Subject(s)
Tuberculosis, Male Genital , Humans , Male , Tuberculosis, Male Genital/diagnosis , Tuberculosis, Male Genital/drug therapy , Tuberculosis, Male Genital/pathology , Prostatic Diseases/diagnosis , Prostatic Diseases/microbiology , Prostatic Diseases/pathology , Prostatic Diseases/diagnostic imaging , Middle Aged , Antitubercular Agents/administration & dosageABSTRACT
Midline prostatic cysts are infrequent and mostly asymptomatic. We presented a striking case of a giant midline cyst and detailed its diagnosis, evolution, and treatment. From this case, we offered a comparison of congenital intraprostatic midline cysts, namely, Müller's cysts and utricle cysts. A 40-year-old male experienced recurrent urinary retention. A 10 × 11 mm2 cyst in the mid-prostatic region was diagnosed through transrectal ultrasound, leading to a transperineal puncture as a minimally invasive intervention. Seven years later, the cyst recurred, manifesting obstructive symptoms such as a weak urinary stream, frequent urination, and residual urine sensation. Laparoscopic surgery was then performed for the confirmed 98 × 13 mm2 cystic recurrence. The postoperative course was favourable with no complications. Symptoms were completely resolved, which was maintained over a three-year follow-up period. The therapeutic approach to midline cysts targets symptomatic cases or infertility, ranging from cyst puncture to transurethral endoscopic treatment. Recurrence after minimally invasive interventions is a challenge, with laparoscopic surgery as an alternative post-failed conservative approach. Although total cyst removal risks adjacent structure damage, marsupialisation improves the clinical outcomes. In summary, symptomatic midline prostatic cysts present challenges owing to recurrences after minimally invasive approaches. Enhanced laparoscopic techniques offer a solution, particularly in highly symptomatic cases requiring definitive treatment, as illustrated by this outstanding case report.
Subject(s)
Cysts , Laparoscopy , Prostatic Diseases , Urinary Retention , Male , Humans , Adult , Urinary Retention/etiology , Prostatic Diseases/complications , Prostatic Diseases/surgery , Prostatic Diseases/diagnosis , Prostate , Cysts/complications , Cysts/surgery , Cysts/diagnosisABSTRACT
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.
Subject(s)
Adenocarcinoma , Malacoplakia , Prostatic Diseases , Prostatic Neoplasms , Male , Humans , Prostate/pathology , Prostatic Diseases/complications , Prostatic Diseases/diagnosis , Prostatic Diseases/pathology , Malacoplakia/complications , Malacoplakia/diagnosis , Malacoplakia/pathology , Prostatic Neoplasms/complications , Prostatic Neoplasms/pathology , Adenocarcinoma/complications , Adenocarcinoma/diagnosis , Adenocarcinoma/pathologyABSTRACT
BACKGROUND: Fever and malaise without the possibility of an adequate anamnesis has a broad differential diagnosis. Under these conditions in male patients several rare urogenital disorders need to be considered. CASE DESCRIPTION: A 26-year-old mentally disabled young man was examined because of a fever, altered behaviour and elevated infection parameters. A CT-scan of the abdomen showed signs of prostatitis. Transrectal ultrasonography was performed under general anaesthesia to rule out a prostatic abscess. This showed prominent, dilated seminal vesicles. Under transurethral sight, large amounts of pus was drained from the ejaculatory ducts by digital rectal examination (unique video). Intravenous antibiotic therapy was continued and the patient successfully recovered. CONCLUSION: Acute bacterial prostatitis is diagnosed based on the clinical presentation of the patient. When there is fever without a focus or no recovery following antibiotic therapy, an abscess of the prostate or empyema of the seminal vesicles should be considered.
Subject(s)
Empyema , Prostatic Diseases , Humans , Male , Adult , Seminal Vesicles/diagnostic imaging , Abscess/diagnosis , Ejaculatory Ducts/diagnostic imaging , Prostatic Diseases/complications , Prostatic Diseases/diagnosis , UltrasonographyABSTRACT
BACKGROUND Staphylococcus aureus (SA) is a rare cause of prostatic abscess. Risk factors include genito-urinary instrumentalization and immunocompromised states. Because of the lack of guidelines on the diagnosis, management, and follow-up of SA prostate abscess, the diagnosis can sometimes be challenging. Our patient was a 60-year-old man who initially presented with lower back pain and was diagnosed with a methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia, prostate abscess, osteomyelitis, and myositis. CASE REPORT A 60-year-old man presented with lower back pain. He had a past medical history of incompletely treated MSSA cervical osteomyelitis with epidural abscess, alcohol use disorder, intravenous drug use (IVDU), and poorly controlled diabetes mellitus (DM). He was afebrile and hemodynamically stable. Laboratory test results revealed leukocytosis and an elevated C reactive protein (CRP). Lumbar spine magnetic resonance imaging (MRI) showed vertebral osteomyelitis and right psoas myositis. Blood cultures isolated MSSA. The patient was treated with vancomycin and piperacillin-tazobactam. On day 5, our patient reported having fever, chills, flank pain, and dysuria. Computed tomography (CT) revealed a 4.0×4.9 cm prostatic abscess. CT-guided percutaneous abscess drainage was performed, and fluid culture revealed MSSA. Both antibiotics were discontinued and cefazolin was started following sensitivities. Post-drainage pelvic ultrasound (US) showed resolution of the abscess. CONCLUSIONS This case highlights the importance of a rapid diagnosis of SA prostate abscess in patients with documented risk factors and characteristic symptoms. Timely management with antibiotics and drainage as indicated are imperative to avoid further complications from the underlying bacteremia, including sepsis and metastatic infections.
Subject(s)
Bacteremia , Epidural Abscess , Low Back Pain , Myositis , Osteomyelitis , Prostatic Diseases , Staphylococcal Infections , Anti-Bacterial Agents/therapeutic use , Back Pain , Bacteremia/complications , Bacteremia/diagnosis , Bacteremia/drug therapy , Epidural Abscess/complications , Humans , Male , Methicillin , Middle Aged , Myositis/complications , Myositis/diagnosis , Osteomyelitis/complications , Osteomyelitis/diagnosis , Prostate , Prostatic Diseases/complications , Prostatic Diseases/diagnosis , Staphylococcal Infections/complications , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus aureusABSTRACT
Objective: To investigate the differences in uric acid (UA), interleukin-6 (IL-6), and free prostatic-specific antigen (fPSA)/total prostatic-specific antigen (tPSA) (F/T) between patients with and without prostate cancer (PCa) in order to discover the value of the three indicators in improving PCa diagnostic accuracy. Methods: Patients with pathologically diagnosed PCa (PCa group, n = 25), patients with other benign prostate diseases (benign group, n = 25), and men who underwent normal physical examination (control group, n = 25) at the First Affiliated Hospital of Guangzhou University of Chinese Medicine between October 2020 and January 2021 were included. The serum UA, IL-6, and F/T levels of participants in the three groups were measured, and the measured data were statistically analyzed. Results: There were statistically significant differences in IL-6 and F/T among the three groups (all P < 0.05), but there were no statistically significant differences in UA (P > 0.05). The area under the receiver operating characteristic (ROC) curve (AUC) for the three indicators was, respectively, as follows: PCa group-benign group 0.5416, 0.6776, and 0.6832; PCa group-control group 0.5432, 0.9536, and 0.9887; and benign group-control group 0.5000, 0.8784, and 0.9456. Logistic regression analysis indicated that IL-6 and F/T were independent predictors of PCa, with AUCs of 0.6776 and 0.6832, respectively, and a combined accuracy of 72.0%. Conclusion: These results suggest that IL-6 and F/T have a good detection effect for PCa screening. Compared with the detection of F/T alone, the combined detection of IL-6 and F/T can improve the diagnosis rate of PCa to a certain extent, providing effective guidance for the clinical diagnosis and treatment of patients. The value of UA needs to be further studied, and its feasibility in the diagnosis of PCa needs to be further explored.
Subject(s)
Interleukin-6/biosynthesis , Kallikreins/blood , Prostate-Specific Antigen/blood , Prostatic Neoplasms/blood , Prostatic Neoplasms/diagnosis , Uric Acid/blood , Biomarkers, Tumor/chemistry , Case-Control Studies , Computational Biology , Diagnosis, Differential , Healthy Volunteers , Humans , Logistic Models , Male , Prostatic Diseases/blood , Prostatic Diseases/diagnosis , ROC Curve , Risk FactorsABSTRACT
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.
Subject(s)
Abscess , Prostatic Diseases , Male , Humans , Abscess/diagnosis , Abscess/therapy , Retrospective Studies , Prostatic Diseases/diagnosis , Prostatic Diseases/therapy , Prognosis , Anti-Bacterial Agents/therapeutic useABSTRACT
A vigilância ativa é a solução encontrada pela urologia para a condução de tumores prostáticos com características de pouca agressividade. Desenvolvida especialmente após as polêmicas que envolveram a validade do rastreamento, essa abordagem vem sendo consolidada como a melhor maneira de se evitar o tratamento desnecessário do câncer de próstata e precisa ser compreendida por todos os médicos que lidam com a saúde do homem.
Active surveillance is the solution found by urology to deal with low-aggressivity prostate tumours. Having been developed following controversies over screening strategies, this has been considered the best approach to avoid unnecessary treatment of prostate cancer and such a concept needs to be well understood by every medical doctor who deals with men's health.
Subject(s)
Humans , Male , Prostatic Neoplasms/prevention & control , Men's Health , Watchful Waiting/methods , Prostatic Diseases/diagnosis , Urology , Preventive Medicine , Health StrategiesABSTRACT
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.
Subject(s)
Cysts/pathology , Mullerian Ducts/pathology , Prostatic Diseases/diagnosis , Prostatic Diseases/pathology , Biomarkers/metabolism , Humans , Immunohistochemistry , Male , PAX8 Transcription Factor/biosynthesis , Young AdultABSTRACT
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.
Subject(s)
MicroRNAs/metabolism , Prostate/metabolism , Prostatic Diseases/diagnosis , Prostatic Neoplasms/diagnosis , Adult , Aged , Aged, 80 and over , Biomarkers/metabolism , Biomarkers, Tumor/genetics , Biomarkers, Tumor/metabolism , Biopsy , Diagnosis, Differential , High-Throughput Nucleotide Sequencing , Humans , Male , MicroRNAs/genetics , Middle Aged , Prostate/pathology , Prostatic Diseases/genetics , Prostatic Diseases/metabolism , Prostatic Diseases/pathology , Prostatic Neoplasms/genetics , Prostatic Neoplasms/metabolism , Prostatic Neoplasms/pathologySubject(s)
Abscess/diagnosis , Diabetes Mellitus, Type 2 , Klebsiella Infections/diagnosis , Klebsiella pneumoniae/isolation & purification , Prostatic Diseases/diagnosis , Prostatic Hyperplasia , Abscess/drug therapy , Administration, Oral , Aged , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/administration & dosage , Ceftriaxone/therapeutic use , Diagnosis, Differential , Humans , Klebsiella Infections/drug therapy , Male , Prostatic Diseases/diagnostic imaging , Prostatic Diseases/drug therapy , Prostatic Diseases/microbiology , Tomography, X-Ray ComputedABSTRACT
AIM: To evaluate prospectively a clinical pathway for investigation of haematuria that involves an initial screening using a urinary biomarker of bladder cancer (Cxbladder Triage™ (CxbT)) in combination with either a renal ultrasound or a computed tomography imaging. Only test-positive patients are referred for specialist assessment and flexible cystoscopy. METHODS: The clinical outcomes of 884 patients with haematuria who presented to their general practitioner were reviewed. Outcome measurements included the findings of laboratory tests, imaging, cystoscopies, specialist assessment and histology. RESULTS: Forty-eight transitional cell carcinomas (TCC) and three small cell carcinomas were diagnosed in the study cohort. The clinical pathway missed a solitary, small, low-risk TCC. When combined, imaging and CxbT had a sensitivity of 98.1% and a negative predictive value of 99.9% to detect a bladder cancer. Follow-up for a median of 21 months showed no further new cases of bladder cancer had occurred in the patient cohort. Review of all new bladder cancers diagnosed in the 15 months following the study showed that none had been missed by haematuria assessment using the clinical pathway. CONCLUSIONS: The combination of CxbT and imaging reliably identifies patients with haematuria who can be managed safely in primary care without the need for a secondary care referral and a flexible cystoscopy.
Subject(s)
Carcinoma, Transitional Cell/diagnostic imaging , Carcinoma, Transitional Cell/urine , Critical Pathways , Hematuria/etiology , Urinary Bladder Neoplasms/diagnostic imaging , Urinary Bladder Neoplasms/urine , Adolescent , Adult , Aged , Aged, 80 and over , Biomarkers/urine , Carcinoma, Transitional Cell/complications , Cystitis/complications , Cystitis/diagnosis , Cystoscopy , Female , Hematuria/diagnostic imaging , Humans , Kidney/diagnostic imaging , Kidney Calculi/complications , Kidney Calculi/diagnosis , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Prostatic Diseases/complications , Prostatic Diseases/diagnosis , Referral and Consultation , Tomography, X-Ray Computed , Ultrasonography , Unnecessary Procedures , Urinary Bladder Neoplasms/complications , Urinary Tract Infections/complications , Urinary Tract Infections/diagnosis , Young AdultABSTRACT
Our case describes an 80-year-old gentleman who presented with delirium and lower urinary tract symptoms. Initially treated for a urinary tract infection, he became more unwell with features of physiological decompensation secondary to sepsis. A computerized tomography scan was performed in light of the findings of suprapubic tenderness, which on examination revealed a prostatic abscess. On discussion with urology and microbiology colleagues a plan for antibiotics was constructed and the gentleman recovered without the need for invasive interventions. Our case goes on to discuss the merits of imaging for the elderly care physician when the diagnosis is not clear or when the clinical picture is of deterioration despite optimal medical care.
Subject(s)
Delirium , Lower Urinary Tract Symptoms , Prostatic Diseases , Urinary Tract Infections , Abscess/diagnostic imaging , Abscess/therapy , Aged , Aged, 80 and over , Delirium/diagnosis , Delirium/etiology , Humans , Lower Urinary Tract Symptoms/diagnosis , Lower Urinary Tract Symptoms/etiology , Lower Urinary Tract Symptoms/therapy , Male , Prostatic Diseases/diagnosis , Prostatic Diseases/diagnostic imaging , Urinary Tract Infections/complications , Urinary Tract Infections/diagnosis , Urinary Tract Infections/drug therapySubject(s)
Cysts/diagnosis , Prostatic Diseases/diagnosis , Prostatic Neoplasms/diagnosis , Aged , Diagnosis, Differential , Humans , Male , Middle Aged , NetherlandsABSTRACT
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.
Subject(s)
Cysts/veterinary , Dog Diseases/diagnosis , Prostatic Diseases/veterinary , Animals , Cysts/diagnosis , Cysts/pathology , Cysts/surgery , Dog Diseases/pathology , Dog Diseases/surgery , Dogs , Male , Prostatic Diseases/diagnosis , Prostatic Diseases/pathology , Sertoli Cell Tumor/pathology , Sertoli Cell Tumor/veterinary , Testicular Neoplasms/veterinarySubject(s)
Colon , Cysts/diagnosis , Intestinal Mucosa , Prostatic Diseases/diagnosis , Humans , Male , Middle AgedABSTRACT
INTRODUCTION: Transrectal ultrasound of prostate provides better visual for biopsy. Transrectal ultrasound guided prostate biopsy is usually performed in men with an abnormal digital rectal examination, and elevated prostate specific antigen (>4ng/ml) or prostate specific antigen velocity (rate of prostate specific antigen change) i.e., >0.4-0.75ng/ml/year. The aim of the study is to find out the complications of transrectal ultrasound guided prostatic biopsies. METHODS: This descriptive cross-sectional study was done among 50 patients who transrectal ultrasound guided prostatic biopsies in a tertiary care hospital, from July 2017 to July 2019 after receiving ethical approval from the Institutional Review Committee of Kathmandu Medical College and teaching hospital. Convenient sampling was done. All patients were informed about the potential benefits and risks of the transrectal ultrasound guided prostate biopsy and patients signed an informed written consent form. Statistical analysis was done by using Statistical Package for Social Sciences version 16. RESULTS: Mean prostate specific antigen was 34.571 and mean weight of prostate was 44.6gm. Moderate to severe pain was experienced by 15 (30%), 2 (4%) had hematuria with fever accounting for 3 (6%) patients. All were managed conservatively with no mortality related to the procedure and complication. Three patients was positive for malignancy on re-biopsy. CONCLUSIONS: Transrectal ultrasound guided biopsy of prostate is a pioneer experience in Nepal. It has proved to be an useful tool of diagnosis of suspected carcinoma of Prostate. Use of neurovascular block may reduce the pain during the procedure.