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Tuberculosis de los Genitales Masculinos , Humanos , Masculino , Tuberculosis de los Genitales Masculinos/diagnóstico , Tuberculosis de los Genitales Masculinos/tratamiento farmacológico , Tuberculosis de los Genitales Masculinos/patología , Enfermedades de la Próstata/diagnóstico , Enfermedades de la Próstata/microbiología , Enfermedades de la Próstata/patología , Enfermedades de la Próstata/diagnóstico por imagen , Persona de Mediana Edad , Antituberculosos/administración & dosificaciónRESUMEN
Maternal malnutrition can alter developmental biology, programming health and disease in offspring. The increase in sugar consumption during the peripubertal period, a worldwide concern, also affects health through adulthood. Studies have shown that maternal exposure to a low protein diet (LPD) is associated with an increase in prostate disease with aging. However, the combined effects of maternal LPD and early postnatal sugar consumption on offspring prostate disorders were not investigated. The effects on aging were evaluated using a maternal gestational model with lactational LPD (6% protein) and sugar consumption (10%) from postnatal day (PND) 21-90, associating the consequences on ventral prostate (VP) rats morphophysiology on PND540. An increase was shown in mast cells and in the VP of the CTR + SUG and Gestational and Lactational Low Protein (GLLP) groups. In GLLP + SUG, a significant increase was shown in TGF-ß1 expression in both the systemic and intra-prostatic forms, and SMAD2/3p had increased. The study identified maternal LPD and sugar consumption as risk factors for prostatic homeostasis in senility, activating the TGFß1-SMAD2/3 pathway, a signaling pathway with potential markers for prostatic disorders.
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Desnutrición , Fenómenos Fisiologicos Nutricionales Maternos , Efectos Tardíos de la Exposición Prenatal , Próstata , Enfermedades de la Próstata , Animales , Masculino , Femenino , Embarazo , Efectos Tardíos de la Exposición Prenatal/metabolismo , Enfermedades de la Próstata/patología , Enfermedades de la Próstata/etiología , Enfermedades de la Próstata/metabolismo , Desnutrición/complicaciones , Próstata/metabolismo , Próstata/patología , Ratas , Inflamación/patología , Inflamación/metabolismo , Factor de Crecimiento Transformador beta1/metabolismo , Factor de Crecimiento Transformador beta1/genética , Dieta con Restricción de Proteínas/efectos adversos , Proteína Smad2/metabolismo , Ratas Wistar , Proteína smad3/metabolismo , Proteína smad3/genética , Transducción de Señal , Animales Recién Nacidos , Mastocitos/metabolismoRESUMEN
BACKGROUND: Autophagy is a well-conserved catabolic process that plays a key role in cell homeostasis. In the prostate, defective autophagy has been implicated in the genesis and progression of several pathological conditions. AIM: The present review explored the autophagy pathway in prostate-related dysfunctions, focusing on prostate cancer (PCa), benign prostatic hyperplasia (BPH) and prostatitis. RESULTS: Impaired autophagy activity has been shown in animal models of BPH and prostatitis. Moreover, autophagy activation by specific and non-specific drugs improved both conditions in pre-clinical studies. Conversely, the efficacy of autophagy inducers in PCa remains controversial, depending on intrinsic PCa characteristics and stage of progression. Intriguingly, autophagy inhibitors have shown beneficial effects in PCa suppression or even to overcome chemotherapy resistance. However, there are still open questions regarding the upstream mechanisms by which autophagy is deregulated in the prostate and the exact role of autophagy in PCa. The lack of specificity and increased toxicity associated with the currently autophagy inhibitors limits its use clinically, reflecting in reduced number of clinical data. CONCLUSION: New therapeutic strategies to treat prostatic diseases involving new autophagy modulators, combination therapy and new drug formulations should be explored. Understanding the autophagy signaling in each prostatic disease is crucial to determine the best pharmacological approach.
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Autofagia , Neoplasias de la Próstata , Humanos , Autofagia/efectos de los fármacos , Masculino , Neoplasias de la Próstata/tratamiento farmacológico , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/metabolismo , Animales , Enfermedades de la Próstata/tratamiento farmacológico , Enfermedades de la Próstata/patología , Hiperplasia Prostática/patología , Hiperplasia Prostática/tratamiento farmacológico , Transducción de Señal/efectos de los fármacosRESUMEN
Malakoplakia is a chronic granulomatous condition that has been rarely seen affecting the prostate. Isolated malakoplakia of the prostate occurring together with prostatic adenocarcinoma is rarer still with only 9 previously recorded cases. We present a case diagnosed through needle biopsy with prostatic adenocarcinoma and then on subsequent prostatectomy was diagnosed with extensive malakoplakia occurring with the carcinoma. Patient was noted to have a urinary tract infection (UTI) 2 weeks after needle biopsy and notably, 4 of the 9 previously reported cases also presented with UTI following their biopsies. The theory that prostatic malakoplakia may be a complication of the prostate needle biopsy is logically possible, but due to the paucity in cases, it is difficult to infer causality.
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Adenocarcinoma , Malacoplasia , Enfermedades de la Próstata , Neoplasias de la Próstata , Masculino , Humanos , Próstata/patología , Enfermedades de la Próstata/complicaciones , Enfermedades de la Próstata/diagnóstico , Enfermedades de la Próstata/patología , Malacoplasia/complicaciones , Malacoplasia/diagnóstico , Malacoplasia/patología , Neoplasias de la Próstata/complicaciones , Neoplasias de la Próstata/patología , Adenocarcinoma/complicaciones , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologíaRESUMEN
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.
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Quistes , Enfermedades de la Próstata , Masculino , Humanos , Enfermedades de la Próstata/diagnóstico por imagen , Enfermedades de la Próstata/patología , Próstata/diagnóstico por imagen , Pelvis/patología , Vejiga Urinaria , Quistes/diagnóstico por imagen , Quistes/cirugíaRESUMEN
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.
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Enfermedades de la Próstata/diagnóstico por imagen , Enfermedades de la Próstata/patología , Tuberculosis Urogenital/diagnóstico por imagen , Tuberculosis Urogenital/patología , Ultrasonografía Intervencional/métodos , Adolescente , Adulto , Medios de Contraste , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
The aim of this report is to introduce an on-going, multicenter, randomized controlled trial to evaluate whether tailored antimicrobial prophylaxis guided by rectal culture screening prevents acute bacterial prostatitis following transrectal prostate biopsy (TRPB). Patients will be randomized into an intervention or non-intervention group; tazobactam-piperacillin or levofloxacin will be prophylactically administered according to the results of rectal culture prior to TRPB in the intervention group whereas levofloxacin will be routinely given in the non-intervention group. The primary endpoint is the occurrence rate of acute bacterial prostatitis after TRPB. Recruitment begins in April, 2021 and the target total sample size is 5,100 participants.
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Antibacterianos/uso terapéutico , Infecciones Bacterianas/microbiología , Estudios Multicéntricos como Asunto , Enfermedades de la Próstata/microbiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/tratamiento farmacológico , Humanos , Masculino , Enfermedades de la Próstata/tratamiento farmacológico , Enfermedades de la Próstata/patologíaRESUMEN
A 20-year-old male presented to the emergency department with lower abdominal pain, urinary retention, and constipation. Computed tomography (CT) revealed a large cyst on the posterior aspect of the prostate gland; he was ultimately diagnosed with a Müllerian duct cyst (MDC). Although much has been written on the radiologic diagnosis of such cysts, there is a paucity of recent literature concerning the pathological diagnosis. While older studies debated the Müllerian origin of a midline cyst abutting the poster prostate, we believe that with the advent of monoclonal PAX8 (which was positive in this lesion) and monoclonal PAX2 (which was negative), we have strong evidence that the present cyst is indeed of Müllerian origin. Further, there is debate in the literature as to whether MDC is synonymous or distinct from prostatic utricle cyst. We present an interdisciplinary analysis as to the merits and weaknesses of both sides of the debate and how data gathered from the current case could be used in a future, larger study to arrive at a more definitive conclusion.
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Quistes/patología , Conductos Paramesonéfricos/patología , Enfermedades de la Próstata/diagnóstico , Enfermedades de la Próstata/patología , Biomarcadores/metabolismo , Humanos , Inmunohistoquímica , Masculino , Factor de Transcripción PAX8/biosíntesis , Adulto JovenRESUMEN
Intraurethral inoculation of mice with uropathogenic Escherichia coli (CP1) results in prostate inflammation, fibrosis, and urinary dysfunction, recapitulating some but not all of the pathognomonic clinical features associated with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). In both patients with LUTS and CP1-infected mice, we observed increased numbers and activation of mast cells and elevated levels of prostate fibrosis. Therapeutic inhibition of mast cells using a combination of a mast cell stabilizer, cromolyn sodium, and the histamine 1 receptor antagonist cetirizine di-hydrochloride in the mouse model resulted in reduced mast cell activation in the prostate and significant alleviation of urinary dysfunction. Treated mice showed reduced prostate fibrosis, less infiltration of immune cells, and decreased inflammation. In addition, as opposed to symptomatic CP1-infected mice, treated mice showed reduced myosin light chain-2 phosphorylation, a marker of prostate smooth muscle contraction. These results show that mast cells play a critical role in the pathophysiology of urinary dysfunction and may be an important therapeutic target for men with BPH/LUTS.NEW & NOTEWORTHY LUTS-associated benign prostatic hyperplasia is derived from a combination of immune activation, extracellular matrix remodeling, hyperplasia, and smooth muscle cell contraction in prostates of men. Using a mouse model, we describe the importance of mast cells in regulating these multiple facets involved in the pathophysiology of LUTS. Mast cell inhibition alleviates both pathology and urinary dysfunction in this model, suggesting the potential for mast cell inhibition as a therapeutic that prevents and reverses pathology and associated symptomology.
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Fibrosis/patología , Mastocitos/fisiología , Miocitos del Músculo Liso/patología , Enfermedades de la Próstata/patología , Animales , Antialérgicos/uso terapéutico , Cetirizina/uso terapéutico , Cromolin Sódico/uso terapéutico , Escherichia coli , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/metabolismo , Infecciones por Escherichia coli/patología , Fibrosis/metabolismo , Humanos , Masculino , Ratones , Ratones Endogámicos C57BL , Miocitos del Músculo Liso/metabolismo , Próstata/metabolismo , Próstata/patología , Enfermedades de la Próstata/metabolismo , MicciónRESUMEN
Senescent cells accumulate with age in all tissues. Although senescent cells undergo cell-cycle arrest, these cells remain metabolically active and their secretome - known as the senescence-associated secretory phenotype - is responsible for a systemic pro-inflammatory state, which contributes to an inflammatory microenvironment. Senescent cells can be found in the ageing prostate and the senescence-associated secretory phenotype and can be linked to BPH and prostate cancer. Indeed, a number of signalling pathways provide biological plausibility for the role of senescence in both BPH and prostate cancer, although proving causality is difficult. The theory of senescence as a mechanism for prostate disease has a number of clinical implications and could offer opportunities for targeting in the future.
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Envejecimiento/fisiología , Senescencia Celular/fisiología , Próstata/fisiología , Hiperplasia Prostática/patología , Neoplasias de la Próstata/patología , Fenotipo Secretor Asociado a la Senescencia/fisiología , Envejecimiento/inmunología , Microambiente Celular/inmunología , Senescencia Celular/inmunología , Citocinas/inmunología , Citocinas/metabolismo , Humanos , Inflamación/inmunología , Inflamación/metabolismo , Masculino , Próstata/citología , Próstata/inmunología , Enfermedades de la Próstata/inmunología , Enfermedades de la Próstata/metabolismo , Enfermedades de la Próstata/patología , Hiperplasia Prostática/inmunología , Hiperplasia Prostática/metabolismo , Neoplasias de la Próstata/inmunología , Neoplasias de la Próstata/metabolismo , Fenotipo Secretor Asociado a la Senescencia/inmunología , Microambiente Tumoral/inmunologíaRESUMEN
Prostate cancer (PCa) is the most common cancer and the third most frequent cause of male cancer death in Germany. MicroRNAs (miRNA) appear to be involved in the development and progression of PCa. A diagnostic differentiation from benign prostate hyperplasia (BPH) is often only possible through transrectal punch biopsy. This procedure is described as painful and carries risks. It was investigated whether urinary miRNAs can be used as biomarkers to differentiate the prostate diseases above. Therefore urine samples from urological patients with BPH (25) or PCa (28) were analysed using Next-Generation Sequencing to detect the expression profile of total and exosomal miRNA/piRNA. 79 miRNAs and 5 piwi-interacting RNAs (piRNAs) were significantly differentially expressed (adjusted p-value < 0.05 and log2-Fc > 1 or < -1). Of these, 6 miRNAs and 2 piRNAs could be statistically validated (AUC on test cohort > = 0.7). In addition, machine-learning algorithms were used to identify a panel of 22 additional miRNAs, whose interaction makes it possible to differentiate the groups as well. There are promising individual candidates for potential use as biomarkers in prostate cancer. The innovative approach of applying machine learning methods to this kind of data could lead to further small RNAs coming into scientific focus, which have so far been neglected.
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MicroARNs/metabolismo , Próstata/metabolismo , Enfermedades de la Próstata/diagnóstico , Neoplasias de la Próstata/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/metabolismo , Biomarcadores de Tumor/genética , Biomarcadores de Tumor/metabolismo , Biopsia , Diagnóstico Diferencial , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Masculino , MicroARNs/genética , Persona de Mediana Edad , Próstata/patología , Enfermedades de la Próstata/genética , Enfermedades de la Próstata/metabolismo , Enfermedades de la Próstata/patología , Neoplasias de la Próstata/genética , Neoplasias de la Próstata/metabolismo , Neoplasias de la Próstata/patologíaRESUMEN
ETHNOPHARMACOLOGICAL RELEVANCE: Hyperplasia, Tumors and cancers are various forms of proliferative disorders affecting humans. Surgery is the main treatment approach while other options are also associated with adverse effects. There is therefore a need for the development of better alternative therapy that is cost effective and readily available with little or no adverse effect. Some bioactive agents in medicinal plants exhibit their anti-proliferative potential by induction of mitochondrial permeability transition pore (mPT) opening. Gloriosa superba, a medicinal plant, is folklorically used in the treatment of tumors and cancers. AIM OF THE STUDY: This study therefore aimed at investigating the effect of ethanol leaf extract of Gloriosa superba (EEGS) on mPT and monosodium glutamate-induced proliferative disorder in some specific tissues using rat model. MATERIALS AND METHODS: Isolated rat liver mitochondria were exposed to different concentrations (10, 30, 50, 70 and 90 µg/ml) of EEGS. The mPT pore opening, cytochrome c release, mitochondrial ATPase activity and lipid peroxidation were assessed spectrophotometrically. Caspases 9 and 3 activities were carried out using ELISA technique. Histological assessment of the liver, prostate and uterus of normal and monosodium glutamate (MSG)-treated rats were carried out. RESULTS: The results showed significant induction of mPT pore opening, release of cytochrome c, enhancement of mitochondrial ATPase activity, inhibition of lipid peroxidation and activation of caspases 9 and 3 activities by EEGS. The histological assessment revealed the presence of MSG-induced hepato-cellular damage, benign prostate hyperplasia and uterine hyperplasia which were ameliorated by EEGS co-administration. CONCLUSIONS: These findings suggest that EEGS contains putative agents that can induce apoptosis via induction of mPT pore opening and as well protect against MSG-induced hepato-cellular damage and proliferative disorder in prostate and uterus.
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Proliferación Celular/efectos de los fármacos , Enfermedad Hepática Inducida por Sustancias y Drogas/prevención & control , Colchicaceae , Hígado/efectos de los fármacos , Potencial de la Membrana Mitocondrial/efectos de los fármacos , Mitocondrias Hepáticas/efectos de los fármacos , Extractos Vegetales/farmacología , Próstata/efectos de los fármacos , Enfermedades de la Próstata/prevención & control , Enfermedades Uterinas/prevención & control , Útero/efectos de los fármacos , Animales , Apoptosis/efectos de los fármacos , Proteínas Reguladoras de la Apoptosis/metabolismo , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Enfermedad Hepática Inducida por Sustancias y Drogas/metabolismo , Enfermedad Hepática Inducida por Sustancias y Drogas/patología , Colchicaceae/química , Modelos Animales de Enfermedad , Femenino , Hiperplasia , Peroxidación de Lípido/efectos de los fármacos , Hígado/metabolismo , Hígado/patología , Masculino , Mitocondrias Hepáticas/metabolismo , Mitocondrias Hepáticas/patología , Extractos Vegetales/aislamiento & purificación , Próstata/metabolismo , Próstata/patología , Enfermedades de la Próstata/inducido químicamente , Enfermedades de la Próstata/metabolismo , Enfermedades de la Próstata/patología , Ratas Wistar , Transducción de Señal , Glutamato de Sodio , Enfermedades Uterinas/inducido químicamente , Enfermedades Uterinas/metabolismo , Enfermedades Uterinas/patología , Útero/metabolismo , Útero/patologíaRESUMEN
OBJECTIVES: The increasing incidence of fluoroquinolones (FQ) resistance may lower its efficacy in preventing UTI following transrectal ultrasound-guided prostate biopsy (TRUS-PB). We assessed the efficacy and safety of FQ and fosfomycin-trometamol (FT) in patients undergoing TRUS-PB. METHODS: A prospective observational study was conducted between April 2017 and June 2019 and enrolled men undergoing TRUS-PB and receiving a single-dose of FQ (FQ-arm) or FT (FT-arm) for UTI prophylaxis per physician's choice. The primary efficacy endpoint was self-reported TRUS-PB UTI. We assessed baseline factors associated with UTI with logistic regression. RESULTS: A total of 222 men were enrolled, 141/222 (64%) received FQ, and 81/222 (36%) FT. The median age was 67.6 years [IQR, 61.4-72.1] and the Charlson score was 3 [IQR, 3-5]. The overall incidence of self-reported TRUS-PB UTI was 12% (24/197, (95%CI, 8%-17%)): 15% (17/116, (95% CI, 10%-17%)) in FQ-arm, versus 9% (7/81, 95% CI (5%-13%)) in FT-arm (RR = 0.55 (95% CI, 0.22-1.40), p-value = 0.209). No baseline characteristic was significantly associated with TRUS-PB UTI. Safety was similar between the arms: the rate of the reported adverse event was 31% (36/116, (95% CI, 25%-37%) in the FQ-arm versus 36% (28/81, (95% CI, 28%-41%)) in the FT-arm (RR = 1.17 (95% CI, 0.64-2.15), p = 0.602). CONCLUSIONS: TRUS-PB UTI prophylaxis with FT and FQ has similar efficacy and safety. A randomized comparison of these two antibiotics is warranted.
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Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Biopsia/métodos , Fluoroquinolonas/uso terapéutico , Fosfomicina/uso terapéutico , Próstata/patología , Trometamina/uso terapéutico , Anciano , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Próstata/diagnóstico por imagen , Enfermedades de la Próstata/patología , Enfermedades de la Próstata/prevención & control , Ultrasonografía IntervencionalRESUMEN
A male dog with benign prostatic hyperplasia and several small intraprostatic cysts was treated with a GnRH-agonist implant containing 4,7â mg deslorelin (Suprelorin®). Within 2â weeks after the implantation, the prior urethral bleeding worsened. A large intraprostatic cyst was detected sonographically. The patient was subsequently treated with osaterone acetate (0.4 mg/kg p.â o. once a day for 7â days) and enrofloxacin (5â mg/kg p.â o. once a day for 21â days). The clinical symptoms receded within 10â days. Within one month, the cyst regressed completely. The mechanisms of cyst enlargement are discussed.
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Quistes , Enfermedades de los Perros , Implantes de Medicamentos/efectos adversos , Hormona Liberadora de Gonadotropina/agonistas , Hiperplasia Prostática , Animales , Quistes/inducido químicamente , Quistes/tratamiento farmacológico , Quistes/veterinaria , Enfermedades de los Perros/inducido químicamente , Enfermedades de los Perros/tratamiento farmacológico , Enfermedades de los Perros/patología , Perros , Implantes de Medicamentos/uso terapéutico , Masculino , Próstata/patología , Enfermedades de la Próstata/inducido químicamente , Enfermedades de la Próstata/tratamiento farmacológico , Enfermedades de la Próstata/patología , Enfermedades de la Próstata/veterinaria , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/tratamiento farmacológico , Hiperplasia Prostática/veterinaria , Pamoato de Triptorelina/administración & dosificación , Pamoato de Triptorelina/efectos adversos , Pamoato de Triptorelina/análogos & derivados , Pamoato de Triptorelina/uso terapéuticoRESUMEN
OBJECTIVE: To describe the clinicopathologic features of patients with incidental prostatic amyloidosis. PATIENTS AND METHODS: We queried the genitourinary pathology database at Mayo Clinic Arizona for prostate specimens which showed amyloid deposits. Congo red stain was used for the diagnosis of amyloidosis and amyloid subtype was performed analysis using Liquid chromatography tandem mass spectrometry. We reviewed the patient's medical charts for past or subsequent diagnosis of systemic amyloidosis and clinical course. RESULTS: Prostatic amyloidosis was identified in 7 patients between 2008-2018. Median age was 79 years (range 69-84) and median follow-up was 5 years (range 0-11). Benign prostate tissue was found in 4 patients, and prostate cancer was diagnosed in 3 patients. Amyloid subtyping was available in 6 patients and was consistent with Amyloid transthyretin Amyloidosis. Liquid chromatography tandem mass spectrometry did not detect an amino acid sequence abnormality in the transthyretin protein in any of the patients. Five of 6 patients were diagnosed with cardiac amyloidosis, which preceded and followed the diagnosis of prostatic amyloidosis in 1 and 4 patients, respectively. Of these 4 patients, 2 were diagnosed immediately and as a consequence of the diagnosis of prostatic amyloidosis, and the remaining 2 3 and 4 years later. CONCLUSION: Incidental prostatic amyloidosis should prompt systemic and cardiac evaluation for amyloidosis. In patients with suspected cardiac amyloidosis, prior prostate specimens should be reviewed for the presence of amyloidosis.
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Neuropatías Amiloides Familiares/patología , Enfermedades de la Próstata/patología , Anciano , Anciano de 80 o más Años , Humanos , Hallazgos Incidentales , Masculino , Estudios RetrospectivosRESUMEN
INTRODUCTION: Calculi encountered in the lower urinary tract typically reside within the bladder, less often in the urethra. In this video, we present a minimally invasive endoscopic approach for removal of the largest total stone volume in the lower urinary tract reported in the literature to date. METHODS: A 25-year-old male (body mass index 61 kg/m2) with neurogenic bladder presented with urosepsis and acute kidney injury secondary to obstructive uropathy. Computerized tomography (CT) of the abdomen and pelvis demonstrated bilateral severe hydroureteronephrosis, a 4.2-cm bladder stone, and 3 urethral stones, including a 7.7-cm prostatic urethral stone and 2 membranous urethral stones (Fig. 1). Urgent bilateral percutaneous nephrostomy tubes were placed. The patient elected for endoscopic management. RESULTS: The patient was placed in the supine lithotomy position. His buried penis and narrow urethra only accommodated a 16-French flexible cystoscope. Multiple stones were encountered in the membranous urethra. A 60-W SuperPulse Thulium Fiber laser at 2 J and 30 Hz was utilized to dust the urethral stones efficiently. Simultaneous ultrasound-guided percutaneous access into the bladder was obtained and ultrasonic lithotripsy via shockpulse was used to clear the bladder stone and prostatic stone from above. Total stone treatment time was 240 minutes. Suprapubic and urethral catheters were placed at the conclusion. Postoperative day 1 CT scan confirmed stone-free status and he was discharged postoperative day 2. Outpatient nephrostogram demonstrated patency of bilateral ureters and nephrostomy tubes were removed. CONCLUSION: Higher morbidity procedures including open or laparoscopic approaches have been described for management of large lower urinary tract stones. In this video, we demonstrate a minimally invasive approach of combined simultaneous antegrade and retrograde lithotripsy to achieve a stone-free status in this morbidly obese and complicated patient.
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Cálculos/cirugía , Cistoscopía/métodos , Enfermedades de la Próstata/cirugía , Enfermedades Uretrales/cirugía , Cálculos de la Vejiga Urinaria/cirugía , Cálculos Urinarios/cirugía , Adulto , Cálculos/patología , Humanos , Masculino , Enfermedades de la Próstata/patología , Enfermedades Uretrales/patología , Cálculos de la Vejiga Urinaria/patología , Cálculos Urinarios/patologíaRESUMEN
BACKGROUND: Paraprostatic cysts are large structures that develop between the prostate gland and urinary bladder, usually in older, intact dogs. Their incidence is reported to be 1.1-5.3% in dogs with prostatic disease. The aetiology of paraprostatic cysts is not fully understood, but they are believed to develop from the uterus masculinus. Whereas the uterus masculinus has been reported to communicate with the urethra in men and horses, no communication between the uterus masculinus and urethra has been identified in dogs. CASE PRESENTATION: An entire male dog was presented with a bloody discharge from its penis and tenesmus of 5 days' duration. A diagnosis of cystic uterus masculinus was made on the basis of the findings of abdominal ultrasonography and histopathology of tissues obtained during an exploratory laparotomy. In addition, a Sertoli cell tumour affecting both testes was diagnosed following scrotal castration. The cystic uterus masculinus was completely resected, after which the tenesmus and bloody discharge resolved. Thus, cystic uterus masculinus should be considered as a differential diagnosis for a paraprostatic cyst when such a lesion develops as part of the feminising effect of a Sertoli cell tumour. CONCLUSIONS: Cystic uterus masculinus should be considered as a differential diagnosis for tenesmus and penile discharge, and for structures resembling paraprostatic cysts. This case report confirms that a uterus masculinus can communicate with the urethra in dogs, as in other species, and demonstrates endocrine responsiveness, manifesting as epithelial and glandular metaplasia and mucus production, with the potential for subsequent infection.
Asunto(s)
Quistes/veterinaria , Enfermedades de los Perros/diagnóstico , Enfermedades de la Próstata/veterinaria , Animales , Quistes/diagnóstico , Quistes/patología , Quistes/cirugía , Enfermedades de los Perros/patología , Enfermedades de los Perros/cirugía , Perros , Masculino , Enfermedades de la Próstata/diagnóstico , Enfermedades de la Próstata/patología , Tumor de Células de Sertoli/patología , Tumor de Células de Sertoli/veterinaria , Neoplasias Testiculares/veterinariaRESUMEN
BACKGROUND To facilitate early treatment, we constructed a nomogram to predict risk of postoperative fever before prostate biopsy in patients with high risk of fever. MATERIAL AND METHODS We collected information on patients undergoing prostate biopsy from January 2015 to December 2018 from their medical records, including clinical characteristics and laboratory test results. Finally, after strict screening, the prediction model was established in 440 patients who underwent a transrectal prostate biopsy (TRPB). We divided these patients into a training group and validation group at a ratio of 7: 3, respectively. Univariate analysis and multivariate logistic regression analysis were used to select the predictors and to develop the model. Calibration curve and C-index were used to evaluate the accuracy of the nomogram, while DCA was used to assess the clinical value. RESULTS The individualized predictive nomogram contained 3 clinical features - Biopsy-positive rate (BPR), Hematuria, and Urine WBC - significantly associated with post-biopsy fever. The nomogram had good discriminating ability in both the training group and validation group - the C-index was 0.774 (95% CI=0.717-0.832) in the training group and 0.808 (95% CI=0.706-0.909) in the validation group. Hosmer-Lemeshow test proved a good calibration curve fit. The DCA curve suggested that the nomogram would have good clinical utility. CONCLUSIONS This is the first study to develop a nomogram to predict fever after prostate biopsy via Biopsy-positive rate (BPR), Hematuria, and Urine WBC. Use of this nomogram might help prevent fever and infection, and could facilitate individualized medical treatment after prostate biopsy.
Asunto(s)
Biopsia con Aguja/efectos adversos , Fiebre/epidemiología , Nomogramas , Neoplasias de la Próstata/diagnóstico , Anciano , Anciano de 80 o más Años , Biopsia con Aguja/métodos , Hematuria , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Valor Predictivo de las Pruebas , Próstata/patología , Enfermedades de la Próstata/diagnóstico , Enfermedades de la Próstata/patología , Neoplasias de la Próstata/patología , Estudios Retrospectivos , Ultrasonografía Intervencional , Orina/citologíaRESUMEN
INTRODUCTION: The aim of this retrospective study was to evaluate preoperative levels of PSA (prostate-specific antigen) and the postoperative development after 180-W XPS™ greenlight laser treatment of the prostate under real-world conditions. METHOD: Preoperative PSA levels were evaluated in 749 patients undergoing a 180-W XPS greenlight laser procedure from 2012 to 2017 in Witten, Germany, in relation to age, volume of the prostate, urinary tract infection, Foley catheter and co-morbidities. The postoperative development of PSA was identified by retrieving PSA levels from general practitioners or urologists. RESULTS: The average age of the patients was 73.33â±â9.26 years. The prostate volume measured by rectal ultrasound was 42.42â±â18.33âml. Median preoperative PSA was 2.59âng/ml. In 268 patients (35.8â%), the PSA level was above 4âng/ml. It was evaluated by prostate biopsy in 106 patients (39.6â%). 6 months after the surgical procedure (nâ=â86), PSA decreased to 1.25âng/ml and increased slightly to 1.46âng/ml after 12 months (nâ=â126). Logistic regression analysis demonstrated that a PSA level elevated to more than 4âng/ml preoperatively is related to prostate volume (pâ=â0.001) the existence of a transurethral Foley catheter (pâ=â0.002), but not to age (pâ=â0.349), the existence of a suprapubic catheter (pâ=â0.207), an infection of the lower urinary tract (pâ=â0.966) and the number of co-morbidities mentioned in the discharge letter (pâ=â0.936). DISCUSSION: In line with expectations and clinical trials, there was a postoperative decrease of PSA by more than a half of the preoperative value. Significant factors related to preoperative elevation of the PSA level were prostate volume, a transurethral Foley catheter instead of the suprapubic type of catheter and a urinary infection. Although elevated PSA levels were seen in about one third of patients, evaluation by prostate biopsy was only performed in 39.6â% of these patients due to their performance status and other clinical issues.