History

Common Genitourinary Problems

Various classifications have emerged, but it is important to distinguish those patients with a complicated infection. In this paper, I will address two specific genitourinary cases and explain the differences between them.
A 16 year old boy presents with fever and shaking chills. on physical examination he has mild right costovertebral angle tenderness, urinalysis shows white blood cells and casts, and leukocyte esterase is positive. In this particular case, a throughout history and physical should be done, on the assumption that male urinary tract infections are not as common. The appearance of the urine is turbid, as a consequence of white blood cells. The physical examination is highly suggestive of upper urinary tract involvement and some risk factors must be investigated. The color of the urine has nothing to do with the diagnosis and other microscopic findings are more specific. particularly important is the presence of pyuria, since it has a high sensitivity and specificity for infection. The patient’s suspected diagnosis is urinary tract infection, but the cause must be investigated by performing an ultrasound and abdominal X ray, since obstruction is a major complication that must be ruled out. Urinary tract stones are frequently complicated with infection by microorganisms, and if the diagnosis is confirmed, aggressive treatment must be established. A urine culture must be ordered and inpatient treatment with antibiotics is warranted.
The second case depicts a 23 year old healthy, heterosexual female, who complaints of lower urinary tract symptoms, no fever, and no abdominal or back pain. She has had previous UTIs and the last episode was 4 months ago, successfully treated with oral antimicrobial. physical examination is unremarkable. For this particular case, the differential diagnosis involves acute uncomplicated cystitis, vulvovaginitis, and subclinical pyelonephritis. Acute cystitis is benign from the perspective of long-term outcomes, but is associated with substantial disruption in a woman’s life with each episode (Nicolle, 2008). Self-diagnosis of infection is highly accurate for women with a history of recurrent infection. When the upper urinary tract is involved, the disease is named pyelonephritis and needs a more careful evaluation and treatment. Since uncomplicated cystitis is more common on sexually active females, and microbial etiology is straightforward, routine radiographic evaluation is not warranted. However, after a 3 day antimicrobial regimen with trimethoprim-sulfamethoxazole or an oral quinolone, this patient should be started on continuous prophylaxis with once a day oral antimicrobials, and reassessed 6 months after the initial visit.
References
Abrahamian, F. Moran, G. Talan, D. (2008). Urinary Tract Infections in the Emergency Department. Infectious Diseases Clinics of North America, 22, 73-87.
Nicolle, L. (2008). Uncomplicated Urinary Tract Infection in Adults Including Uncomplicated Pyelonephritis. Urology Clinics of North

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