Urology – JournalFeed

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Diagnostic characteristics that help differentiate testicular torsion from other causes of acute scrotal pain include vomiting, age > 13, scrotal edema, and palpation of a hard testis. Use caution with normal ultrasound results in those with high pretest probability.

Source
Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. Emerg Med J. 2022 Dec 16;emermed-2021-211946. doi: 10.1136/emermed-2021-211946. Online ahead of print.

Oct 20 2022October 18, 2022

Fluoroquinolone Resistance in UTI – Is It Time to Change Drugs?

Infectious Disease, Pharmacy/Pharmacology, Urology

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Fluoroquinolone-resistant (FQR) E. coli was present in 22.1% of UTI pathogens studied at 15 geographically diverse EDs. IDSA guidelines recommend changing empiric treatment if local resistance is >10% and adding a dose of parenteral antibiotic, such as ceftriaxone, prior to discharge home.

Source
High prevalence of fluoroquinolone-resistant UTI among US emergency department patients diagnosed with urinary tract infection, 2018-2020. Acad Emerg Med. 2022 Sep;29(9):1096-1105. doi: 10.1111/acem.14545. Epub 2022 Aug 5.

Jun 2 2022May 28, 2022

The Downside of Antibiotics for UTI

Infectious Disease, Pharmacy/Pharmacology, Urology

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Antibiotics have a good and bad side for women with uncomplicated cystitis. Use of trimethoprim-sulfamethoxazole (TMP-SMX) and other antibiotics, when compared to nitrofurantoin, had higher risk of adverse events.

Source
Association of Adverse Events With Antibiotic Treatment for Urinary Tract Infection. Clin Infect Dis. 2022 Apr 28;74(8):1408-1418. doi: 10.1093/cid/ciab637.

Jul 13 2021February 28, 2022

Pediatric Urine Concentration and UA Accuracy

Infectious Disease, Pediatrics, Urology

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Children <24 months may still have a UTI even with as few as 3 WBCs/hpf on urine microscopy if the urine is very dilute. Small leukocyte esterase on urinalysis was a powerful positive discriminator at all urine concentrations.

May 26 2021February 28, 2022

CT with Contrast for Kidney Stones?

Imaging, Urology

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Contrast-enhanced CT has a very high negative predictive value (100%) for obstructive urolithiasis and appears to accurately and safely exclude obstructing ureteral calculi for patients with acute flank pain. In addition, IV contrast improves the diagnostic yield for other acute abdominopelvic pathology and perhaps should be the test of choice for patients presenting with acute flank pain.

Mar 26 2021March 1, 2022

New Nerve Block for Renal Colic?

Pain/Sedation/Procedure, Pharmacy/Pharmacology, Ultrasound, Urology

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Consider the erector spinae plane block to reduce NSAID and opioid use in patients with renal colic.

Mar 22 2021March 1, 2022

How to Manage Pediatric UTI – Spoon-Feed Version

Infectious Disease, Pediatrics, Pharmacy/Pharmacology, Urology

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Appropriate diagnosis of urinary tract infection (UTI) in children is important, as missed UTI can lead to renal scarring and other complications while over-diagnosis promotes antibiotic resistance.

Feb 5 2021March 1, 2022

Ketorolac for Renal Colic – 10, 20, or 30mg IV?

Pain/Sedation/Procedure, Pharmacy/Pharmacology, Urology

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For acute pain from renal colic in the ED, a dose of ketoroloc as low as 10mg IV was as effective as a 30mg dose.

Sep 10 2019

Is There a Better Way to Image Renal Colic?

Imaging, Renal, Ultrasound, Urology

Ultrasound appears to be best in most renal colic clinical scenarios. CT is best in older patients (especially with no stone history), those with tenderness on abdominal exam, and those with uncontrolled pain.

May 20 2019

New IDSA Guideline on Asymptomatic Bacteriuria

Hematology/Oncology, Infectious Disease, Medicine/Geriatrics, OB/GYN, Pediatrics, Pharmacy/Pharmacology, Renal, Urology

The IDSA now only recommends screening for and treating asymptomatic bacteriuria (ASB) in pregnant women and those undergoing an invasive urologic procedure.