lay eggs (containing miracidia larvae)that penetrate bladder and enter urine the disease have 2 stage: 1- active :worms actively laying eggs) 2- inactive :worm died and there is immunological reaction to eggs

11. 6 Worms continue to develop in the liver, then migrate to blood vessels around the urinary bladder 7 Adult worms end up in veins around the bladder. Eggs penetrate the bladder wall and are passed out with the urine 6 7 5 …and enter unbroken skin, then migrate through blood vessels to the liver 1 Eggs are passed out in urine 4 Cerariae leave the snail… 2 Miricidia hatch from eggs in water 3 Larval multiplication in Bulinis snail

12. Presentation • Swimmer itch • Katayama fever ( generalize allergic reaction) • Active inflamination causing terminal painful haematuria • Investigation • mid day urine sample show terminal spinal eggs • Bladder and rectal biopsy • Serology test (ELISA) • Cystoscopy may normal or show sandy patches ,tubercles, polyps,weepingulcers,stones,tuomer • IVU may show acalcifed,contracted bladder, and obstructive uropathy • U/S may show hydronephrpsis and thickened bladder wall

13. Treatment Praziquantel 40 mg in 2 divided doses ,ather like metrifonate Complications Obstrictiveuropathy ,uretericstenosis Bladder contraction Ulceration Renal failure Squamousmetaplasia,squamous cell carcnoma Prognosis Mild and early disease have benign course while sever lat stage carry harmful fate

14. Urethratis Infection/inflammation of the urthera 1/Conococcal urethratis :N.gonorrhea 2/ Non conoccal urtheratis :mostly chlamydia trachonats Clinical features: Urtheral discharge,dysuria,40% asymptomatic Investigations: Gram staining and culture of urethral swap 30% of men have both chlamydia and N.gonorrhea Treatment: 1/ N.gonorrhea : ceftriaxone IM single dose or fluroquinolon

15. 2/ Non gonoccal :doxycycline 100mg1*2 for 10 days or erythromycin 500mg *4 time for 10 day 3 point should be taken • Hidden non gonococcal • Partner should be treated • Seek for anther sexually transmitted dis.(hepatitis) EPIDIDYMORCHITIS • Infection /inflamination of epididymis,mainly ascending roat from lower urinary tract • Most causes of epididymitis <35 year are due to sexually transmit gonorrial or chlamidial infection • Children and older >35 usually due to uropathogen like E.coli

16. children it mostly congenital(ectopic ureter) • older age look to functional cause(BPH) • Middle age look to sexually transmitted rout C/F • Sever scrotal pain and swelling • Secondary hydrocele • LUTs ,cystitis,prostitis • Difficult to distinguish epididmys from tests • Thick spermatic cord Investigation Urinalysis :pus , CBP: leukocytosis

17. Differential diagnosis Testicular torsion can defiantly diagnose by Color Doppler us in infection increment vascalaty in torsion hypovascaler Radionuclide scan Treatment: Antibiotic against specific infection for 4 week ,bed rest, scrotal elevation,NSAID,in sepsis hospitalization and paranteral AB ,if abscess then drainage, treat sexual partner

18. Prostatitis Infection/inflamination of prostate Epidemiology prevelenceis 5% Risk factor • UTI • Epdidymitis • Urethral instrumentation like catheter or surgery • Intraprostatic ducal reflux • Phimosis • Prostatic stones form nidus for infection

19. Classification • Acute bact. Prostatis • Chronic bact. Prostatis • Chronic pelvic pain syndrom • Asymptomatic inflammatory prostatis Acute bacterial prostatis is of acute onsit of LUTs with sign of systemic toxotaty including fever ,tachycardia ,hypotension Rx : admission ,paranteral impciline+aminoglygosid Analgsia,alpha blocker and releave retention 2/ chronic bact.prostatis : recurrent UTI,pain during or after ejaculation,pernial or penil pain

20. Chronic pelvic pain syndrome A-Inflaminatary B-Non inflam. types Obstructive and irratitive symptoms history of more than 3 months of pain(supra pubic ,pernial ,penile ) Rx • Oral quinolon • Alpha blocker • Anti inflamintary • Muscle relaxant • Prostatic massage • Hormnal like finstrid