GENITOURINARY INFECTIONS, DIAGNOSTIC AND TREATMENT

2. UROLOGY
ACUTE PYELONEPHRITIS
ACUTE BACTERIAL PROSTATITIS
ACUTE NON BACTERIAL PROSTATITIS
ACUTE CYSTITIS
PROSTATODYNIA
ACUTE EPIDIMYTIS
URINARY STONE DISEASES
URINARY INCONTINENCE
ACUTE ERECTILE DYSFUNCTION

3. UROLOGY
BENIGN PROSTATIC HYPERPLASIA
PROSTATIC CANCER AND OTHERS MALIGNACIES
PEDIATRICS UROLOGY  CONGENITAL ABNORMALITIES, undescended
testes, hypospadia, phimosis and genitourinary infections.

4. UROLOGIC EXAMINATION
Phisycal examination :
Including, bladder,
scrotum. testes, penis,
anus and prostate.
(male)
Inspection, palpation and rectal digital exam
Tumoral markers: PSA total and free PSA; Ca 19.9;
CEA
Urinalysis
Dipstick : pH ,proteins, glucose and ketones,
nitrites (positive in bacteriuria)
Microscopic urinalysis: hematuria, leukocytosis,
casts,epytelial cells, chrystals.

5. STRIP TEST ANALYSIS (DIPSTICK)
Ph
Leukocytes
Glucose and ketones
Billirrubin
Erythrocytes
Creatinin
Nitrites

6. GENITOURINARY TRACT INFECTIONS
SYMPTOMS
1- IRRITATIVE VOIDING
2- SUPRAVESICAL PAIN
3- FEVER
4- FLANK PAIN

7. HOST SUSCETIBILITY FACTORS
EFFICIENT EMPTYING DECREASE COLONY COUNTS AND
GLYCOSAMINEGLICAN LAYER PROTECTION
ANTIMICROBIAL PROPRIETIES OF URINE  EXTREME PH AND HIGH
OSMOLARITY
VESICOURETERAL REFLUX INCREASE RISK OF UPPER TRACT
INFECTIONS
WOMEN: SHORT URETRA, VAGINA COLONIZATION, FISTULAS
MEN : OBSTRUTIVE PROSTATIC HYPERPLASIA ; LOW ZINC LEVELS IN
SEMEM IN CHRONIC PROSTATITIS ( ZINC IS A POTENT
ANTIBACTERIAL)

8. PERSISTENT BACTERIURIA
INFECTED STONES
CHRONIC PYELONEPHRITIS
PROSTATITIS
URETRAL DIVERTICULA
FOREIGN BODIES

9. LOWER TRACT INFECTIONS – ACUTE CYSTITIS
FEVER IS UNCOMMON
DYSURIA
MOST COMMON IN WOMEN, rare in men (prostatitis and epididymitis)
MOST COMMON MICROORGANISM: E.Coli, Enterococus,
Viral cystitis BY ADENOVIRUS could be seen in children

10. DIFFERENCIAL DIAGNOSIS IN WOMEN
VULVOVAGINITIS
INFLAMMATORY PELVIC DISEASE

11. PYELONEPHRITIS
FEVER
FLANK PAIN
PYURIA AND LEUKOCYTOSIS
GROSS HEMATURIA
URINE CULTURE POSITIVE > 100.000 COLONY but 50% OF WOMEN WITH
GENITOURINARY INFECTIONS HAS LESS THAN 100.000 COLONY/ML
BLOOD CULTURE MAY BE POSITIVE

12. PYELONEPHRITIS
MICROORGANISMS
E. COLI
KLEBSIELLA
ENTEROBACTERIAL
PSEIDOMONAS
ENTEROCOCCUS FAECALLIS
STAPHILOCOCCUS AUREUS (HEMATOGENOUS)

13. TREATMENT
PYELONEPHRITIS AND PROSTATITIS (PARENQUIMA
INFECTIONS)REQUIRE 3-4 WEEKS OF TREATMENT
CYSTITIS 1 -3 DAYS
TRIMETHROPRIM AND SULPHAMETHOXAZOLE
NITROFURANTOINA
CEPHALEXINE
PROPHYLAXIS: CIPROFLOXACIN DAILY VERSUS POST-INTERCOURSE
CEPHALEXIN

14. COMPLICATIONS
UNRESOLVED BACTERIURIA
MIXED INFECTIONS
RENAL INSUFFICIENCY
MICROORGANISM RESISTANCE

15. URINARY TRACT STONES-- CAUSES
HYPERCALCIURIA
ACID URIC
HYPEROXALURIC
HYPEROXALURIC- CALCIUM
CYSTINE
STRUVITE CALCIUM ( mixtures of calcium phosphate and calcium
oxalate )

16. URINARY STONES
FLANK PAIN
HEMATURIA
OBSTRUCTIVE STONES  HYDRONEPHROSIS AND PYELONEPHRITIS

17. URINARY STONES TREATMENT
WATER INTAKE
DECREASE PROTEIN AND SALT INTAKE
SURGYCAL TREATMENT : PERCUTANEUS NEPHROLITHOTOMY OR
ENDOSCOPIC EXTRACTION.
DESOBSTRUCTION BY CATHETER
ESWL EXTRACORPOREAL WAVE LYTHOTRIPSY

18. DIAGNOSIS BY IMAGING
RADIOLOGY : SPIRAL TOMOGRAPHY
ULTRASONOGRAPHY ; INTRAVENOUS UROGRAPHY
INDICATED FOR PYELONEPHRITIS, RENAL STONES, SEARCH FOR
ABNORMALITIES

19. THANK YOU