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.

[Calculus formation in the prostatic cavity after transurethral resection of the prostate: causes, treatment and prevention].

OBJECTIVE: To study the causes, clinical manifestations, treatment and prevention of calculus that develops in the prostatic cavity after transurethral resection of the prostate. METHODS: We reported 11 cases of calculus that developed in the prostatic cavity after transurethral resection or transurethral plasmakinetic resection of prostate. The patients complained of repeated symptoms of frequent micturition, urgent micturition and urodynia after operation, accompanied with urinary tract infection and some with urinary obstruction, which failed to respond to anti-infective therapies. Cystoscopy revealed calculi in the prostatic cavity, with eschar, sphacelus, uneven wound surface and small diverticula in some cases. After diagnosis, 1 case was treated by holmium laser lithotripsy and a second transurethral resection of the prostate, while the other 10 had the calculi removed under the cystoscope, followed by 1 -2 weeks of anti-infective therapy. RESULTS: After treatment, all the 11 cases showed normal results of routine urinalysis, and no more symptoms of frequent micturition, urgent micturition and urodynia. Three- to six-month follow-up found no bladder irritation symptoms and urinary tract infection. CONCLUSION: Repeated symptoms of frequent micturition, urgent micturition, urodynia and urinary tract infection after transurethral resection of the prostate should be considered as the indicators of calculus in the prostatic cavity, which can be confirmed by cystoscopy. It can be treated by lithotripsy or removal of the calculus under the cystoscope, or even a second transurethral resection of the prostate. For its prevention, excessive electric coagulation and uneven wound surface should be avoided and anti-infection treatment is needed.

The effects and prospects of the integration of traditional Chinese medicine and Western medicine on andrology in China.

Andrology has a long history in traditional Chinese medicine (TCM) discussions concerning andropathies, and documentation of relevant therapeutic methods abound in the ancient literature on TCM. Integrated treatment combining TCM and Western medicine has seen both broad and in-depth development, with formidable status in the field of modern andrology in China. This article attempts to demonstrate the unique advantage of integrated treatment in the therapy of andropathies through a review of the ancient literature on andrology in the field of TCM and on the integrative treatment of prostatic diseases, sexual dysfunction, male infertility and late-onset hypogonadism. There is a need for the advancement of a medical theory that integrates TCM and Western medicine practices to create a new therapeutic system with standardized therapeutic and evaluative protocols for diseases involving male sexual health.

Prostatic abscess: diagnosis and management in the modern antibiotic era.

This retrospective study was aimed at analyzing the clinical findings and therapeutic strategies in 24 patients who were admitted with prostatic abscess, during the period from 1999 to 2008. The diagnosis of prostatic abscesses was made clinically by digital rectal palpation based on the presence of positive fluctuation with tenderness. All cases were confirmed by trans-rectal ultrasound (TRUS), and only positive cases were included in this study. The diagnostic work-up included analysis of midstream urine and abscess fluid culture for pathogens. Therapeutic options included endoscopic trans-urethral incision or trans-perineal aspiration under ultrasound guidance, or conservative therapy. Of the 24 patients studied, 45.83% of the cases had a pre-disposing factor, and diabetes mellitus (37.50%) was the most common. Digital rectal palpation revealed fluctuation in 70.83% of the cases. Trans-abdominal ultrasonography missed the condition in 29.16% of the cases. On TRUS, all the study patients showed hypo-echoic zones, while nine others showed internal septations. In most of the cases, the lesion was peripheral. A causative pathogen could be identified in 70.83% of the cases. Surgical drainage of the abscess by trans-urethral deroofing was performed in 17 cases (including one with failed aspiration), trans-perineal aspiration under TRUS guidance was performed in three cases and conservative therapy was followed in five cases. Our data confirms the importance of predisposing factors in the pathogenesis of prostatic abscess. In most of the cases, the clue to diagnosis is obtained by digital rectal palpation. TRUS gives the definite diagnosis and also helps in follow-up of patients. Trans-urethral deroofing is the ideal therapy where the abscess cavity is more than 1 cm, although in some selected cases, TRUS-guided aspiration or conservative therapy does have a role in treatment.

Prostatic abscess: diagnosis and treatment of an infrequent urological entity.

OBJECTIVE: To report two cases of prostatic abscess of difficult management and review the literature on diagnosis and management of this entity. METHODS /RESULTS: We describe two patients with prostatic abscess. The first one, a 73-year-old diabetic male, was treated using a more passive approach with percutaneous transrectal drainage; after a slow response, the patient passed away due to sepsis. The second case was a 59-year-old male who experienced a negative clinical response to antibiotic treatment. While under antibiotic ambulatory care the patient was treated with a transurethral resection of the prostate, which yielded a successful outcome. CONCLUSION: Prostatic abscess is a rare entity that affects individuals experiencing weakness and can be a serious condition. Measures taken to arrive at a resolution must be rapid and appropriate.

Prostatic abscess associated with Bacteroides fragilis mediastinitis after heart surgery.

Anaerobic mediastinitis after cardiac surgery is a rare and poorly understood condition. We observed a patient with diabetes and myelodysplastic syndrome who developed Bacteroides fragilis mediastinitis in conjunction with a prostatic abscess, several days after coronary artery bypass surgery; this hitherto unpublished observation suggests that suppurative infection of the genito-urinary tract may constitute a portal of entry for postoperative anaerobic mediastinitis in predisposed patients.

Transurethral drainage for prostatic abscess in a patient with metastatic testicular cancer undergoing systemic chemotherapy.

We report a case of prostatic abscess in a 22-year-old man with metastatic testicular cancer being treated by BEP (bleomycin, etoposide and cisplatin) chemotherapy. This abscess was successfully treated by surgical drainage with transurethral resection of the prostate (TURP) under the guidance of transrectal ultrasound, allowing the patient to continue be receiving BEP without significant interruption. Drainage TURP is suggested to be a useful strategy for prostate abscess, when prompt control of symptoms caused by prostatic abscess is required.

Treatment of prostatic abscesses by aspiration of the purulent matter and injection of tea tree oil into the cavities in dogs.

Ultrasonography-guided transabdominal needle aspiration was carried out to remove 3 to 14 ml of purulent matter from the cavities of prostatic abscesses in 6 dogs, and the same volume of tea tree oil was injected into the cavities to treat the abscesses. The same treatment was repeated 3 weeks later in 4 dogs, and subsequent disappearance of the purulent matter in the cavities and a marked reduction in the volume of the cavities were observed. These findings indicate that the treatment of prostatic abscesses by aspiration of the purulent matter and injection of tea tree oil into the cavities is very effective in dogs.

Maori men's perceptions and experiences of health seeking for prostate health problems in New Zealand.

To discover Maori men's perceptions and experiences of health seeking for prostate health problems. A qualitative research design was sued with semi-structured interviews being the primary data source. From January 2000 to February 2002 a total of 357 Maori men were recruited into the Wellington Region Community Prostate Study, Wellington School of Medicine and Health Sciences, New Zealand. 20 men were interviewed in total, including 16 who were symptomatic of prostate disease and four who were non-symptomatic. A number of barriers were described for not seeking prostate health care, and the majority of these were related to the health system not dealing appropriately with cultural issues. Additionally, a lack of prostate knowledge, due to unavailability of appropriate information and societal pressure of being male, were implicated. Solutions offered by participants were also largely culturally related, for example, whanau (family), te reo Maori (Maori language), rongoa (traditional Maori medicine) and more Maori health professionals. Results re-affirm the need for attention to be paid to the establishment of culturally safe health care and access to appropriate prostate health information. Findings could have implications beyond prostate disease and New Zealand, to countries with indigenous populations who share similar health experiences to Maori.

Novel approaches to the diagnostics and treatment of chronic prostatic diseases.

This article presents a modified technique for investigating the prostatic blood flow--rheoprostatography (impedance electroplethysmography of the prostate gland). It also gives some averaged rheographic parameters typical of most prevalent prostatic diseases (such as prostatitis, benign prostatic hyperplasia, and prostate cancer). These parameters were measured both under normal conditions and during functional tests. Furthermore, this article classifies prostatic blood-flow insufficiency into several stages. It is recommended that the combined therapy of chronic prostatic diseases should involve endorectal procedures of pulsed fluctuating stimulation (PFS), with rheographic monitoring being used as a feedback loop of such procedures.

Transrectal ultrasound-guided needle aspiration for prostatic abscesses: an alternative to transurethral drainage?

PURPOSE: Prostatic abscesses traditionally are drained transurethrally. Problems of this method include the risk of anesthesia, dissemination of bacteria, incomplete drainage of multiloculated or peripheral abscesses, and retrograde ejaculation, which may not be acceptable for young patients. Prostatic abscesses can be drained under transectal ultrasound (TRUS) guidance. Multiple, peripheral, or multiloculated abscesses are visualized. No anesthesia would be required. Repeat procedures can be performed easily with minimal morbidity. The risks of dissemination and retrograde ejaculation is negligible. MATERIALS AND METHODS: A standard TRUS probe and a 21-gauge Chiba needle are inserted through the biopsy guide into the abscesses. Five patients underwent the procedure. Four patients had a mean follow-up of 18 months. RESULTS: TRUS could visualize the abscess in all patients. Aspirate cultures corresponded to the urine culture except in one patient with sterile urine. Three had residual disease on repeat TRUS, but only two patients required repeat aspiration. All patients recovered and had no evidence of disease on follow-up. However, it was an average of 4 months before patients could be considered cured according to TRUS findings. Prostate volume decreased from a mean of 54 mL on diagnosis to 16 mL on follow-up. There was no hospital readmission or morbidity. CONCLUSIONS: TRUS needle aspiration for prostatic abscess is a feasible alternative to transurethral drainage. Repeat procedures may be required, but all patients recovered. There is minimal morbidity associated with the procedure; however, the recovery period may be longer.

Summary of ICD-9-CM Coordination and Maintenance Committee meeting.

The ICD-9-CM Coordination and Maintenance Committee, cosponsored by the National Center for Health Statistics (NCHS) and the Health Care Financing Administration (HCFA), recently met in Baltimore, MD. Donna Pickett, RRA (NCHS), and Patricia Brooks, RRA (HCFA), cochaired the meeting. Proposed modifications to ICD-9-CM were presented and are summarized below. Unless otherwise indicated, the audience generally supported the proposed changes.

Development and investigation of ultrasound linear phased arrays for transrectal treatment of prostate.

We used the rectangular radiator method as a numerical solution to the Rayleigh-Sommerfeld diffraction integral for calculating the acoustic fields produced by linear arrays. The appropriate phases and amplitudes of voltages applied to the elements were computed using the pseudo-inverse method. We have developed and acoustically evaluated several constructions of planar linear ultrasound phased arrays for transrectal thermotherapy of prostate diseases. The designs of the linear phased arrays used in this work were the result of compromise in terms of the choice of frequency and number and size of elements, in order to investigate a means of improving array performance which might lead to increased efficacy and safety of the thermal treatment. The results obtained are in agreement with the data of other studies and show that a linear plane phased array may be potentially useful for thermal therapy.

Urethral anaesthesia with topical bupivacaine. A role for a longer-acting agent.

OBJECTIVE: To assess the efficacy and toxicity of bupivacaine as a topical urethral anaesthetic. PATIENTS AND METHODS: This prospective two-part study comprised a pilot study of 10 men (mean age 73 years, range 39-86), to determine the toxicology, pharmocokinetics and suitable preparation of bupivacaine gel, and a study of 40 men (mean age 76 years, range 59-92) to compare the efficacy of bupivacaine with lignocaine gel. All patients were undergoing treatment for benign prostatic hyperplasia by transurethral radiofrequency heating using the Direx Thermex II system. RESULTS: There were no major adverse events. Bupivacaine provided good topical anaesthesia with a mean duration of 141 min, compared with 29 min for lignocaine. Serum samples taken from patients showed that the drug was absorbed slowly, and with a dose of 50 mg there was a wide margin between serum drug concentrations and toxic levels. CONCLUSION: Bupivacaine is safe and effective as a topical anaesthetic agent in the urethra in circumstances where prolonged duration of action is desirable. For lower urinary tract procedures 20-22 mL of anaesthetic gel is required, giving 2-3 h of analgesia/anaesthesia with no significant toxicity or adverse effect. The application of longer-acting anaesthetic agents need not be only during surgical intervention, but might usefully be extended post-operatively to provide early management of pain.

Cooled microwave transrectal applicator with adjustable directional beam for prostate treatment.

A new intracavitary applicator design for microwave hyperthermia, particularly for transrectal prostate treatment, is presented. It includes an exchangeable multisection antenna that enables us to create a required longitudinal heating pattern, a cooling system to shift the maximum temperature away from the surface and a microwave reflecting system embedded in the cooling system that allows one to shape the irradiation beam in a transverse direction. Independent control of the longitudinal and transverse irradiation patterns of the applicator along with the cooling system, enable precise heating of selected tissues. Results of SAR measurements, E-field measurements and steady state temperature distributions, in solid and liquid tissue-equivalent phantoms are presented. Clinical performance of this applicator was evaluated earlier in patients heated intraoperatively and in a phase I clinical study. The applicator was found capable of effectively heating a tissue volume extending radially 3-25 mm from the applicator surface, angularly defined by configuration of reflecting system and longitudinally determined by specific choice of the multisection antenna.

Transurethral microwave thermotherapy of nonbacterial prostatitis and prostatodynia: initial experience.

OBJECTIVES: To report our early experience using transurethral microwave thermotherapy (TUMT) to treat patients with nonbacterial prostatitis (NBP) and prostatodynia. METHODS: Nineteen patients with NBP (symptoms, negative cultures, no response to antibiotics, leukocytosis in expressed prostatitic fluid) and 5 patients with prostatodynia (symptoms, negative cultures, no response to antibiotics, no leukocytosis in expressed prostatitic fluid) were treated with TUMT at interstitial temperatures of 45 degrees to 60 degrees C for 1 hour. Response was assessed by a consistent symptom severity index and global assessment of symptoms. RESULTS: A marked and significant early (3 months) favorable response was noted in nearly one half of the NBP group but little benefit was found in the prostatodynia group. The treatment was associated with few adverse experiences. CONCLUSIONS: TUMT appears to be a potentially effective therapy for NBP, but its real efficacy as well as the durability of the response needs to be confirmed with a randomized double-blind sham-controlled trial.