[Diagnosis and treatment of prostatic abscess: Report of 11 cases and review of the literature].

OBJECTIVE: To analyze the clinical features, imaging characteristics, treatment options and prognosis of prostatic abscess (PA), and provide some new ideas for the diagnosis and treatment of the disease. METHODS: This retrospective study included 11 cases of confirmed PA treated in the Fifth Medical Center of PLA General Hospital. We analyzed the clinical data obtained from the electronic medical records, including basic demographic statistics, risk factors, clinical symptoms, laboratory results, imaging findings, treatment methods, treatment-related complications and outcomes. RESULTS: The 11 patients diagnosed with PA between May 2016 and August 2022 were aged (64.18 ± 7.19) years and all had at least 1 comorbidity, including 5 cases of diabetes mellitus (45.5%) and 8 cases of dysuria (72.8%). PA was confirmed in 3 cases by CT and in 8 cases by MRI, 6 (54.5%) multifocal and 10 (90.9%) >2 cm in diameter, with a median size of 3.84 cm. After admission, positive urine culture was found in 3 cases, positive blood culture in 1, Klebsiella pneumoniae in 2 and Enterococcus Faecalis in 1. Three of the patients were treated by intravenous administration of antibiotics alone, and the other 8 by transurethral PA unroofing in addition. Antibiotics medication lasted for a median of (12.9 ± 3.88) d and hospital stay averaged (19.18 ± 8.20) d. The patients were followed up for 3 months, which revealed the presence of PA in 2 of the cases treated with antibiotics alone, but not in any of the cases treated by surgery. CONCLUSION: PA is relatively rare and has no specific symptoms clinically. Imaging examination is very important for accurate diagnosis, and transurethral PA unroofing plus antibiotics administration could be considered as an optimal management of the disease.

Cytotoxic T lymphocyte-associated protein 4 antibody aggrandizes antitumor immune response of oncolytic virus M1 via targeting regulatory T cells.

Oncolytic virotherapies are perceived as remarkable immunotherapies coming into view and represent highly promising cancer treatments, yet to figure out its specific immune responses and underlying barriers remains critical. Albeit recent studies have demonstrated that oncolytic viruses (OVs) could fine tune tumor microenvironment (TME) to elicit tumor suppression mainly due to effective T-cell responses, the interaction between suppressive T cells and OVs is barely undetermined. Herein, we found that regulatory T cells (Treg cells) were increased in the TME following systemic administration of oncolytic virus M1 along with the higher expression of relative cytokines and chemokines in both mouse RM-1 prostatic carcinoma model and mouse B16F10 melanoma model. Besides, Treg cells expressed high levels of CD25 post-M1 treatment, and its suppressive effect on CD8+ T cells was also elevated. Depletion of Treg cells in M1-treated groups significantly reinforced antitumor effect of M1. Specific targeting of Treg cells using cytotoxic T lymphocyte-associated protein 4 (CTLA-4) antibody (Ab) in combination with M1 treatment elicited a more profound tumor suppression and longer overall survival time than M1 alone in both tumor models. Moreover, CTLA-4 Ab further aggrandized antitumor immune response elicited by M1, including increased infiltration of CD45+ immune cells and CD8+ or CD4+ T lymphocytes, decreased ratio of Treg cells to CD4+ T lymphocytes, the intensified lymphocytotoxicity and elevated secretion of cytotoxic cytokines like interferon-γ, granzyme B and perforin. Therefore, our findings constituted a suggestive evidence that targeting Treg cells in M1-based oncolytic virotherapy may achieve a highly response in clinical cancer research.

Male urinary incontinence after prostate disease treatment.

INTRODUCTION: Incontinence after prostate treatment (IPT) is an important and common problem for men and can lead to decreased quality of life. The proper evaluation and management of IPT requires both knowledge of the mechanisms for its development and of multiple evolving therapy types. MATERIALS AND METHODS: An update is provided on the evaluation and management for IPT. The underlying pathophysiology of the contributing conditions is explored along with the appropriate assessment prior to therapy. Surgical techniques including the artificial urinary sphincter (AUS) and male urethral sling are detailed specifically and compared. RESULTS: IPT can result from radical prostatectomy (RP), prostate radiation, and surgery for benign prostatic hyperplasia. All of these may increase the risk for stress urinary incontinence (SUI), urge urinary incontinence (UUI), or mixed incontinence. SUI after RP remains the largest component of IPT. Perioperative pelvic floor muscle therapy and advances in surgical technique have helped to prevent and treat post-RP SUI. The AUS and male urethral sling are both excellent surgical options for SUI with the AUS being currently indicated for a broader set of patients. Predominant UUI should be treated in a stepwise manner based upon guidelines for overactive bladder. CONCLUSIONS: Evaluation of men with IPT should include determining components of SUI and UUI as these will direct medical and surgical therapy. While advances in surgical technique and technology have reduced prevalence of SUI after RP, many men still require treatment. Surgical treatments with AUS and male urethral sling provide excellent outcomes in well selected patients.

[Preoperative PSA levels and development of PSA after 180-W XPS greenlight laser treatment of the prostate: what is the reality in clinical routine practice?] / Präoperative PSA-Werte und PSA-Verlauf nach 180-Watt-XPS-Greenlight-Laserung der Prostata ­ wie ist die Realität im klinischen Alltag?

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 73.33 ±â€Š9.26 years. The prostate volume measured by rectal ultrasound was 42.42 ±â€Š18.33 ml. Median preoperative PSA was 2.59 ng/ml. In 268 patients (35.8 %), the PSA level was above 4 ng/ml. It was evaluated by prostate biopsy in 106 patients (39.6 %). 6 months after the surgical procedure (n = 86), PSA decreased to 1.25 ng/ml and increased slightly to 1.46 ng/ml after 12 months (n = 126). Logistic regression analysis demonstrated that a PSA level elevated to more than 4 ng/ml preoperatively is related to prostate volume (p = 0.001) the existence of a transurethral Foley catheter (p = 0.002), but not to age (p = 0.349), the existence of a suprapubic catheter (p = 0.207), an infection of the lower urinary tract (p = 0.966) and the number of co-morbidities mentioned in the discharge letter (p = 0.936). 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 39.6 % of these patients due to their performance status and other clinical issues.

Prostatic Artery Embolization in Nonindex Benign Prostatic Hyperplasia Patients: Single-center Outcomes for Urinary Retention and Gross Prostatic Hematuria.

OBJECTIVE: To present outcomes for prostatic artery embolization (PAE) to treat urinary retention and gross prostatic hematuria in nonindex benign prostatic hyperplasia patients. MATERIALS AND METHODS: Seventy-five patients undergoing PAE from December 2013 to August 2018 (age = 77.5 ± 8.6, age-adjusted Charlson comorbidity index = 4.6 ± 2.0, prostate volume = 224 mL ± 135 mL) for retention (n = 46) and/or gross prostatic hematuria (n = 55) were retrospectively reviewed. Twenty-six patients had both problems. Urinary retention patients (UR, n = 46, catheterization = 162.4 ± 148.1 days) underwent voiding trials 1-2 months post-PAE, with International Prostate Symptom Score (IPSS), Quality of Life (QoL), and postvoid residual (PVR) recorded at 3, 6, 12, 24, and 36 months. Pre- and post-PAE hematuria-related visits were compared for gross hematuria patients (GH, n = 39), as were transfusion rates for severe hematuria patients requiring bladder irrigation (SH, n = 16). Ninety-day adverse event tabulation used Clavien-Dindo classification. RESULTS: Three months post-PAE, 33/38(87%) UR patients were catheter-free (IPSS = 8.9 ± 5.3, QoL = 1.6 ± 1.7, PVR = 158 mL ± 207 mL). Results were similar at 6 months (catheter-free = 26/28(93%), IPSS = 6.5 ± 4.4, QoL = 1.1 ± 0.9, PVR = 149 mL ± 139 mL), 12 months (catheter-free = 19/20(95%), IPSS = 4.7 ± 4.8, QoL = 0.6 ± 0.9, PVR = 125 mL ± 176 mL), 24 months (catheter-free = 11/12(92%), IPSS = 4.4 ± 3.0, QoL = 0.9 ± 0.8, PVR = 66 mL ± 68 mL), and 36 months (catheter-free = 5/6(83%), IPSS = 5.8 ± 3.8, QoL = 0.8 ± 1.0, PVR =99 mL ± 71 mL). Out of 37, 34(92%) GH patients remained hematuria-free at 483 ± 137 days, with 22 hematuria-related visits pre-PAE vs none post-PAE. Hematuria resolved <48 hours post-PAE in 14/16(87.5%) SH patients, with 36 blood units transfused pre-PAE, 4 units transfused <48 hours post-PAE, and none thereafter. Subsequently, 13/16(81%) remained hematuria-free at 500 ± 501 days; 2/16(13%) required fulguration; 1/16(6%) developed bladder tumor. There were 2 deaths <30 days post-PAE, and 8(11%) Grade-II urinary infections. CONCLUSION: PAE provided safe, effective, and durable treatment for retention and gross hematuria in nonindex benign prostatic hyperplasia patients.

Eight Days of Water-Only Fasting Promotes Favorable Changes in the Functioning of the Urogenital System of Middle-Aged Healthy Men.

The aim of this study was to determine whether, after 8 days of water-only fasting, there are changes in the efficiency of the lower urinary tract, the concentration of sex hormones, and the symptoms of prostate diseases in a group of middle-aged men (n = 14). For this purpose, before and after 8 days of water-only fasting (subjects drank ad libitum moderately mineralized water), and the following somatic and blood concentration measurements were made: total prostate specific antigen (PSA-T), free prostate specific antigen (PSA-F), follicle stimulating hormone (FSH), luteotropic hormone (LH), prolactin (Pr), total testosterone (T-T), free testosterone (T-F), dehydroepiandrosterone (DHEA), sex hormone globulin binding (SHGB), total cholesterol (Ch-T), ß-hydroxybutyrate (ß-HB). In addition, prostate volume (PV), volume of each testis (TV), total volume of both testes (TTV), maximal urinary flow rate (Qmax), and International Prostate Symptom Score (IPSS) values were determined. The results showed that after 8 days of water-only fasting, Qmax and IPSS improved but PV and TTV decreased significantly. There was also a decrease in blood levels of PSA-T, FSH, P, T-T, T-F, and DHEA, but SHGB concentration increased significantly. These results indicate that 8 days of water-only fasting improved lower urinary tract functions without negative health effects.

Does Prostate Artery Embolization (PAE) Improve Voiding Symptoms, Storage Symptoms, or Both?

INTRODUCTION: Many studies have looked at global changes in the International Prostate Symptom Score (IPSS) following PAE; however, no studies have examined the breakdown between storage and voiding symptoms. We aimed to explore the extent to which PAE improves storage symptoms in relation to voiding symptoms. METHOD: This single-center, prospective cohort study recruited consecutive patients undergoing PAE from June 2012 to June 2016. The IPSS breakdown was recorded pre-PAE, at 3 months and 12 months post-PAE. Planned statistical analysis included the paired t test. RESULTS: A total of 43 patients were recruited (mean age 64.72 ± 6.27, prostate volume 88.65 ± 37.23 cm3, IPSS 23.02 ± 5.84, QoL 4.98 ± 1.01, PSA 4.2 ± 2.8). Storage symptoms were more frequently the most severe symptom (58.1%). Voiding score (13.35-5.39, p < 0.001) and storage score (9.67-5.08, p < 0.001) both improved; however, voiding improved to a greater extent (1.9 vs. 1.5 mean per question, p = 0.023). PAE was most consistent when improving storage symptoms ('Urgency' improved in 86% patients, 'Frequency' and 'Nocturia' 77%). CONCLUSION: Storage symptoms are a significant problem for patients with benign prostatic obstruction. PAE is an effective treatment for both storage and voiding symptoms. More research is needed to evaluate how this compares with surgical techniques.

Effectiveness of a newly developed online self-management program for male patients with uncomplicated lower urinary tract symptoms.

AIMS: To explore the effect of an online self-management program in secondary care for men with lower urinary tract symptoms (LUTS). METHODS: We performed a prospective nonrandomized double-cohort pilot study of consecutive adult men referred with uncomplicated LUTS to three urology outpatient departments. Men in both cohorts received care as usual from a urologist, but men in the intervention cohort also had access to an online self-management program. Outcomes were assessed after 6 and 12 weeks: LUTS severity was assessed with the International Prostate Symptom Score (IPSS), the Overactive Bladder Questionnaire (OABq), and the Perceived Global Impression of Improvement (PGI-I). The main outcome of interest was a clear improvement in the PGI-I scores ("much better" or "very much better"). RESULTS: Age, symptom severity, and quality of life scores were comparable between the intervention (n = 113) and standard care (n = 54) cohorts. Clear improvement in the PGI-I scores was reported after 12 weeks in 19.4% and 26.1% of men in the intervention and standard care cohorts, respectively. However, logistic regression analysis indicated that the difference between cohorts was not significant. Multivariable linear regression analysis also indicated no significant differences between cohorts for the IPSS or the OABq score at either assessment point. Notably, the uptake of the intervention was low (53%). CONCLUSIONS: We found no significant benefit from adding an online self-management program to standard care for men with LUTS, probably due to the low uptake of the intervention that may have resulted from the timing in the care pathway.

Incontinence after Prostate Treatment: AUA/SUFU Guideline.

PURPOSE: Urinary incontinence after prostate treatment (IPT) is one of the few urologic diseases that is iatrogenic, and, therefore, predictable and perhaps preventable. Evaluation of the incontinent patient, risk factors for IPT, the assessment of the patient prior to intervention, and a stepwise approach to management are covered in this guideline. Algorithms for patient evaluation, surgical management, and device failure are also provided. MATERIALS AND METHODS: This guideline was developed using a systematic review from the Mayo Clinic Evidence Based Practice Center with additional supplementation by the authors. A research librarian conducted searches from 2000 to December 21st, 2017 using Ovid, MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Databases of Systematic Reviews. Additional references through 12/31/2018 were identified. RESULTS: This guideline was developed by a multi-disciplinary panel to inform clinicians on the proper assessment of patients with IPT and the safe and effective management of the condition in both surgical and non-surgical contexts. Statements guiding the clinician on proper management of device failure are also included. CONCLUSION: Most patients who undergo radical prostatectomy (RP), and some patients who undergo radiation therapy (RT) or surgery for benign prostatic hyperplasia (BPH), will experience IPT. Although non-surgical options, such as pelvic floor muscle exercises (PFME), can hasten continence recovery, patients who remain incontinent at one-year post-procedure, or have severe incontinence at six months, may elect to undergo surgical treatment (e.g. artificial urinary sphincter). Prior to IPT surgery, the risks, benefits, alternatives, and additional likely procedures should be discussed with the patient.

Clinical approach to prostatic diseases in the dog.

In small animal practice, prostatic diseases are increasingly encountered. All dogs may experience prostatic disease, but particular care should be addressed to breeding dogs, in which prostatic affection may lead to decrease in semen quality and fertility. The most common prostatic disease is the benign prostatic hyperplasia (BPH) followed by prostatitis, prostatic neoplasia and prostate squamous metaplasia. These diseases do not have pathognomonic symptoms, therefore, making a correct diagnosis may not be easy. An accurate clinical examination and a correct diagnostic protocol are essential in order to begin the most appropriate treatment, and also to do a good prophylaxis where it is possible. BPH therapy is usually recommended when mild-severe signs are present or if symptoms disturb the patient. New therapeutic approaches, both medical and surgical, allow to maintain fertility in most animals with prostatic disorders. Prostate cancer is relatively infrequent. Elective therapy is the surgical one, but it is considered palliative and can result in important post-operative complications. The aim of this paper is to lay down the most appropriate diagnostic process describing the aetiologies of prostatic disease, their symptoms, the right investigative tools and therapy.

Role of lasers in urology.

Laser technology has long been a standard treatment for many diseases. In particular, laser treatment is considered the standard of care in various urological diseases. While originally primarily restricted to stone treatment, lasers have since evolved to play an important role even in the treatment of malignant diseases. In this review, we take a closer look at the history of lasers in urology and some implications for treatments today.

Use of platelet-rich plasma for the treatment of prostatic cysts in dogs.

Abnormalities of the canine prostate gland, in particular, benign hyperplasia and cysts, are frequent in dogs over 5 years of age. Treatment strategies for dogs with prostatic cysts include ultrasound-guided percutaneous drainage with alcohol sclerotherapy, reduction surgery, and omentalization. The aim of this study was to evaluate the use of platelet-rich plasma (PRP) for the treatment of prostatic cysts in dogs. Ten mixed breed adult male dogs were included in the study. Percutaneous drainage was performed prior to ultrasound-guided PRP injection with a 21G spinal needle. The PRP dose contained half of the solution drained from the cyst. Follow-ups were performed 6, 12, 24, and 60 d after treatment. Ten prostatic cysts were successfully treated with PRP after the ultrasound-guided drainage of the cystic cavities. No side effects were observed during the procedures. After the introduction of PRP, cysts detected by ultrasound appeared hypoechoic. On the sixth day, the hypoechoic appearance was maintained and margins were still identifiable. At 24-day and 60-day follow-ups, cysts were no longer detectable by ultrasound. One of the ten dogs had to be euthanized because of the presence of a malignant mesenchymal neoplasm of the oral cavity (fibroblastic sarcoma) and histological examination of serial sections of the prostate gland was performed. Histologic evaluation 1 year after treatment showed a regression of the cystic lesion injected with PRP. The therapy, which uses PRP injection in combination with ultrasound-guided drainage, can be considered a safe and effective strategy for the treatment of prostatic cysts in dogs.

Les anomalies de la prostate chez le chien, plus particulièrement l'hyperplasie bénigne et les kystes, sont fréquentes chez les chiens âgés de 5 ans ou plus. Les stratégies de traitement pour les chiens avec des kystes prostatiques incluent le drainage transcutané par échographie guidée avec sclérothérapie à l'alcool, chirurgie de réduction, et omentalisation. Le but de la présente étude était d'évaluer l'utilisation de plasma enrichi de plaquettes (PEP) pour le traitement de kystes prostatiques chez des chiens. Dix chiens mâles adultes de race mélangée ont été inclus dans l'étude. Le drainage transcutané a été effectué avant l'injection par échographie guidée de PEP avec une aiguille spinale de 21G. La dose de PEP contenait la moitié de la solution drainée du kyste. Des suivis ont été faits à 6, 12, 24, et 60 j suivant le traitement. Dix kystes prostatiques ont été traités avec succès avec le PEP suite au drainage des cavités kystiques par échographie guidée. Aucun effet secondaire ne fut observé durant les procédures. Après l'introduction du PEP, les kystes détestés par échographie apparaissaient hypoéchogène. Au sixième jour, l'apparence hypoéchogène était maintenue et les bordures étaient toujours identifiables. Lors des suivis aux jours 24 et 60, les kystes n'étaient plus détectables par échographie. Un des dix chiens dû être euthanasié à cause de la présence d'un néoplasme mésenchymateux malin de la cavité orale (sarcome fibroblastique) et l'examen histologique de sections sériées de la prostate a été effectué. L'évaluation histologique 1 an après le traitement a montré une régression de la lésion kystique injectée avec du PEP. La thérapie, qui utilise l'injection de PEP en combinaison avec un drainage par échographie guidée, peut être considérée comme une stratégie sécuritaire et efficace pour le traitement de kystes prostatiques chez le chien(Traduit par Docteur Serge Messier).

Prostatic abscess: a rare complication of staghorn calculi.

A staghorn calculus is a calculus accommodating the majority of a renal calyx extending into the renal pelvis. A conservative approach to its treatment may lead to high morbidity and mortality rates. Such morbidity usually manifests with renal failure, obstructed upper urinary tractand/or life-threatening sepsis. Prostatic abscesses have never been associated with staghorn calculi in the literature. We report a case of a 70-year-old man who presented with sepsis, which was found to originate from a complex prostatic abscess. The patient had no history of urinary tract infections or risk factors. The authors believe that the incidentally identified staghorn calculi promoted the growth of Proteus mirabilis which led to the development of the prostatic abscess. The patient underwent a transurethral resection and drainage of the abscess following a failed course of antibiotic therapy. This case also highlights the paucity of guidelines available in treating prostatic abscesses.

Robotics in MRI-Guided Interventions.

Robots have been found to be a useful tool in magnetic resonance imaging (MRI)-guided intervention. The utility of robots in MRI-guided therapy ranges from aid for precision targeting to high-dexterity surgical tools to improve or even enable new MRI-guided therapy options. The objective of this article is to review the technical aspects of robotics in MRI-guided interventions, highlight the role of MRI robots in prostate interventions, and finally discuss the future contribution of emerging robotics technology useful in MRI-guided intervention.

Diagnosis and treatment of patients with prostatic abscess in the post-antibiotic era.

We reviewed the pathogenesis, clinical presentation, treatment options and outcomes of prostatic abscess in the post-antibiotic era, focusing on how patient risk factors and the emergence of multidrug-resistant organisms influence management of the condition. A MEDLINE search for "prostate abscess" or "prostatic abscess" was carried out. Prostate abscess is no longer considered a consequence of untreated urinary infection; now, men with prostatic abscess are typically debilitated or immunologically compromised, with >50% of patients having diabetes. In younger men, prostatic abscess can be the initial presentation of such chronic conditions. In older men, prostatic abscess is increasingly a complication of benign prostatic hyperplasia or prostate biopsy. Diagnosis is based on a physical examination, leukocytosis, leukocyturia and transrectal ultrasound, with magnetic resonance imaging serving as the preferred confirmatory imaging modality. Treatment of prostatic abscess is changing as a result of the emergence of atypical and drug-resistant organisms, such as extended-spectrum ß-lactamase-producing enterobacteriaceae and methicillin-resistant Staphylococcus aureus. As many as 75% of infections are resistant to first-generation antibiotics, necessitating aggressive therapy with broad-spectrum parenteral antibiotics, such as third-generation cephalosporins, aztreonam or antibiotic combinations. A total of 80% of patients require early surgical drainage, frequently through a transurethral approach. In the post-antibiotic era, prostatic abscess is evolving from an uncommon complication of urinary infection to a consequence of immunodeficiency, growing antibiotic resistance and urological manipulation. This condition, primarily affecting patients with chronic medical conditions rendering them susceptible to atypical, drug-resistant organisms, requires prompt aggressive intervention with contemporary antibiotic therapy and surgical drainage.

Endoscopic ultrasound-guided pelvic and prostatic abscess drainage: experience in 30 patients.

BACKGROUND: Endoscopic ultrasound (EUS)-guided drainage is an effective treatment for many abscesses in the abdomen. We review our experience with EUS-guided drainage of pelvic abscesses. METHODS: Thirty consecutive patients who underwent EUS-guided pelvic abscess drainage were evaluated after excluding three patients with distance to transducer >2 cm or organized abscess. RESULTS: Thirty patients (25 male) aged 60 ± 4.5 years (mean ± SD) had 4 prostatic abscesses, 7 perisigmoid abscesses, and 19 perirectal abscesses with mean ± SD sizes of 2.5 ± 0.3, 4.7 ± 0.6, and 5.4 ± 0.4 cm, respectively. Surgery was the most common predisposing factor (n = 14, 46.6 %) followed by diverticulitis (n = 5, 16.6 %). Interventions included aspiration only (2 prostatic and 3 perisigmoid), aspiration and dilatation (2 patients in each group), and dilatation and stenting (2 perisigmoid and 17 perirectal). Five (16.6 %) patients needed re-intervention, and two (6.6 %) needed surgery. There were no recurrences. Technical success of EUS-guided pelvic abscess drainage overall was 90.9 % (30/33) and was 93.3 % (27/30) in patients in whom EUS-guided drainage was attempted, with 16.5 % (n = 5) re-intervention rate. CONCLUSION: EUS-guided drainage has an excellent success rate in drainage of pelvic abscesses.

Current role of transcatheter arterial embolization for bladder and prostate hemorrhage.

Intractable hematuria from the bladder or the prostate can be life-threatening and its management remains a difficult clinical problem. Severe bleeding can arise as a result of radiation cystitis, bladder carcinoma, cyclophosphamide-induced cystitis, severe infection, transurethral resection of the prostate and prostate cancer. When irrigation of the bladder through a three-way catheter and fulguration of the bleeding lesions fail to stop the hematuria, a life-threatening situation can develop, when blood transfusion fails to keep pace with the rate of blood loss. Patients with massive uncontrollable hematuria are often elderly and unfit for cystectomy as a treatment. Many urologists have had to manage this difficult problem, and several different treatments have been attempted and described, with varying degrees of success. Transcatheter arterial embolization of the vesical or prostatic arteries is occasionally indicated in these patients when all other measures have failed. There is limited published experience with this procedure, but success in 90% of patients is reported when the vesical or prostatic arteries can be identified. The aim of this review is to describe the current place of transcatheter arterial embolization in the management of severe bladder or prostate bleeding after failed conservative therapy, and to review its efficacy and morbidity.

Diagnostic and therapeutic utility of transrectal ultrasound in urological office prostatic abscess management: a short report from a single urologic center.

OBJECTIVES: Prostatic abscess (PA) is an infrequent condition in the modern antibiotic era. The everyday use of transrectal ultrasound (TRUS) during diagnostic work-up and the widespread recurrence to prostatic biopsies may lead to an increase of PA diagnosis. In this short report we analyze the patients characteristics and the management of seven recent cases of PA diagnosed in our institution. MATERIALS AND METHODS: The records of 7 patients admitted to our Center for LUTS associated to septic fever or acute urinary retention, was prospectively collected. Suspect of PA was done on digital rectal examination (DRE) and confirmed by TRUS performed after urinary system ultrasound (UUS) evaluation. Patients were admitted to hospital only in case of septic signs. A sovrapubic (SPC) or urethral catheter (UC) was placed depending on symptoms. A TRUS-guided aspiration of PA was performed with patient in lithotomic position, using a 18 gauge two-part needle, side/end fire needle access. Patient was discharged with antibiotic therapy and followed up until complete resolution of the PA and symptoms. RESULTS: Mean age was 62 years (range 24-82). Two patients were diabetics and one was affected by the immunodeficiency acquired syndrome (HIV). In one case, PA was detected after a persistent fever post TRUS guided prostate biopsy. Average prostate volume was 69 ml (range 19-118 ml). DRE was able to diagnose PA only in 2 cases (29%), UUS evaluation in 1 case (14%). All cases were confirmed by TRUS as hypo-anechoic areas with or without internal echoes in all patients. Mean PA dimension was 3.64 cm (range 1.5-8). SPC was placed in 3 cases (43%), UC in 3 patients (43%). Only 1 patient refused catheterization. Side fire needle aspiration was performed in all cases and in combination with end fire access in case of particular location of abscess cavities. Second look was needed in 2 cases (29%). Antibiotics were administered in all cases. The aspirated pus showed a positive culture for Escherichia coli (43%), Klebsiella pneumoniae (29%), Pseudomonas aeruginosa (14%) and Enterococcus faecalis (14%). PA resolution time mean was 9 days (range 3-24). CONCLUSIONS: TRUS evaluation in case of persistent LUTS associated with fever or acute urinary retention is determinant in the diagnosis of PA. Office or institutional management with TRUS needle aspiration is a good option in these cases.