- Acute Bacterial Prostatitis
- Acute Kidney Injury
- Testicular Torsion
Acute Bacterial Prostatitis
- 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.
- Symptoms: Fever, chills, low back pain, irritative bladder symptoms (frequency, urgency, dysuria)
- Signs: Tender, enlarged prostate
- Clinical diagnosis
- UA will show pyuria and hematuria
- 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)
*Deep Dive: Prostatitis (emDOCs)
Acute Kidney Injury
- 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)
- Usually asymptomatic; may have nausea/vomiting or skin changes (purpura)
- May show signs of fluid overload. Seizures and coma may occur if untreated.
- 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.
- Overall goal is to treat the underlying cause.
- IV fluids, correct electrolyte deficiencies, dialysis if needed
- Infection of the kidney by a urinary tract infection ascending from the bladder.
- Most commonly caused by E. coli
- Symptoms: Flank pain, dysuria, nausea/vomiting
- Signs: (+) CVA tenderness, (+) Fever
- Urinalysis will likely show pyuria, hematuria, bacteriuria, and/or WBC casts
- Diagnosis confirmed with urine culture
- Outpatient: Ciprofloxacin or bactrim
- Inpatient: Gentamicin or 3rd/4th gen cephalosporin
- 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.
- Symptoms: sudden, severe pain in testicle. May have nausea/vomiting
- Signs: (-) Cremaster reflex, (-) Prehn’s sign. Very tender to palpation
- Ultrasound w/ doppler
- Manual detorsion (open-book method)
- If unsuccessful, will require emergent surgery
*Deep Dive: Testicular Torsion (Core EM)
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