Nephrology: Genitourinary Part 2

What is Cystitis?

An inflammation of the bladder wall typically caused by a lower urinary tract infection.

What is Pyelonephritis?

An infection of the renal pelvis and parenchyma that is usually associated with an ascending bacterial infection of the bladder.

What are the risk factors for Cystitis?

Female, history of UTI, sex, vaginal infection, diabetes, obesity, genetic susceptibility

What are the clinical manifestations for Cystitis?

Frequent and urgent urination, dysuria, suprapubic pain, nocturia, hematuria, malaise

What are the causative organisms in Cystitis?

UPEC, Klebsiella, Staph, Enterococcus

How is Cystitis treated?

Fosfomycin, Bactrim DS, or Nitrofurantoin

What are the risk factors for Pyelonephritis?

Diabetes, HIV/AIDS, iatrogenic immunosuppression, congenital or acquired urodynamic abnormalities

What are the clinical manifestations for Pyelonephritis?

Back and/or flank pain, fever, chills, malaise, nausea, vomiting, anorexia

What are the causative organisms in Pyelonephritis?

UPEC, Klebsiella, Staph, Enterococcus, Proteus

How is Pyelonephritis treated?

Cipro or Levo

What is Emphysematous Pyelonephritis?

Acute necrotizing pyelonephritis caused by gas forming bacteria.

How is Emphysematous Pyelonephritis diagnosed?

Visualization of intra-renal gas on KUB, CT, or US

How is Emphysematous Pyelonephritis treated?

IV antibiotics, percutaneous drainage, emergency nephrectomy

What is Testicular Torsion?

Strangulating twisting of the testis around the spermatic cord

What are the risk factors for Testicular Torsion?

Bell clapper deformity: absence of soft tissue attachment causing an intravaginal type of testicular torsion

What are the clinical manifestations of Testicular Torsion?

Severe pain of sudden onset, swollen tender testicles, testicular asymmetry, absent cremasteric reflex

What are the differential diagnoses for Testicular Torsion?

Epididymitis and Mumps Orchitis

How is Testicular Torsion diagnosed?

Testicular ultrasound

What is the treatment for Testicular Torsion?

Surgical repair (emergency)

What is Testicular Appendage Torsion?

A rotation of the hydatid of Morgagni, an embryological remnant at the upper pole of the testes, around its own axis, causing ischemia.

What are the clinical manifestations of Testicular Appendage Torsion?

Severe pain of sudden onset, Palpable tender testicular lump, Visible Blue dot sign (Scrotal skin)

What are the differential diagnoses for Testicular Appendage Torsion?

Epididymitis and Testicular trauma

How is Testicular Appendage Torsion diagnosed?

Testicular ultrasound

What is the treatment for Testicular Appendage Torsion?

Pain management and Testicular elevation

What is Varicocele?

A pathological dilatation of the pampiniform venous plexus in the scrotum. Usually left-sided since the left testicular vein is longer (more gravitational pull) and drains into the left renal vein at a right angle without an antireflux valve at the junction, leading to poor outflow of blood and an increased reflux.

What are the causes of Varicocele?

Incompetent venous valves, high venous pressure, high arterial pressure (nutcracker syndrome)

What are the clinical manifestations of Varicocele?

Usually asymptomatic, infertility, pain, palpable bag of worms

How is Varicocele diagnosed?

Testicular ultrasound and testicular thermography

How is Varicocele treated?

Laparoscopic surgery

What is Nutcracker Syndrome?

Compression of the left renal vein between the aorta and the superior mesenteric artery. Causes high arterial pressure that can lead to Varicocele.

What is Hydrocele?

An accumulation of fluid within the tunica vaginalis of the scrotum surrounding one or both testicles.

What are the two types of Hydrocele?

Primary (reduced fluid reabsorption seen in congenital and infantile forms) and Secondary (increased fluid formation seen in cancer, torsion, and elephantiasis)

What are the clinical manifestations of Hydrocele?

Primary will be painless, cystic swelling, and positive transillumination. Secondary will have small-moderate swelling of the testicle that may be painful and may not transilluminate.

How is Hydrocele diagnosed?

Testicular ultrasound

What is the treatment for Hydrocele?

Primary often spontaneously resolves. Secondary requires treatment of the cause.

What is Spermatocele?

An abnormal cystic collection of sperm within the epididymal duct. It is usually located on the upper testicular pole and is palpable as a mass distinct from the testis.

What are the clinical manifestations of Spermatocele?

Can be asymptomatic. If symptomatic, there will be pain, swelling, scrotal mass, and have positive transillumination.

How is Spermatocele diagnosed?

Clinical, testicular ultrasound

How is Spermatocele treated?

Surgery if painful

What is an Inguinoscrotal Hernia?

Protrusion of abdominal content through a weak point in the anterior abdominal wall into the scrotum under pressure. Can be direct (Hesselbach triangle) or indirect (Inguinal canal).

What are the clinical manifestations of an Inguinoscrotal Hernia?

Painless inguinoscrotal swelling aggravated by erect posture and high abdominal pressure. Pain usually signals incarceration, bowel obstruction, or ischemia.

What is the treatment for Inguinoscrotal Hernia?

Surgery