Severe, sudden testicular pain w/o fever, pyuria or hx of recent mumps
-Testicular torsion
What are the characteristics of testicular torsion?
- Swollen testis, exquisitely tender
- “High riding” and with “horizontal lie”
- Cord is not tender
How is testicular torsion treated?
- Urological emergency
- Immediate surgical intervention
- Orchiopexy done after the testis is untwisted
- Some surgeons fix both testicles
What condition is commonly confused with testicular torsion?
-Acute epididymitis
How does Acute epididymitis present?
-In young men old enough to be sexually active
-Severe, sudden testicular pain
-Has fever and pyuria
-Testis is swollen and tender, but in the right position
-Cord is very tender
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How is Acute epididymitis treated?
- r/o testicular torsion
- antibiotics
What are the two main urologic emergency?
- Testicular torsion
- Combination of obstruction and infection of the urinary tract
What is the most dire consequence of having both obstruction and infection of the urinary tract?
-Destruction of the kidney within hours and potential death from sepsis
How is the Combination of obstruction and infection of the urinary tract managed?
- IV antibiotics
- Immediate decompression of urinary tract above the obstruction using the quickest and simplest means
Urinary frequency, painful urination with small volumes of cloudy and malodorous urine:
Urinary tract infection (UTI; cystitis)
In which patient are UTI’s most common?
- Women of reproductive age
- Does not require elaborate workup
How are UTI’s managed?
-empiric antimicrobial therapy
What does an urologic workup consist of?
- Sonogram to look for dilation/obstruction
- CT used for renal tumors
- Cystoscopy is the only way to look at the bladder mucosa in detail (to detect early cancers)
- Intravenous Pyelogram (IVP) which is the gold standard, but only used when safer, cheaper tests have been done
What is an IVP? What is it good for? What are its limitations?
- Intravenous Pyelogram
- Good to view the kidney, collecting ducts, ureters and some of the bladder (does not detect early bladder cancer)
- Provides good idea of function of the kidney, ureters and bladder
- Limited by potential dye allergy, contraindications in patients with limited renal function (Cr>2)
A patients with chills, high fever, nausea and vomiting, and flank pain, most likely has:
-Pyelonephritis
How is pyelonephritis treated?
- Hospitalization
- IV antibiotics guided by cultures
- Urologic workup
An elder male patient with chills, fever, dysuria, urinary frequency, diffused low back pain, and exquisitely tender prostate on rectal exam, most like has:
-Acute bacterial prostatitis
How is acute bacterial prostatitis treated?
- IV antibiotics
- NO more rectal exams bc continuous prostatic massage can lead to septic shock
What is the most common reason for a new-born boy to NOT urinate during the first day of life?
-Posterior urethral valves (congenital)
How are posterior urethral valves managed?
- r/o meatal stenosis
- Catheterization to empty the bladder
- Dx w voiding cystourethrogram
- Tx w endoscopic fulguration/resection
In what patients should circumcision never be done? Why?
- Patients with hypospadias (congenital)
- Urethral opening in on dorsal side of the penis, between the tip and the base of the shaft.
- The skin of the prepuce will be needed for the plastic reconstruction that will eventually be done
When should urologic workup always be done?
-In the case of UTIs in children since they may be caused by vesicouretereal reflux, or another congenital abnormality
A child having burning with urination, urinary frequency, low abdominal and perineal pain, flank pain, and fever and chills, most like has:
-Vesicoureteral reflux and infection
How is a vesicoureteral reflux and infection in a child managed?
- Tx infection with antibiotics (empiric, then culture guided)
- Do IVP and voiding cystogram to look for reflux
- Long term abx are used until the child “grows out of the problem”
