Renal/Genitourinary

  • Acute Bacterial Prostatitis
  • Acute Kidney Injury
  • Pyelonephritis
  • Testicular Torsion

Acute Bacterial Prostatitis

  • 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)
Video Credit: JJ Medicine

*Deep Dive: Prostatitis (emDOCs)



Acute Kidney Injury

  • 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
Video Credit: Armando Hasudungan

*Deep Dive: Acute Kidney Injury – A Simple Emergency Approach to AKI (EM Cases)


Pyelonephritis

  • 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
Video Credit: Osmosis

*Deep Dive: Pyelonephritis: It’s not always so straightforward… (emDOCs)



Testicular Torsion

  • 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
Video Credit: Larry Mellick

*Deep Dive: Testicular Torsion (Core EM)


Brandon Simpson, PA-S2
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