Transperineal drainage of prostate abscesses: A minimally invasive, low-risk management strategy that yields satisfactory results.

Objectives: In this narrative review, we aim to present two cases of transperineal drainage of prostate abscesses with a good clinical outcome. Furthermore, we reviewed the literature on this treatment approach and aim to propose a minimally invasive protocol for managing this rare condition. Patients and Methods: Our patients are 33- and 61-year-old males who both underwent uncomplicated transperineal drainage of prostate abscess with the use of a Precision Point device with rapid clinical improvement and complete resolution of the abscess within the follow-up period. We used PubMed to conduct a literature search and included and evaluated 16 relevant case reports and case series in which the authors utilized transperineal drainage techniques for prostatic abscesses. Results: Our first patient was young and very unwell with sepsis and a pulmonary embolism. He had a complex abscess extending through the prostate to the left pelvic side wall. Trans-gluteal drainage of the pelvic side-wall collection was required in addition to transperineal drainage of the prostate abscess. After drainage and a prolonged course of antibiotics, he achieved resolution of the abscess by 7 weeks with ejaculatory function intact. Our second patient who was very keen on the preservation of ejaculatory function had multiple small abscesses and underwent transperineal drainage. He had significant interval improvement of his abscess burden at the 4-week follow-up and complete resolution at the 6-month follow-up. The total number of cases in the literature on our review is 22, with considerable variability in how the authors managed the prostate abscesses that underwent transperineal drainage, including variability in their follow-up time frame, choice of imaging modality, duration of antibiotic treatment, drain placement, and use of irrigation solutions (including antibiotics) into the abscess cavity. Furthermore, the sizes of the prostate abscesses were not consistently reported. Given the small sample size and variability in management from different authors, it was not possible to draw any statistical analysis. Conclusion: Transperineal prostate abscess drainage combined with prolonged antibiotic therapy provides a less invasive alternative to treating prostate abscesses for those who which to preserve ejaculatory function and avoid the other adverse events of transurethral de-roofing. In itself, it can achieve complete resolution of abscess. It provides the benefit of drainage under real-time imaging; for percutaneous drain placement; prevents urethral injury; retrograde ejaculation; and can be done under local anaesthetic which is preferable for the unstable patient. The utility of the procedure may be limited by the complexity of the abscess or whether it has extended beyond the prostate. The patient should always be informed that further drainage via percutaneous methods or transurethral methods may be necessary if their clinical condition does not improve. We recommend this procedure be offered as an alternative to transurethral methods in younger patients and those who would like to preserve ejaculatory function. Furthermore, we highly encourage a prolonged course of antibiotic therapy and interval follow-up with clinical review of symptoms and imaging to confirm resolution.

The scrotal lump that you can't get above: A case report of a spermatic cord dermoid cyst mimicking an incarcerated inguinal hernia.

A 24-year-old healthy male with left sided groin pain and swelling extending into the left hemiscrotum. Computed tomography reported an encysted spermatic cord hydrocoele. Open exploration revealed a cystic structure arising from the spermatic cord. Histopathological analysis demonstrated sebaceous glands within the wall of the cyst, pathognomonic for a dermoid cyst. A literature review demonstrates just 12 cases of inguinal dermoid cysts to date. Our case demonstrates the importance of radiological imaging in cases of groin lumps to facilitate surgical planning as well as the importance of sending surgical specimens for histopathological analysis to aid in the event of recurrence.

How I Do It: Transperineal prostate biopsy using local anesthetic in an outpatient setting.

Transperineal prostate biopsy (TPPB) is proven to be an effective diagnostic tool for prostate cancer detection. It allows satisfactory sampling of apical and anterior areas which is not well achieved with the transrectal route, without the associated risks of urinary tract infection or sepsis. The main objective of this paper is to describe the technique utilized in our institution to perform transperineal prostate biopsy under local anesthetic in the outpatient clinic setting.

Bilateral multifocal renal oncocytoma in pregnancy.

Renal oncocytomas are the most common benign solid renal tumor, accounting for 3-7% of renal neoplasms. Oncocytomas are multifocal in 2-12% and bilateral in 4-14% of cases. Multifocal bilateral oncocytomas represent only 1.4% of renal cases. We present an extraordinary case of a patient with multifocal bilateral renal oncocytomas during pregnancy. An electronic literature search revealed fewer than 30 reports of on cases of bilateral multifocal renal oncocytomas, none of them occurring in pregnancy. The management of this patient differed from the recommended guidelines for renal masses suspected to be malignant because elective caesarean section and nephrectomy in the second trimester was refused.