More invasive tests—such as cystoscopy, ureteroscopy, and nephroscopy—allow clinicians to make diagnoses under direct vision and simultaneously perform therapeutic interventions. These tests, however, do not provide any functional information. Acute…
Decompensation occurs as the ureter lengthens and becomes tortuous, followed by replacement of normal ureteral muscle with scar tissue. As a result, the ureter progressively loses its ability to contract…
In some cases, these inflammatory processes involve the ureteric orifices or urethra, causing stricture formation and obstruction. These abnormalities may lead to hydronephrosis and, in a small percentage of cases,…
PROGNOSIS In the developed world, tuberculosis is rarely a cause of chronic kidney disease. Preservation of renal function, however, depends on early detection to limit renal parenchymal destruction. In developing…
PRESENTATION AND DIAGNOSIS The symptoms of genitourinary tuberculosis can be very nonspecific. Patients often complain of urinary frequency and may, in some cases, experience gross hematuria or flank pain. Some…
The duration of antibiotic therapy depends on the size of the abscess and the extent of drainage. Generally, it is continued for 2 to 3 weeks following successful drainage. The…
In nonpregnant women, asymptomatic bacteriuria increases the risk of cystitis, but neither general screening nor treatment is recommended because bacteriuria tends to rapidly recur. Likewise, there is no benefit to…
COMPLICATED PYELONEPHRITIS Emphysematous pyelonephritis (EPN) is an uncommon but life-threatening necrotizing infection that causes gas formation in the collecting system and renal parenchyma. It is most common in diabetic patients…
PRESENTATION AND DIAGNOSIS In addition to the symptoms associated with cystitis (see Plate 5-2), which may or may not be present, acute pyelonephritis features high fever, anorexia, nausea/vomiting, costovertebral angle…
When initiating treatment, rapid hydration of the patient can increase urine production and facilitate clearance of some bacteria through voiding. As discussed earlier, urinary pH plays an integral role in…
