Multispecies comparative prostate anatomy by imaging: Implications for experimental models of prostatic disease.

BACKGROUND: There is an increasing interest in using preclinical models for development and assessment of medical devices and imaging techniques for prostatic disease care. Still, a comprehensive assessment of the prostate's radiological anatomy in primary preclinical models such as dogs, rabbits, and mice utilizing human anatomy as a reference point remains necessary with no optimal model for each purpose being clearly defined in the literature. Therefore, this study compares the anatomical characteristics of different animal models to the human prostatic gland from the imaging perspective. METHODS: We imaged five Beagle laboratory dogs, five New Zealand White rabbits, and five mice, all sexually mature males, under Institutional Animal Care and Use Committee (IACUC) approval. Ultrasonography (US) was performed using the Vevo® F2 for mice (57 MHz probe). Rabbits and dogs were imaged using the Siemens® Acuson S3000 (17 MHz probe) and endocavitary (8 MHz) probes, respectively. Magnetic resonance imaging (MRI) was also conducted with a 7T scanner in mice and 3T scanner in rabbits and dogs. RESULTS: Canine transrectal US emerged as the optimal method for US imaging, depicting a morphologically similar gland to humans but lacking echoic zonal differentiation. MRI findings in canines indicated a homogeneously structured gland similar to the human peripheral zone on T2-weighted images (T2W) and apparent diffusion coefficient (ADC). In rabbits, US imaging faced challenges due to the pubic symphysis, whereas MRI effectively visualized all structures with the prostate presenting a similar aspect to the human peripheral gland on T2W and ADC maps. Murine prostate assessment revealed poor visualization of the prostate glands in ultrasound due to its small size, while 7T MRI delineated the distinct prostates and its lobes, with the lateral and dorsal prostate resembling the peripheral zone and the anterior prostate the central zone of the human gland. CONCLUSION: Dogs stand out as superior models for advanced preclinical studies in prostatic disease research. However, mice present as a good model for early stage studies and rabbits are a cost-effective alternative and serve as valuable tools in specific research domains when canine research is not feasible.

Giant Prostate Abscess: A Case Report and Literature Review.

Prostate abscess, a rare condition often associated with prostate bacterial infections, often occurs in immunosuppressive individuals and manifests as fever and lower urinary tract symptoms. Clinical practice lacks standardized diagnostic and treatment protocols for prostate abscesses, resulting in predominantly empirical approaches with uncertain outcomes. This study presents a case of a giant prostate abscess, diagnosed in a patient exhibiting fever, lower urinary tract symptoms (including dysuria, urinary frequency, urgency, and weakness), and anal pain. The diagnosis was confirmed through prostate magnetic resonance imaging and transrectal color ultrasound examinations. Treatment included targeted anti-infective therapy (based on the urine culture results), urine flow diversion (suprapubic bladder puncture stomy), ultrasound-guided perineal puncture drainage of the prostatic abscess, intermittent abscess cavity irrigation, and urethral electroprostatectomy. The patient experienced a complete recovery and significantly improved quality of life. This successful case underscores several key points: (1) the importance of targeted anti-infective therapy based on etiological findings in prostate abscess treatment; (2) early urine flow diversion, precise puncture drainage, and intermittent abscess cavity irrigation may be one of crucial elements in abscess management; (3) the potential significance of transurethral prostate resection following abscess resolution in preventing recurrence. It is hoped that this case report offers new valuable insights for diagnosing and treating prostate abscesses. Slightly different from previous treatment experience, we extra used early urine diversion, intermittent abscess cavity irrigation, and etiological electroprostatectomy, which might also hold promise as potential therapies.

[Giant prostate stones: case report].

Small prostate stones are often found incidentally during clinical and radiological examination. Large stones, however, also may develop, replacing completely the prostate tissue and causing various symptoms. Such a large stones are commonly formed due to chronic urine reflux. There are 20 publications in the literature devoted to the patients with giant prostate stones. Open as well as endoscopic procedures can be performed. In our clinical case both approaches were done simultaneously. Such tactic was chosen in order to carry out a single-stage intervention, immediately solving two problems, i.e., urethral stricture and a giant prostate stone.

The confusing pelvic cystic mass: A case of giant prostatic utricle cyst diagnosed by ultrasound.

The giant prostatic utricle cyst, located behindthe bladder with removable irregular mixed echo, communicating with the urethraat the level of the seminal colliculus, was diagnosed by ultrasound andverified by pathology and surgery.

[Segmentation of prostate region in magnetic resonance images based on improved V-Net].

Magnetic resonance (MR) imaging is an important tool for prostate cancer diagnosis, and accurate segmentation of MR prostate regions by computer-aided diagnostic techniques is important for the diagnosis of prostate cancer. In this paper, we propose an improved end-to-end three-dimensional image segmentation network using a deep learning approach to the traditional V-Net network (V-Net) network in order to provide more accurate image segmentation results. Firstly, we fused the soft attention mechanism into the traditional V-Net's jump connection, and combined short jump connection and small convolutional kernel to further improve the network segmentation accuracy. Then the prostate region was segmented using the Prostate MR Image Segmentation 2012 (PROMISE 12) challenge dataset, and the model was evaluated using the dice similarity coefficient (DSC) and Hausdorff distance (HD). The DSC and HD values of the segmented model could reach 0.903 and 3.912 mm, respectively. The experimental results show that the algorithm in this paper can provide more accurate three-dimensional segmentation results, which can accurately and efficiently segment prostate MR images and provide a reliable basis for clinical diagnosis and treatment.

Prostatic Abscess Combined With Spleen Abscess Due to Multi-Drug-Resistant Gram-Negative Bacilli: A Case Report and Literature Review.

The prostatic abscess is a rare complication of a bacterial infection of the prostate. Since the early use of potent antibiotics to treat urinary tract infections, the incidence of the prostatic abscess has declined significantly. In keeping with that, prostatic abscess combined with abscesses in the spleen or other distant organs become an extremely rare but fatal clinical condition. Here, we present a case of prostate and spleen abscess due to multi-drug-resistant gram-negative bacilli without obvious risk factors. The patient initially complained of high-grade fever and dysuria. After screening the source of infection by computed tomography (CT) scans, prostate and spleen abscesses were diagnosed. In addition, extended-spectrum beta-lactamase positive Escherichia coli was detected both in urine and blood culture. The patient was successfully treated by a transurethral resection of the prostate followed by splenic puncture and drainage, as well as intravenous administration of meropenem. Although the prostate abscess combined with spleen abscess was rare, the possibility of dissemination in remote tissues should be taken into consideration before the surgical treatment of prostatic abscesses. The concurrent drainage of multiple abscesses followed by intensive and sensitive antibiotics was safe and effective for indicated patients.

Coupling of Inflammation and Microcalcification in the Pathogenesis of Prostate Calculi: Detection Using 18 F-NaF and 18 F-FDG PET/CT.

ABSTRACT: Prostatic calculi are common and usually asymptomatic calcified stones frequently found incidentally in imaging or during the evaluation of benign prostatic hyperplasia. Those associated with chronic prostatitis can lead to bacterial colonization, inflammation, and blockage of secretory ducts, resulting in pelvic pain and lower urinary tract symptoms. Although PET tracers such as 18 F-NaF and 18 F-FDG have been used to assess metastatic and benign bone disorders, their comparative avidity in the domain of extraosseous and prostate calcification remains to be fully explored. We present incidentally detected bilateral prostatic calcification in an asymptomatic 42-year-old man exhibiting coavidity of 18 F-NaF and 18 F-FDG, highlighting the molecular coupling of inflammation and microcalcification in the pathogenesis of prostate calculi.

[A Case of Massive Prostate Abscess Treated by Transperineal Drainage].

The patient was an 81-year-old man who visited a clinic for fever and lower abdominal pain. He was subsequently diagnosed with prostatitis based on computed tomography (CT) findings that showed swelling of the prostate. Despite treatment with antibacterial therapy, his symptoms did not improve significantly. Since the patient also had myelodysplastic syndrome, he was transferred to our hospital and subsequently diagnosed with prostate abscess based on findings on magnetic resonance imaging (MRI). The abscess had spread widely from the dorsal side of the trigone of the bladder to anterior wall of the rectum. Transperineal drainage was performed to preserve the urethral mucosa of the prostatic urethra. Considering the shape of the abscess cavity, one pigtail catheter was placed in the prostate and another was placed transperineally on the dorsal side of the trigone of the bladder. Cystostomy was performed at the same time. Culture of the abscess revealed the presence of Staphylococcus aureus. As there was little exudate from the abscess 9 days after drainage, the pigtail catheter on the dorsal side of the trigone of the bladder was removed following an injection of minocycline into the abscess. CT showed shrinkage of the abscess 4 days later, and the remaining intraprostatic pigtail catheter was removed after an injection of minocycline. The cystostomy pigtail catheter was subsequently removed since the patient was able to urinate smoothly after clamping. MRI confirmed the disappearance of the abscess cavity 2 months later.

Imaging findings of prostate tuberculosis by transrectal contrast-enhanced ultrasound and comparison with 2D ultrasound and pathology.

OBJECTIVES: This study aimed to investigate the contrast-enhanced ultrasound (CEUS) appearances of prostate tuberculosis (PTB) and its correlation with histopathology. METHODS: Clinical, transrectal ultrasonography (TRUS) and CEUS data of 12 PTB patients confirmed by pathology were retrospectively analyzed, and compared to the pathological findings to identify the pathological structures corresponding to different image enhancement areas. RESULTS: No specific characteristics could be found for the clinical appearances. Enlarged gland, hypoechoic lesions and calcification due to PTB could be found by TRUS, which were also non-specific. CEUS showed hypo- or non-enhanced lesions with varying size, which were related to different pathological stages of PTB. The incidence rate of non-enhanced lesions was 83.3%. The detection rate of suspected lesion by CEUS was significantly higher than that by TRUS (χ2 = 8.000, p = 0.005). Histopathology showed that the hypoenhanced area consisted of tuberculous granulomas, caseous necrosis and incomplete destruction of the glands, while the non-enhanced area consisted of caseous or liquified necrosis. CONCLUSION: CEUS could improve the detection rate of PTB lesions, and the diversity of its manifestations was related to different pathological structures. An enlarged, soft gland with non-enhanced on CEUS may provide valuable information for the diagnosis of PTB, but it is not a substitute for biopsy due to the diversity of CEUS findings. ADVANCES IN KNOWLEDGE: When the lesions of prostate gland are unclear in TRUS examination, CEUS is an ideal option for the detection of lesions, which is conducive to targeted guidance of biopsy areas.

Localization of external urethral orifice in coronary sulcus during urethroplasty in case of severe hypospadias accompanied by prostatic utricle cyst.

BACKGROUND: To explore whether opening the external urethral orifice in the coronal sulcus can reduce the incidence of epididymitis after operating on hypospadias with prostatic utricle cyst (PUC) connecting to the vas deferens. Group A consisted of 3 patients with severe hypospadias and PUC undergoing cystostomy, hypospadias correction and urethroplasty, along with the relocation of the external orifice of the urethra to the coronal sulcus. Group B consisted of 4 patients having initial hypospadias repaired with meatus in the orthotopic position in the glans, presenting with multiple epididymitis after hypospadias surgery and unsuccessful conservative treatment. MR confirmed that all the Group B patients had PUC connecting to the vas deferens. Group B patients underwent urethral dilatation along with urethral catheterization, cutting of the original corpus cavernosum that encapsulated the urethra, and extension of the position of the external urethral orifice to the coronal sulcus. RESULTS: In group A, 3 children underwent bladder fistula removal 2 weeks after the operation. The penis developed normally without any complications. Four children in group B underwent stent removal 12 weeks after operation, and one patient was still stenosed and dilated again. All patients in group B were followed without epididymitis recurrence. CONCLUSIONS: For patients with hypospadias complicating with a PUC, connecting to one side of the vas deferens, the positioning of the external urethral orifice in the coronary sulcus would be helpful to reduce the occurrence of epididymitis.

[Mucinous Adenocarcinoma of the Prostate Diagnosed after Transurethral Treatment of a Prostatic Abscess].

A 70-year-old man visited his doctor because of hip pain and gross hematuria. Digital rectal examination and computed tomography revealed a prostatic abscess. Although antibiotics were prescribed, his symptoms did not improve; he was transferred to our hospital, where transurethral fenestration of the prostatic abscess was performed. During prostatic fenestration, a papillary mucous membrane was confirmed inside the cavity of the prostatic abscess. Pathological examination revealed a mucinous adenocarcinoma of the prostate. Although hormonal therapy was administered, magnetic resonance imaging revealed tumor extension necessitating robot-assisted radical prostatectomy. Mucinous adenocarcinoma of the prostate is rare, and to our knowledge this is the first report of mucinous adenocarcinoma of the prostate diagnosed after transurethral treatment of a prostatic abscess.

[Treatment of patients with abscess of prostate gland by the method of percutaneous punction].

OBJECTIVES: Demonstrate the treatment of prostatic abscess with a minimally invasive method - abscess puncture with aspiration of purulent fluid and injection of an antibiotic into abscess cavity. MATERIALS AND METHODS: Diagnosis of prostatic abscess of 23 patients using ultrasonography, computed tomography and magnetic resonance imaging of the pelvic region. 19 patients with the abscess within the prostatic capsule were treated with perineal percutaneous puncture method with aspiration of the abscess fluid and injection of antibiotics into cavity. For 4 patients with prostatic abscess and purulent paraprostatitis we performed incision and drainage of purulent cavity with open transperineal access. RESULTS: Single abscess puncture was enough to normalize health status of 15 patients. In 4 cases additional puncture was required in 4-5 days after the first manipulation. All the patients recovered and were discharged from the clinic in 7-8 days. Patients after abscess incision and drainage stayed in hospital for 10-14 days. In 1-3 months after the surgery, imaging methods revealed a high-density lesion in prostate whatever the method was used. DISCUSSION: Treatment response was controlled by imaging methods. 2 days after puncture 4 patients had a lesion with liquid content larger than 50% of the initial purulent lesion size. Repeated puncture was performed in this patients. CONCLUSION: Abscess puncture with aspiration of fluid is an effective method of treatment when prostatic abscess is within the capsule. In cases of purulent paraprostetitis incision and drainage of an abscess cavity is needed.

Prostatic cyst in a pediatric patient with autosomal dominant polycystic kidney disease.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inheritable form of renal cystic disease and is associated with cysts in other organs. Prostatic cysts are rare though and have not been reported in the paediatric population. Reported is the presence of a prostatic cyst that was incidentally noted on routine sonogram in a 15 year old with ADPKD.

Gas Where It Shouldn't Be! Imaging Spectrum of Emphysematous Infections in the Abdomen and Pelvis.

OBJECTIVE. The purpose of this article is to review the spectrum, etiopathogenesis, clinical presentation, imaging features, differential diagnoses, and management of emphysematous infections of the abdomen and pelvis. CONCLUSION. Emphysematous infections are associated with high morbidity and mortality and thus need urgent medical and surgical interventions. CT is the most sensitive modality to detect gas; CT provides definitive diagnosis in most cases and can depict the extent of involvement.

Multiparametric prostate MRI-based intensity-modulated radiation therapy guided by prostatic calcifications.

OBJECTIVES: The optimal technique to administer image-guided radiation therapy for prostate cancer remains poorly defined. This study assessed outcomes after multiparametric prostate MRI-based planning was delivered with image-guided radiation therapy using prostatic calculi observed on cone beam CT (CBCT). METHODS: Between January 2015 and December 2017, 94 consecutive patients were treated with CBCT-based image-guided radiation therapy (IGRT) without fiducial markers. MRI was routinely incorporated for target delineation and intraprostatic tumor nodules were boosted to allow reduced doses to normal appearing prostate. The primary endpoint was the prevalence of prostatic calcifications while toxicity and biochemical control were secondary endpoints. RESULTS: Median follow-up was 39.7 months with 82% NCCN intermediate to very high risk. Intraprostatic calculi were noted in 68% of patients. The 3-year biochemical control, late grade ≥2 rectal toxicity and late grade ≥2 urinary toxicity rates were 96%, 3 and 7%, respectively. Biochemical control and toxicity were not significantly impacted by the presence of prostatic calculi. CONCLUSION: Prostatic calcifications can serve as natural fiducial markers to allow for non-invasive IGRT for prostate cancer with promising early disease control and toxicity outcomes. ADVANCES IN KNOWLEDGE: Prostate calcification-guided IGRT is technically feasible.

Prostatic abscess: an unusual cause of delirium associated with lower urinary tract symptoms.

Our case describes an 80-year-old gentleman who presented with delirium and lower urinary tract symptoms. Initially treated for a urinary tract infection, he became more unwell with features of physiological decompensation secondary to sepsis. A computerized tomography scan was performed in light of the findings of suprapubic tenderness, which on examination revealed a prostatic abscess. On discussion with urology and microbiology colleagues a plan for antibiotics was constructed and the gentleman recovered without the need for invasive interventions. Our case goes on to discuss the merits of imaging for the elderly care physician when the diagnosis is not clear or when the clinical picture is of deterioration despite optimal medical care.

A Rare Case of Partial Unilateral Corpus Cavernosum Agenesis With Concomitant Multiple Genitourinary Anomalies.

Congenital penile agenesis is a rare condition with an incidence of 1 in 30 million, while other congenital malformations of the cavernous bodies are much less common. In a few cases in the literature, it has been reported that the reason for consulting a physician with these conditions is the insufficient erection. As a first reported case, we present a 16-year-old male patient with partial unilateral corpus cavernosum agenesis accompanying genitourinary anomalies.

Standardization of acquisition protocols using PET/CT with 18F-Choline in prostate cancer. / Estandarización de los protocolos de adquisición mediante PET/TC con 18F-Colina en el cáncer de próstata.

AIM: To standardize acquisition protocols for 18F-Choline PET/CT to prevent from urine interference, to determine the best time point for the whole-body study, and to assess whether "dual point" acquisition allows for differentiating malignant vs. benign lesions. METHODS: One hundred consecutive patients with prostate cancer were prospectively studied. Immediately after 18F-Choline injection, a pelvis study was acquired, and a whole-body was subsequently obtained 1 and 2 hours p.i. Mean SUVmax was obtained in regions and for every sequential imaging. Mean analysis (χ2) and SUV percentage change (2/1 hours; 1 hours/0 min) were obtained. Metabolic pattern dynamics were assessed: accumulative vs. clearance. Patient follow-up after therapy and directed classification whenever ethically possible were performed. RESULTS: Fifty-three prostate foci, without disturbing urinary activity was ever found on early images. Accumulative pattern in 42, with percentage increase was: 0 min/1 hour: +16.7% (χ20.94); 1/2 hours: +10,0% (χ2 0.83). Clearance pattern in 11, with percentage decrease: 0 min/1 hour: -21.4% (χ20.91): -7.7% (χ20.85), corresponding in 7 to initial staging and in 4 post-radiotherapy biochemical recurrence. Every infradiaphragmatic uptake (n: 24) showed accumulative pattern, with percentage increase of +9.1% (χ20.97), all of them depicted on early imaging. As for 12 supradiaphragmantic uptake, 8 of them showed clearance pattern with percentage decrease: -13.0% (χ20.95). Accumulative pattern showed in 4 of them with percentage increase +13.0% (χ2 0.96), thus being assessed as invasive/malignant. Every bone uptake (n: 18) showed accumulative pattern, with percentage increase: +17.1% (χ20.95), all of them depicted on 1 hour imaging. CONCLUSIONS: As for prostate assessment is concerned, dual point at 0 min/1 hour proved to be the best procedure. As for supradiaphragmatic lymph-nodes detection, dual point with 1/2 hours performed best. As for infradiaphragmatic and bone involvement, as well as for inconclusive findings, the 2 hour imaging increased our diagnostic confidence.