UTI

Specific Infections of the Genitourinary System

Tuberculosis of the genitourinary tract

TB of GU tract is caused by mycobacterium bovis it predominantly affect Asian male more than female Rt kidney more than left
Pathogenesis
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)
Ureter: it gat 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 trabiculation then disease progress to fibrosis
contraction small capacity bladder ( thimble bladder)
Epididymis and vas : gate beaded cord
Kidney and prostate is properly gat primary TB
Presentation
GU TB should be suspected in present of any present or past history of TB with :
chronic cystitis resistant to treatment
sterile pyuria
Gross or microscopic haematuria
Non tender enlarge epididmis with beaded or thinking vas
Chronic discharging scrotal sinus
Indurations or nodulation of prostate and thinking of one or both seminal vesicles
Investigation
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 steno sis, cavitations ,bladder calcification
CT
Cystoscopy and biopsy
Treatment : for 6 months
Inculd isoniazid,rifampicin,ethambutol,streptomycin and pyrizinamide
Ureteric stricture treated by stenting, nephrostomy or reimplantion
Bladder may required augmentation or reconstruction, or diversion
Any surgical intervention .need at least 6 week medical Rx
The site most commonly affected is the ureterovesical junction (UVJ)
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
Urinary Schistosomiasis
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



67123457Eggs are passed out in urineMiricidia hatch from eggs in waterLarval multiplication in Bulinis snail …and enter unbroken skin, then migrate through blood vesselsto the liverWorms continue to developin the liver, then migrate to blood vessels around the urinary bladderAdult worms end up in veins around the bladder.Eggs penetrate the bladder walland are passed out with the urine6Cerariae leave the snail…

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,weeping ulcers,stones,tuomer
IVU may show acalcifed,contracted bladder, and obstructive uropathy
U/S may show hydronephrpsis and thickened bladder wall
Treatment : Praziquantel 40 mg in 2 divided doses ,ather like metrifonate
Complications
Obstrictive uropathy ,ureteric stenosis
Bladder contraction
Ulceration
Renal failure
Squamous metaplasia,squamous cell carcnoma
Urethratis


Infection/inflammation of the urthera
1/Conococcal urethratis : cause by N.gonorrhea
2/ Non conoccal urtheratis :mostly cause by 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
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 B)

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
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
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
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
Classification
Acute bact. Prostatis
Chronic bact. Prostatis
Chronic pelvic pain syndrom
Asymptomatic inflammatory prostatis
Acute bacterial prostatis is of acute onset of LUTs with sign of systemic toxataty including fever ,tachycardia ,hypotension
Rx : admission ,paranteral impciline+aminoglygosid
Analgsia,alpha blocker and releave retention if present
2/ chronic bact.prostatis : recurrent UTI,pain during or after ejaculation,pernial or penil pain
Chronic pelvic pain syndrome
A-Inflaminatary B-Non inflam. types both carry Obstructive and irratitive symptoms with 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