Atypical microorganisms in expressed prostatic secretion from patients with chronic prostatitis/chronic pelvic pain syndrome: microbiological results from a case-control study.

OBJECTIVES: To investigate the microorganisms in expressed prostatic secretions (EPS) of both chronic prostatitis patients and normal young male adults and to determine which microorganisms are associated with the degree of intraprostatic inflammation. METHODS: Specific polymerase chain reaction (PCR) technology was performed to confirm Neisseria gonorrhoeae, Mycobacterium tuberculosis, Mycoplasma and Chlamydia trachomatis as well as human papilloma virus (HPV), herpes simplex virus type 2 (HSV-2) and cytomegalovirus (CMV). Universal primer PCR technology was carried out to detect 16S bacteria rDNA, followed by cloning and sequencing of the entire 16S rDNA product. RESULTS: The total number of bacteria and/or viruses detected by PCR assays was significantly associated with disease severity (p < 0.001). The white blood cell count and lecithin level was significantly correlated with the number of detected bacteria and/or viruses (p = 0.001 and p = 0.046, respectively). 17 bacterial isolates were identified from 14 EPS samples by 16S rDNA sequencing. CONCLUSIONS: Various microorganisms including Ureaplasma urealyticum, C. trachomatis, CMV, HPV and HSV-2 were identified in the EPS from patients with type III prostatitis. HPV infection may be associated with the degree of intraprostatic inflammation.

Laparoscopic extravascular renal vein stent placement for nutcracker syndrome.

PURPOSE: To report our experience in the laparoscopic extravascular management of the nutcracker syndrome. PATIENTS AND METHODS: Three patients (two men and one woman) between the ages of 20 and 35 years (mean 25.7 y) underwent laparoscopic extravascular stent placement in the left renal vein for management of the nutcracker syndrome that is associated with severe recurrent gross hematuria and left gonadal vein varices. The postoperative follow-up was 16 to 37 months (mean 25.3 mos). RESULTS: All patients met the criteria for establishing the diagnosis of the nutcracker syndrome. Ultrasonography, CT, and MRI revealed visible entrapment of the left renal vein between the superior mesenteric artery and aorta. Bleeding from the left ureteral orifice was detected by urethrocystoscopy and ureterorenoscopy. We attempted a novel laparoscopic method to manage this anatomic anomaly. No complications occurred during surgery. Total relief was achieved in two men without a relapse of symptoms, and abnormalities were not found in the results of the urine test. There is partial relief in a 20-year-old woman because of microhematuria after the operation. CONCLUSIONS: The indications for surgical management with the nutcracker syndrome depend on the severity of the symptoms, and laparoscopic extravascular stent placement in the renal vein is a feasible approach for reestablishing free renal venous outflow. This slightly invasive treatment can eliminate the symptoms of the condition. Longer follow-up and more experience are necessary to make conclusions about its feasibility in contemporary practice, however.