IgG4 paratesticular fibrous pseudotumor: Case presentation and literature review.

PFP with IgG-4 immunostaining is a rare paratesticular tumour. Pre-operative ultrasound scan and MRI usually confirm the benign nature of the paratesticular mass avoiding the need for radical orchiectomy. The final diagnosis is based on histology of the removed paratesticular tumour. FDG PET scan plays an important role in ruling out systematic IgG4-related disease (IgG4-RD). We describe a case of multiple paratesticular fibrous pseudotumors with IgG4 immunostaining, not associated with systemic IgG4 related disease.

EXIT from TRansrectal prostate biopsies (TREXIT): sepsis rates of transrectal biopsy with rectal swab culture guided antimicrobials versus freehand transperineal biopsy.

BACKGROUND: Transrectal prostate biopsy (TRUSBx) holds a risk of prostate biopsy related sepsis. We discuss our step-wise strategies aiming to reduce this risk, including targeted antimicrobials and switching to a freehand transperineal approach (FHTPBx). SUBJECTS AND METHODS: This longitudinal cohort study included three groups. Group A underwent TRUSBx with empirical augmented antimicrobial prophylaxis; Group B underwent TRUSBx with targeted antimicrobial prophylaxis, based on rectal-swab cultures/sensitivity; Group C underwent FHTPBx with empirical antimicrobial prophylaxis. Post biopsy sepsis, defined according to the surviving sepsis campaign and confirmed with blood or urinary cultures, were determined and rates between groups were analysed using fisher's exact test. RESULTS: Of all 1501 patients, 23 developed post biopsy sepsis; Group A (12/609, 2.0%), B (9/403, 2.2%), C (2/489, 0.4%). Targeted antimicrobials did not reduce the risk of post biopsy sepsis following TRUSBx (A vs B, 2.0% vs 2.2%; p = 0.82). Patients with antimicrobial-resistant rectal flora had an increased post biopsy sepsis rate following TRUSBx despite targeted antimicrobials (9.1% vs 1.1%, p = 0.003). Switching to FHTPBx reduced the risk of developing post biopsy sepsis (A vs C, 2% vs 0.4%, p = 0.03; B vs C, 2.2% vs 0.4%, p = 0.03). CONCLUSIONS: Targeted antimicrobials based on rectal swab culture failed to reduce the overall risk of post biopsy sepsis, while FHTPBx nearly eliminated this risk. We recommend the use of transperineal prostate biopsies for all patients as the most effective method to reduce the risk of sepsis.

A case report of uncommon paratesticular liposarcoma of spermatic cord presenting as a scrotal mass.

Paratesticular liposarcomas are uncommon malignancies, often misdiagnosed preoperatively, that present as a painless scrotal mass. There is no universal consensus on their management due to scarcity of reported cases. Early detection and prompt surgical intervention provide the best disease outcome. We present the case of a 74-year-old man with a painless left testicular mass. Ultrasound and CT scan showed a paratesticular tumour. He underwent left high inguinal orchidectomy. Histopathological, immunohistochemical and cytogenetics studies confirmed the diagnosis of a Grade 2 well differentiated paratesticular liposarcoma with clear surgical margins. The case was referred to our regional sarcoma centre and currently undergoes regular follow-up.

Long term follow up of ultrasound diagnosed bilateral testicular sarcoidosis: Case report and literature review.

Testicular sarcoidosis is a rare condition characterised by non-caseating granulomas located within the testicles. This case study reports a 44-year-old man who presented initially in 2011 with testicular pain and bilateral testicular sarcoidosis was confirmed on scrotal US. In 2019 he presented with erectile dysfunction. Scrotal ultrasound scan (US) showed bilateral testicular sarcoidosis that has not changed in size and nature when compared with US in 2011.

Effect of Augmented Antimicrobial Prophylaxis and Rectal Swab Culture-guided Targeted Prophylaxis on the Risk of Sepsis Following Transrectal Prostate Biopsy.

BACKGROUND: Sepsis is a severe complication following transrectal ultrasound-guided prostate biopsy (TRUSPBx). Ciprofloxacin is commonly used for prophylaxis; however, there is an increasing incidence of resistant enteric organisms worldwide. OBJECTIVE: To investigate the effect of a targeted prophylactic antimicrobial regimen based on rectal swab cultures in reducing the rate of sepsis. DESIGN, SETTING, AND PARTICIPANTS: A total of 1012 patients were included. Group A (609 patients) received an empirical prophylactic antimicrobial regimen of gentamicin, metronidazole, and ciprofloxacin. Targeted antimicrobial prophylaxis was introduced due to significant ciprofloxacin and gentamicin resistance in patients admitted with sepsis following TRUSPBx. The remaining 403 patients (Group B) had rectal swab cultures performed prior to biopsy. Patients with organisms resistant to ciprofloxacin or gentamicin received a targeted prophylaxis regimen of fosfomycin, amikacin, and metronidazole. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We retrospectively collected and analysed data on sepsis and bacteraemia for all patients as well as data on rectal swab culture, recent foreign travel, and recent antibiotic use for patients in Group B. RESULTS AND LIMITATIONS: In group A, 12 (2.0%) patients developed sepsis following TRUSPBx, while in group B, 9 (2.2%) patients developed sepsis despite targeted prophylaxis (p=0.82). Patients with ciprofloxacin-resistant rectal flora had a significantly higher rate of sepsis (9.1% vs 1.1%; p=0.003). There was a reduction in patients admitted with bacteraemia and severe sepsis between group A (1.2%) and group B (0.3%) which did not reach statistical significance (p=0.16). In group B, 55 of 403 (13.6%) patients had ciprofloxacin-resistant rectal flora, while 66 (16.4%) had organisms resistant to both ciprofloxacin and gentamicin. A recent foreign travel history was associated with an increased incidence of ciprofloxacin-resistant rectal flora (23.6% vs 10.8%; p=0.007). The main limitations of our study include its retrospective nature and potential under-reporting of less severe infectious complications. CONCLUSIONS: Rectal swab cultures identify patients with ciprofloxacin-resistant rectal flora who have an eight-fold risk of sepsis. Targeted antimicrobial prophylaxis may not be beneficial in reducing the sepsis rate when compared with augmented empirical prophylaxis. In an era of increasing antimicrobial resistance, transperineal prostate biopsies should be considered to reduce the risk of infective complications. PATIENT SUMMARY: Performing rectal swab culture prior to transrectal prostate biopsy can help identify patients at risk of developing sepsis despite targeted prophylactic antibiotics.

Vaccines for the prevention of recurrent urinary tract infections: a systematic review.

OBJECTIVES: To systematically review the evidence regarding the efficacy of vaccines or immunostimulants in reducing the recurrence rate of urinary tract infections (UTIs). MATERIALS AND METHODS: The Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), PubMed, Cochrane Library, World Health Organization (WHO) International Clinical Trials Registry Platform Search Portal, and conference abstracts were searched up to January 2018 for English-titled citations. Randomised placebo-controlled trials evaluating UTI recurrence rates in adult patients with recurrent UTIs treated with a vaccine were selected by two independent reviewers according to the Population, Interventions, Comparators, and Outcomes (PICO) criteria. Differences in recurrence rates in study populations for individual trials were calculated and pooled, and risk ratios (RRs) using random effects models were calculated. Risk of bias was assessed using the Cochrane Collaboration's tool and heterogeneity was assessed using chi-squared and I2 testing. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence (QOE) and summarise findings. RESULTS: In all, 599 records were identified, of which 10 studies were included. A total of 1537 patients were recruited and analysed, on whom data were presented. Three candidate vaccines were studied: Uro-Vaxom® (OM Pharma, Myerlin, Switzerland), Urovac® (Solco Basel Ltd, Basel, Switzerland), and ExPEC4V (GlycoVaxyn AG, Schlieren, Switzerland). At trial endpoint, the use of vaccines appeared to reduce UTI recurrence compared to placebo (RR 0.74, 95% confidence interval [CI] 0.67-0.81; low QOE). Uro-Vaxom showed the greatest reduction in UTI recurrence rate; the maximal effect was seen at 3 months compared with 6 months after initial treatment (RR 0.67, 95% CI 0.57-0.78; and RR 0.78, 95% CI 0.69-0.88, respectively; low QOE). Urovac may also reduce risk of UTI recurrence (RR 0.75, 95% CI 0.63-0.89; low QOE). ExPEC4V does not appear to reduce UTI recurrence compared to placebo at study endpoint (RR 0.82, 95% CI 0.62-1.10; low QOE). Substantial heterogeneity was observed across the included studies (chi-squared = 54.58; P < 0.001, I2  = 84%). CONCLUSIONS: While there is evidence for the efficacy of vaccines in patients with recurrent UTIs, significant heterogeneity amongst these studies renders interpretation and recommendation for routine clinical use difficult at present. Further randomised trials using consistent definitions and endpoints are needed to study the long-term efficacy and safety of vaccines for infection prevention in patients with recurrent UTIs.

Villous adenoma of the urachal remnant: A diagnostic conundrum.

Villous adenoma is a rare pathology seen in the urinary tract; it is mostly found in the large bowel. When encountered in the urinary tract, it mainly originates from intestinal segments of urinary reconstruction. Villous adenoma is commonly seen in patients more than 50 years and has a male predominance. In the urinary tract, it has been reported in the urachus, bladder dome and trigone. A few cases of villous adenoma have been described in the literature. We report a case of primary villous adenoma in the remnant of the urachus and discuss the pathophysiology, investigation and management.

Obstructive jaundice as a presenting symptom of metastatic carcinoma of the prostate.

Liver dysfunction is not an uncommon association with malignancy. However, obstructive jaundice as the first clinical presentation of metastatic carcinoma of the prostate is rare with only a few such cases reported in the literature. The aetiology of obstructive jaundice in these cases can be due to direct invasion of the tumour or external compression of the biliary tree or, rarely, related to a paraneoplastic phenomenon. Here, we report a case of obstructive jaundice being the presenting symptom of metastatic carcinoma of the prostate secondary to lymph node obstruction and review the literature.

Current issues in the management of female urinary incontinence.

Urinary incontinence can affect the quality of life of many women at all ages. When assessing a woman with urinary incontinence, it is important to establish the type and severity of problem to allow provision of the correct type of treatment. This article highlights current issues in the diagnosis and management of this condition.

5-year outcome of a prospective randomized trial to compare transurethral electrovaporization of the prostate and standard transurethral resection.

OBJECTIVES: To update our prospective randomized trial comparing the safety, efficacy, and durability of transurethral electrovaporization of the prostate (TUVP) using the VaporTrode with standard transurethral resection of the prostate (TURP). METHODS: A total of 104 patients, taken from the waiting list for surgery for benign prostatic hyperplasia were randomized to TUVP (52 patients, mean age 67.5 years) or TURP (52 patients, mean age 70.2 years). In each group, 51, 47, and 40 patients completed 1, 2, and 3 years of follow-up, respectively. Of the 104 patients, 27 TURP and 26 TUVP patients completed 5 years of follow-up. RESULTS: Both groups were comparable in terms of the mean preoperative International Prostate Symptom Score, quality-of-life score, maximal urinary flow rate, and postvoid residual volume. The follow-up data at 5 years showed a significant and maintained improvement in the mean International Prostate Symptom Score (TUVP: 5.9 +/- 6.3 versus TURP: 8.6 +/- 7.1, P = 0.16), quality-of-life score (TUVP: 1.1 +/- 1.2 versus TURP: 1.7 +/- 1.4, P = 0.09), and mean maximal urinary flow rate (TUVP: 21 +/- 9 mL/s versus TURP: 17.9 +/- 13.1 mL/s, P = 0.17), with decreases in the mean postvoid residual volume (TUVP: 27.3 +/- 44.3 mL versus TURP: 10.7 +/- 13.1 mL, P = 0.08). Two patients in each group (4%) developed urethral strictures. Two TURP patients (4%) developed bladder neck strictures compared with one TUVP patient (2%). In each arm, 7 patients (13%) underwent reoperation during a 5-year period (approximate reoperation rate: 3% in each arm per year). Postoperatively and during 3 years of follow-up, impotence was reported in 17% of the TUVP group and 11% of the TURP group (P = 0.49); retrograde ejaculation was reported in 72% of the TUVP group and 89% of the TURP group (P = 0.47). CONCLUSIONS: Our 5-year follow-up results confirm that TUVP is as effective as standard TURP in the treatment of moderate-size benign prostatic hyperplasia. The reoperation rate and long-term complication rate are comparable and the initial improvement has been maintained during a 5-year period for most patients in both groups.

La electrovaporización transuretral de la próstata es efectiva, segura y duradera / Transurethral electro-vaporisation of the prostate is effective, safe and long-lasting

La resección transuretral de la próstata todavía es la operación más popular para la HBP sintomática. Sin embargo, las complicaciones asociadas, así como el alto coste asociado con la hospitalización prolongada han espoleado el interés en desarrollar procedimientos quirúrgicos alternativos. La vaporización transuretral de la próstata (VTUP), una modificación de la tecnología transuretral, es la alternativa reciente más prometedora a la RTUP.Este artículo revisa los principios y factores que afectan a la electrovaporización (ajuste de potencia, velocidad de vaivén del electrodo, tipo de generador y configuración del electrodo) y discute cómo se ha evaluado el posible daño térmico causado durante la vaporización, los cambios histopatológicos que produce, el equipo y la técnica y revisa los estudios clínicos prospectivos sobre la VTUP, analizando el sangrado perioperatorio, la absorción de fluidos, el tiempo de sondaje, la estancia hospitalaria, los síntomas irritativos postoperatorios, su eficacia y durabilidad, y las complicaciones a largo plazo (incontinencia, estenosis de uretra y esclerosis del cuello vesical, tasa de reoperación, disfunción eréctil y eyaculación retrógrada). Esta revisión de los estudios prospectivos de cohortes y ensayos clínicos prospectivos con un seguimiento de 1-3 años, muestra que la VTUP es tan efectiva como la RTUP para el alivio de la obstrucción secundaria a la HBP con una durabilidad similar. (AU)