
Acute Bacterial Prostatitis
Rapid Review
- Background
- Inflammation of the prostate due to ascending infection of gram-negative rods into the prostatic ducts.
- Most commonly caused C. trachomatis and N. gonorrhoeae patients <35 years old; E. coli for patients >35 years old.
- Signs/Symptoms
- Symptoms: Fever, chills, low back pain, irritative bladder symptoms (frequency, urgency, dysuria)
- Signs: Tender, enlarged prostate
- Diagnosis
- Clinical diagnosis
- UA will show pyuria and hematuria
- Treatment
- If < 35 years old, treat for chlamydia and gonorrhea (Ceftriaxone + Doxycycline)
- If > 35 years old, treat for E. coli and pseudomonas (fluoroquinolones or TMP-SMZ)
- Disposition
- Patients with non-complicated prostatitis can be discharged as long as they can tolerate PO antibiotics
- Admit toxic-appearing patients or those with urinary retention.
Pearls
- For severe or persistent cases, consider ultrasound or CT to look for prostate abscess. If present, these patients will require urgent urologic consultation.
- Consider STIs in any sexual active male with prostatitis, regardless of their age.
Deep Dive

Acute Kidney Injury
Rapid Review
- Background
- Acute reduction in renal function over hours to days. Previously referred to as “acute renal failure”.
- Causes may be prerenal (CHF, hemorrhage, hypovolemia), intrarenal (ATN, vasculitis, glomerulonephritis), or postrenal (nephrolithiasis, BPH)
- Signs/Symptoms
- Usually asymptomatic; may have nausea/vomiting or skin changes (purpura)
- May show signs of fluid overload. Seizures and coma may occur if untreated.
- Diagnosis
- Laboratory diagnosis; defined as increase in serum creatinine 1.5x presumed baseline or an increase in serum creatinine by 0.3 mg/dL over 48 hours
- Imaging, biopsy, and other labs (FENa, urine osmolality, etc.) will help determine cause.
- Treatment
- Overall goal is to treat the underlying cause.
- IV fluids, correct electrolyte deficiencies, dialysis if needed
- Disposition
- Mild AKI with a clear cause and no electrolyte derangements can be discharged with follow-up as needed.
- Admit any patients with significant metabolic derangements, AMS, or unclear etiology of the AKI.
Pearls
- NSAIDs should be avoided when possible in any patient with an AKI, as these cause a decrease in glomerular blood flow.
- Although contrast as been associated with AKI, you should never withhold contrast from a patient who needs it to diagnose a life-threatening diagnosis, regardless of baseline renal function.

Pyelonephritis
Rapid Review
- Background
- Infection of the kidney by a urinary tract infection ascending from the bladder.
- Most commonly caused by E. coli
- Signs/Symptoms
- Symptoms: Flank pain, dysuria, nausea/vomiting
- Signs: (+) CVA tenderness, (+) Fever
- Diagnosis
- Urinalysis will likely show pyuria, hematuria, bacteriuria, and/or WBC casts
- Diagnosis confirmed with urine culture
- Treatment
- Antibiotics
- Outpatient: Ciprofloxacin or bactrim
- Inpatient: Gentamicin or 3rd/4th gen cephalosporin
- Antibiotics
- Disposition
- Admit any complicated cases (sepsis, pregnancy, concomitant obstruction, failed outpatient therapy)
- Uncomplicated cases who are tolerating PO and have close follow-up in 48-72 hours can be discharged.
Pearls
- CT imaging is not required to diagnose pyelonephritis, but can evaluate for obstructing stones or renal abscesses.
- Always remember to get a urine culture. It may not change management in the ED initially, but will be very useful in the inpatient setting or those who bounceback after being discharged.

Testicular Torsion
Rapid Review
- Background
- Urologic emergency involving rotation of the testicle around the spermatic cord, causing compromised blood flow and ischemia that can quickly lead to permanent effects on fertility within 4-6 hours.
- Signs/Symptoms
- Symptoms: sudden, severe pain in testicle. May have nausea/vomiting
- Signs: (-) Cremaster reflex, (-) Prehn’s sign. Very tender to palpation
- Diagnosis
- Ultrasound w/ doppler
- Treatment
- Manual detorsion (open-book method)
- If unsuccessful, will require emergent surgery
- Disposition
- All cases of confirmed testicular torsion will require admission for surgery. Consult urology early.
Pearls
- Remember time is testicle! The earlier the diagnosis can be made, the more likely the testicle can be salvaged. The risk of orchiectomy is 5% at 0-6 hours, 20% at 7-12 hours, and 80% at > 24 hours.
- Not every case of testicular torsion will present with testicular pain. Consider testicular torsion in any case of lower abdominal pain, especially in pediatrics.
Deep Dive