The NCCPA™ PANCE Genitourinary Content Blueprint covers six types of infectious GU conditions
| Cystitis | Patient will present as → a 34-year-old woman with a 3-day history of hematuria, dysuria, increased urinary frequency, and nocturia. She has had no fever, chills, or back pain. On examination, she does not look ill. Her temperature is 37.5 ° C. Her abdomen is nontender. There is no CVA tenderness. Cystitis is inflammation of the bladder, typically caused by a bacterial infection leading to symptoms of pelvic pain, frequent and urgent urination, and hematuria
DX: Urine dipstick: nitrite, leukocyte esterase
Treat with Nitrofurantoin (not over age 65), Bactrim, Fosfomycin
Lower UTI in pregnancy
Interstitial cystitis: A chronic inflammation of the bladder wall, characterized by pelvic pain, urinary frequency, and urgency, which can severely impact quality of life
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| Epididymitis | Patient will present as → a 25-year-old male with a dull, achy scrotal pain that has been gradually increasing over the last several days. He also reports pain with urination. Physical exam reveals a swollen right testicle with substantial induration. Urinalysis reveals positive leukocyte esterase and 20 WBC/HPF. Epididymitis is characterized by dysuria, unilateral scrotal pain, and swelling The pathogen is based on the patient's age and risk factors
+ Prehn's sign = relief with elevation is a classic sign TX: < 35 years, or suspected STD etiology
≥ 35 years, with suspected enteric organism
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| Orchitis | Patient will present as → a 31-year-old male complaining of unilateral scrotal swelling with pain radiating to the ipsilateral groin. Examination reveals a tender swollen testicle, scrotal edema with erythema, and shininess of the overlying skin. Unilateral swollen testicle with erythema and shininess of the overlying skin
DX: Urinalysis with cultures will show pyuria and bacteriuria with cultures positive for suspected organisms
TX: bed rest, NSAIDS, scrotal support, ice, and antibiotics (if bacterial)
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| Prostatitis | Patient will present as → a 63-year-old man with a history of benign prostatic hyperplasia who reports 3-days of fever, chills, and pain with urination. He was recently catheterized during admission to the hospital. Physical exam reveals a tender and enlarged prostate on digital rectal exam. Urinalysis reveals pyuria and hematuria. Sudden onset of fever, chills, and low back pain combined with urinary frequency, urgency, and dysuria DX: Urinalysis will reveal pyuria (↑ WBC in acute) +/- hematuria
TX:
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| Pyelonephritis | Patient will present as → a 32-year-old female presents with fever, chills, nausea, and flank pain for 24 hours. She developed dysuria and urinary frequency 3 days prior and states that both have worsened. On physical exam, you note suprapubic abdominal pain and CVA tenderness. The urinalysis reveals white blood cell casts. Irritative voiding + fever + flank Pain + nausea and vomiting + CVA tenderness
DX: Urinalysis
TX: An oral regimen is considered the best initial outpatient treatment (7 days of outpatient treatment is equivalent to longer treatment regimens)
IV antibiotics are indicated for inpatients who are toxic or unable to tolerate oral antibiotics
Management of acute pyelonephritis in pregnant women includes hospital admission for parenteral antibiotics.
 "The decision to hospitalize a patient is usually clear in the setting of critical illness or sepsis. Otherwise, general indications for inpatient management include persistently high fever (eg, >101°F/>38.4°C) or pain, marked debility, inability to maintain oral hydration or take oral medications, suspected urinary tract obstruction, and concerns regarding adherence to therapy." |
| Urethritis | Patient will present as → a 22-year-old heterosexual male who recently started having unprotected intercourse with his new girlfriend. He now reports a painful itching and burning sensation with urination and discomfort in the urethra. He says that sometimes in the morning it appears that the walls of the meatus are stuck together with evidence of dried secretions. On exam, there is no purulent discharge. The meatus does appear red. His girlfriend does not have any symptoms. Urethritis is an infection of the urethra with bacteria (or with protozoa, viruses, or fungi) and occurs when organisms that gain access to it acutely or chronically colonize the numerous periurethral glands in the bulbous and pendulous portions of the male urethra and in the entire female urethra
DX First-void or first-catch urine and sometimes urine culture
TX:
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