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Urología
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UrologíaUrología...............................................................................................................................................................................................................................................................................................................................................................1
Infecciones del Tracto Urinario..........................................................................................................................................................................................................................................................................................................3
Epidemiología.........................................................................................................................................................................................................................................................................................................................................3
FR : relaciones sexuales, uso de espemicidas, IVU en infancia, cambio de pareja sexual, obesidad, DM, cistocele, aumento de orina residual, cateterismo,
deterioro funcional, incontinencia urinaria, IVU revio a la menopausia........................................................................................................................................................................................................3
Clasificación..............................................................................................................................................................................................................................................................................................................................................3
Términos......................................................................................................................................................................................................................................................................................................................................................3
Patogenia...................................................................................................................................................................................................................................................................................................................................................3
Etiología: colonización→ penetración urotelio→ ascensión (pili) → pielonefritis → LRA..........................................................................................................................................................................5
Clínica............................................................................................................................................................................................................................................................................................................................................................5
2 síntomas >90% →tratamiento...................................................................................................................................................................................................................................................................................................5
Diagnóstico...............................................................................................................................................................................................................................................................................................................................................5
Bacteriuria asintomática.................................................................................................................................................................................................................................................................................................................6
ITU no complicada...............................................................................................................................................................................................................................................................................................................................6
UTI complicada.......................................................................................................................................................................................................................................................................................................................................7
UTI recurrente.........................................................................................................................................................................................................................................................................................................................................8
Pielonefritis aguda no Complicada.........................................................................................................................................................................................................................................................................................8
Pielonefritis Complicada..................................................................................................................................................................................................................................................................................................................9
Pielonefritis Enfisematosa..............................................................................................................................................................................................................................................................................................................9
IVU en hombres...................................................................................................................................................................................................................................................................................................................................10
Prostatitis..................................................................................................................................................................................................................................................................................................................................................10
Orquiepididimitis.................................................................................................................................................................................................................................................................................................................................11
Absceso Renal.........................................................................................................................................................................................................................................................................................................................................11
Absceso perirrenal...............................................................................................................................................................................................................................................................................................................................11
UTI asociada a catéter.......................................................................................................................................................................................................................................................................................................................11
Gangrena de Fournier.......................................................................................................................................................................................................................................................................................................................11
Tuberculosis genitourinaria.........................................................................................................................................................................................................................................................................................................12
Cistitis intersticial.................................................................................................................................................................................................................................................................................................................................13
Prostatitis........................................................................................................................................................................................................................................................................................................................................................14
Prostatitis Bacteriana Aguda......................................................................................................................................................................................................................................................................................................15
Prostatitis Bacteriana Crónica...................................................................................................................................................................................................................................................................................................17
Prostatitis crónica no bacteriana.............................................................................................................................................................................................................................................................................................18
, Síndrome de Dolor Pélvico Crónico.......................................................................................................................................................................................................................................................................................18
Prostatitis asintomática.................................................................................................................................................................................................................................................................................................................18
Orquiepididimitis.......................................................................................................................................................................................................................................................................................................................................19
Hiperplasia y carcinoma prostático..............................................................................................................................................................................................................................................................................................21
Etiopatogenia.........................................................................................................................................................................................................................................................................................................................................21
Fases:............................................................................................................................................................................................................................................................................................................................................................21
Clínica..........................................................................................................................................................................................................................................................................................................................................................21
Diagnóstico..............................................................................................................................................................................................................................................................................................................................................21
Tratamiento............................................................................................................................................................................................................................................................................................................................................22
Patología traumática..............................................................................................................................................................................................................................................................................................................................23
Trauma testicular...............................................................................................................................................................................................................................................................................................................................23
Trauma uretral......................................................................................................................................................................................................................................................................................................................................25
Anterior: bulbar más afectada..................................................................................................................................................................................................................................................................................................25
Trauma de pene..................................................................................................................................................................................................................................................................................................................................27
Carcinoma prostático............................................................................................................................................................................................................................................................................................................................28
Litiasis Renal.................................................................................................................................................................................................................................................................................................................................................30
Fisiología..................................................................................................................................................................................................................................................................................................................................................30
Clínica..........................................................................................................................................................................................................................................................................................................................................................31
Diagnóstico..............................................................................................................................................................................................................................................................................................................................................31
Estudio metabólico............................................................................................................................................................................................................................................................................................................................31
Litiasis cálcica........................................................................................................................................................................................................................................................................................................................................32
Litiasis úrica............................................................................................................................................................................................................................................................................................................................................33
Litiasis cistinica.....................................................................................................................................................................................................................................................................................................................................33
Litiasis infecciosa................................................................................................................................................................................................................................................................................................................................33
Tratamiento Médico.........................................................................................................................................................................................................................................................................................................................34
Tratamiento...........................................................................................................................................................................................................................................................................................................................................34
Fimosis, parafimosis y priapismo...................................................................................................................................................................................................................................................................................................36
Incontinencia Urinaria...........................................................................................................................................................................................................................................................................................................................38
Disfunción sexual.......................................................................................................................................................................................................................................................................................................................................41
, Infecciones del Tracto Urinario
Epidemiología
● Cistitis 50% en mujeres
● FR : relaciones sexuales, uso de espemicidas, IVU en infancia, cambio de pareja sexual, obesidad, DM, cistocele, aumento de orina
residual, cateterismo, deterioro funcional, incontinencia urinaria, IVU revio a la menopausia
Clasificación
● Localización
○ ITU alta: infecciones renales
○ ITU baja: cistouretritis, prostatitis
● Severidad:
○ Complicada: catéteres, uropatía obstructiva, reflujo vesicoureteral, anomalía anatómica, insuficiencia renal, trasplante renal, hombre,
embarazo, niños. , síntomas >7 días, nosocomial
○ No complicada: escozor miccional, urgencia, frecuencia +/- hematuria terminal, dolor hipogástrico, febrícula
Términos
● Reinfección: infección nueva por germen distinto
● Recidiva: infección por mismo germen.
○ FR: Litiasis infectiva, prostatitis crónica, fístulas vaginales/intestinales, divertículos vesicales infectados, cuerpos extraños, necrosis papilar
infectada, otras causas de reservorio
Patogenia
● Vías:
○ Hematógena
○ Linfática
○ Ascendente:
■ Mujeres: corta y ancha
■ Cateterismo uretral: riesgo 5% por cada día de sondaje
● Factores de infección
, ○ Virulencia del microorganismo: fimbrias, hemolisina, cápsula polisacáridos
○ Tamaño del inóculo
○ Defensa del huésped: chorro urinario, flujo unidireccional, proteína de Tamm Horsfall, flora, pH.
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