Uro-1. A case of recurrent acute urinary tract infection (UTI) and prostatitis: the value of a detailed history.Learning objectives were to (1) recognize the differential diagnosis and workup of recurrent UTI in males and (2) recognize the importance of a detailed sexual history. A 23-year-old male presented with a 1-day history of dysuria, fever, chills and flank pain. He had acute prostatitis 16 months prior. Cystoscopy Cystoscopy Definition Cystoscopy (cystourethroscopy) is a diagnostic procedure that is used to look at the bladder (lower urinary tract), collect urine samples, and examine the prostate gland. then revealed an inflamed porostatic urethra. Examination revealed a febrile tachycardic male. The abdomen was soft, with no costo-vertebral angle or suprapubic tenderness. Rectal examination: revealed an enlarged, tender, boggy prostate. The remaining examination was unremarkable. Lab work revealed WBC 16.6 mm TH, normal BUN/Cr; urine analysis: pH 5.5, large albuminuria albuminuria /al·bu·min·uria/ (al-bu?mi-nu´re-ah) presence in the urine of serum albumin, the most common kind of proteinuria.albuminu´ric al·bu·mi·nu·ri·a n. , leucocyte esterase, blood, WBCs, Gram-negative rods; culture: pseudomonas aeruginosa; kidney ultrasound: normal. The patient was treated with IV antibiotics. He was afebrile in 48 hours and was placed on 6 weeks' oral antibiotics. Due to recurrent urinary tract infection urinary tract infection (UTI), n infection in one or more of the structures that make up the urinary system. Occurs more often in women and is most commonly caused by bacteria. after repeated direct inquiry, the patient admitted to using different types and sizes of objects as anal toys. Prostatitis, a lower urinary tract infection, occurs by retrograde entry of organisms into the prostatic ducts via urethra from oral, anal, genital intercourse or masturbating practices, by hematogenous hematogenous /he·ma·tog·e·nous/ (he?mah-toj´e-nus) 1. produced by or derived from the blood. 2. disseminated through the blood stream. he·ma·tog·e·nous adj. 1. spread from other foci, or lymphatic extension from infected kidneys. Diagnosis is made from history, tender prostate on examination with pyuria pyuria /py·u·ria/ (pi-ur´e-ah) pus in the urine. py·u·ri·a n. The presence of pus in the urine, usually a sign of urinary tract infection. , positive urine culture and leukocytosis Leukocytosis Definition Leukocytosis is a condition characterized by an elevated number of white cells in the blood. Description Leukocytosis is a condition that affects all types of white blood cells. . Common organisms are E coli, proteus, enterococci, Staphylococcus aureus and epidermidis. Antibiotic treatment should be given for 4-6 weeks to assure eradication. In our patient, repeated trauma by use of anal toys increased his risk for urinary tract infection. This case helps to remind physicians of the value of detailed sexual history even though it can be embarrassing. Jasmine Shah, MD, and Mukta Panda, MD. University of Tennessee, Chattanooga-Unit, Chattanooga, TN. |
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