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Patient History, Physical Examination, Diagnostics
A 40-year-old male complains about right flank pain, high fever, and burning during urination. His personal history includes periodic sexual intercourses, living in the middle-income neighborhood, and frequent alcohol consumption. As for the medical history, the patient has diabetes and hypertension, both of which are controlled. The family history is characterized by prostate cancer in his father and hypertension in mother and two sisters. The above information shows that the identified patient is at a high risk of developing genitourinary diseases, including cancer.
The physical examination reveals moderate flank tenderness without rebound and normal bowel sounds. The patient appears sick and anxious, yet he remains oriented and attentive. A set of diagnostic measures is critical to properly identify the disease and further treatment options. Urinalysis (clean-voided specimen) along with urine sensitivity and culture is performed to analyze bacteria and other indicators (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cook, 2017). Radiography of kidney or renal ultrasonography can be helpful in determining the kidney size, presence of stones, and any other abnormalities.
Differential Diagnoses
- Urinary tract infection (Pyelonephritis). This kidney disease of an infectious etiology is accompanied by an inflammatory process, the cause of which is the penetration and reproduction in the tissues of the kidneys of pathogenic bacteria located in the lower parts of the urinary system (bladder) (Davies, Dargan, & Sved, 2018).
- Kidney stones in urethra. These are solid formations of various sizes that are localized in the urethra. Most often, they fall into the urethra descending from the bladder, urethras, or kidney (Vijaya, Kumar, Ramarao, Babu, & Ramarao, 2013). The presence of stones in the urethra is accompanied by pain, difficulty in urination up to its acute delay, as well as a change in the shape of the urine stream or its weakening.
- Urolithiasis. The formation of kidney stones is associated with a metabolic disorder that allows the accumulation of insoluble salts in the kidneys, which is characterized by pain in the lower flack (Vijaya et al., 2013). Pain is amplified or altered during movements and changes in the position of the body. Burning during urination and high grade fever as well as vomiting and blood in urine are the key symptoms of the mentioned disease.
- Prostate cancer. It is a malignant neoplasm, which arises due to the secretory epithelium of the prostate gland characterized by difficult urination, urinary incontinence, and frequent urination (Heidenreich et al., 2014). The only sign in the absence of the expressed symptoms is an increase in the blood level of PSA (prostate specific antigen). As a rule, in this case, the tumor size is insignificant.
Treatment Options
The treatment of pyelonephritis in men requires the consultation with a urologist. Most often, it is chronic in male patients and associated with stagnation of urine and a difficulty in its outflow due to diseases of the genitourinary system such as kidney disease, prostatitis, prostate adenoma, et cetera (Davies et al., 2018). An antibiotic agent should be prescribed to eliminate inflammation (Ciprofloxacin 250mg, daily for 14 days) (Buttaro et al., 2017). Another option is semisynthetic penicillin in combination with clavulanic acid (Augmentin 875/125 mg twice a day for 14 days), as stated by Davies et al. (2018). With the help of antibiotics, the inflammation may be removed in the shortest possible time. However, if the cause is not eliminated, pyelonephritis may become aggravated again, and after a certain number of such relapses, the bacteria will acquire resistance to the selected antibacterial drug. Therefore, a comprehensive approach should be applied to the treatment of pyelonephritis. The patient should be prescribed biopsy to eliminate the presence of prostate cancer.
References
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.
Davies, S. J., Dargan, J., & Sved, P. (2018). Literature review and case of medically managed bilateral emphysematous pyelonephritis. Urology Case Reports, 17, 73-75.
Heidenreich, A., Bastian, P. J., Bellmunt, J., Bolla, M., Joniau, S., van der Kwast, T.,… Mottet, N. (2014). EAU guidelines on prostate cancer. Part 1: Screening, diagnosis, and local treatment with curative intent—Update 2013. European Urology, 65(1), 124-137.
Vijaya, T., Kumar, M. S., Ramarao, N. V., Babu, A. N., & Ramarao, N. (2013). Urolithiasis and its causes-short review. The Journal of Phytopharmacology, 2(3), 1-6.
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