ABSTRACT
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
Small prostate stones are often found incidentally during clinical and radiological examination. Large stones, however, also may develop, replacing completely the prostate tissue and causing various symptoms. Such a large stones are commonly formed due to chronic urine reflux. There are 20 publications in the literature devoted to the patients with giant prostate stones. Open as well as endoscopic procedures can be performed. In our clinical case both approaches were done simultaneously. Such tactic was chosen in order to carry out a single-stage intervention, immediately solving two problems, i.e., urethral stricture and a giant prostate stone.
Subject(s)
Lithotripsy , Prostatic Diseases , Urethral Stricture , Male , Humans , Prostate , Endoscopy , Prostatic Diseases/diagnostic imaging , Prostatic Diseases/surgery , Radiography , Lithotripsy/methodsABSTRACT
OBJECTIVE: To analyze the proper time and method for treatment of prostatic abscess (PA). METHODS: This is a retrospective study that included 18 patients diagnosed with and treated for prostatic abscess between February 2017 and July 2022. After obtaining data from the patients' medical records, we analyzed their clinical features as well as the therapeutic methods opted for and their effectiveness. Resultsï¼ Of the 18 patients included, one achieved a full recovery after a spontaneous rupture of the abscess. Transrectal ultrasound (TRUS)-guided aspiration was performed in the remaining 17 patients, of whom 14 had a complete resolution after this procedure whereas 3 experienced recurrence. The recurrent cases were successfully managed with transurethral (TU) de-roofing. CONCLUSION: TRUS-guided aspiration is a treatment modality with a marked curative effect for simple PAs. For refractory abscesses (recurrent, multifocal, incomplete or unsuccessful drainage) or PA located near the urethra, TU de-roofing can be considered as a first choice to shorten the course of the disease and alleviate the medical treatment expenses due to recurrence.
Subject(s)
Abscess , Prostatic Diseases , Humans , Male , Abscess/surgery , Retrospective Studies , Drainage , Prostatic Diseases/surgery , UrethraABSTRACT
The patient was an 81-year-old man who visited a clinic for fever and lower abdominal pain. He was subsequently diagnosed with prostatitis based on computed tomography (CT) findings that showed swelling of the prostate. Despite treatment with antibacterial therapy, his symptoms did not improve significantly. Since the patient also had myelodysplastic syndrome, he was transferred to our hospital and subsequently diagnosed with prostate abscess based on findings on magnetic resonance imaging (MRI). The abscess had spread widely from the dorsal side of the trigone of the bladder to anterior wall of the rectum. Transperineal drainage was performed to preserve the urethral mucosa of the prostatic urethra. Considering the shape of the abscess cavity, one pigtail catheter was placed in the prostate and another was placed transperineally on the dorsal side of the trigone of the bladder. Cystostomy was performed at the same time. Culture of the abscess revealed the presence of Staphylococcus aureus. As there was little exudate from the abscess 9 days after drainage, the pigtail catheter on the dorsal side of the trigone of the bladder was removed following an injection of minocycline into the abscess. CT showed shrinkage of the abscess 4 days later, and the remaining intraprostatic pigtail catheter was removed after an injection of minocycline. The cystostomy pigtail catheter was subsequently removed since the patient was able to urinate smoothly after clamping. MRI confirmed the disappearance of the abscess cavity 2 months later.
Subject(s)
Abscess , Prostatic Diseases , Abscess/diagnostic imaging , Abscess/surgery , Aged, 80 and over , Drainage/methods , Humans , Male , Minocycline , Prostate , Prostatic Diseases/diagnostic imaging , Prostatic Diseases/surgeryABSTRACT
BACKGROUND: To explore whether opening the external urethral orifice in the coronal sulcus can reduce the incidence of epididymitis after operating on hypospadias with prostatic utricle cyst (PUC) connecting to the vas deferens. Group A consisted of 3 patients with severe hypospadias and PUC undergoing cystostomy, hypospadias correction and urethroplasty, along with the relocation of the external orifice of the urethra to the coronal sulcus. Group B consisted of 4 patients having initial hypospadias repaired with meatus in the orthotopic position in the glans, presenting with multiple epididymitis after hypospadias surgery and unsuccessful conservative treatment. MR confirmed that all the Group B patients had PUC connecting to the vas deferens. Group B patients underwent urethral dilatation along with urethral catheterization, cutting of the original corpus cavernosum that encapsulated the urethra, and extension of the position of the external urethral orifice to the coronal sulcus. RESULTS: In group A, 3 children underwent bladder fistula removal 2 weeks after the operation. The penis developed normally without any complications. Four children in group B underwent stent removal 12 weeks after operation, and one patient was still stenosed and dilated again. All patients in group B were followed without epididymitis recurrence. CONCLUSIONS: For patients with hypospadias complicating with a PUC, connecting to one side of the vas deferens, the positioning of the external urethral orifice in the coronary sulcus would be helpful to reduce the occurrence of epididymitis.
Subject(s)
Cysts/surgery , Hypospadias/surgery , Plastic Surgery Procedures/methods , Prostatic Diseases/surgery , Urologic Surgical Procedures, Male/methods , Catheterization , Child, Preschool , Cystostomy , Cysts/complications , Cysts/diagnostic imaging , Dilatation , Epididymitis/etiology , Epididymitis/prevention & control , Humans , Hypospadias/complications , Hypospadias/diagnostic imaging , Male , Postoperative Complications , Prostatic Diseases/complications , Prostatic Diseases/diagnostic imaging , Plastic Surgery Procedures/adverse effects , Stents , Urologic Surgical Procedures, Male/adverse effectsABSTRACT
A 70-year-old man visited his doctor because of hip pain and gross hematuria. Digital rectal examination and computed tomography revealed a prostatic abscess. Although antibiotics were prescribed, his symptoms did not improve; he was transferred to our hospital, where transurethral fenestration of the prostatic abscess was performed. During prostatic fenestration, a papillary mucous membrane was confirmed inside the cavity of the prostatic abscess. Pathological examination revealed a mucinous adenocarcinoma of the prostate. Although hormonal therapy was administered, magnetic resonance imaging revealed tumor extension necessitating robot-assisted radical prostatectomy. Mucinous adenocarcinoma of the prostate is rare, and to our knowledge this is the first report of mucinous adenocarcinoma of the prostate diagnosed after transurethral treatment of a prostatic abscess.
Subject(s)
Adenocarcinoma, Mucinous , Prostatic Diseases , Prostatic Neoplasms , Abscess/diagnostic imaging , Abscess/etiology , Abscess/surgery , Adenocarcinoma, Mucinous/surgery , Aged , Humans , Male , Prostatic Diseases/diagnostic imaging , Prostatic Diseases/surgery , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/surgeryABSTRACT
OBJECTIVE: To demonstrate technique of salvage thylium fiber laser enucleation of prostate in men with history of prior prostatic urethral lift (PUL) implant. PUL is an accepted treatment modality for benign prostatic hyperplasia (BPH) and is currently recommended for surgical management of prostates <80 g in size.1 However, in reality some patients with prostate >80 g also receive PUL.2 A substantial number of these patients may requirement re-treatment for recurrent or persistent lower urinary tract symptoms after PUL.3-5 Patients with larger prostates who fail PUL might be better managed with endoscopic enucleation which is a size-independent modality for treatment of BPH.1,6 Endoscopic enucleation can be accomplished via a variety of energy sources. Thulium fiber laser is a new addition to urologist armamentarium for endoscopic enucleation of prostate. We hereby present a video demonstrating salvage thulium fiber laser enucleation of 198 cc prostate in a men with history of prior PUL. METHODS: A 66-year-old male presented with a history of recurrent urine retention after prior PUL done 2 years prior at an outside institution. Pre-operative international prostate symptom score was 13, maximum uroflow rate was 6.1 ml/sec, residual urine was 26 ml despite maximal medical management. MRI demonstrated a 198 g prostate and PSA was 13.4 ng/dl with negative prostate biopsy. After a detailed discussion of options, he elected endoscopic enucleation. We employed a 550-micron Soltive superpulsed laser fiber set at 2 J and 30 Hz to perform en-bloc enucleation of prostate, and morcellation was performed with the VersaCut Morcellator. We edited the video to demonstrate the technical nuances of this procedure. RESULTS: Surgery was uneventful with enucleation time of 70 minutes and morcellation time of 142 minutes. Implants encountered during enucleation were easily separated with the thulium fiber laser. No attempt was made to remove implants segments extending beyond the plane of enucleation. Morcellation was challenging, with evidence of damage to morcellation probes requiring replacement of 3 morcellator probes. The patient was discharged on post-operative day one after successful voiding trial. At six-week follow up, his international prostate symptom score of 3 with maximum urinary flow rate of 50 mL/sec. He reported no urinary incontinence and his pathology demonstrated BPH. CONCLUSION: This video demonstrates the feasibility of thulium fiber laser enucleation of prostate after PUL, however the findings need to be reproduced in cohort studies. It also demonstrates difficulties encountered during morcellation. For smaller prostates, vaporization may be preferable, thereby avoiding difficulties associated with morcellation.
Subject(s)
Laser Therapy/methods , Postoperative Complications/surgery , Prostatectomy/methods , Prostatic Diseases/surgery , Prostatic Hyperplasia/surgery , Thulium/therapeutic use , Urethra/surgery , Humans , Male , Prostate , Urologic Surgical Procedures, Male/methodsABSTRACT
OBJECTIVE: To describe the surgical treatment and outcome of a large cohort of dogs with sterile prostatic cysts (PCs). STUDY DESIGN: Retrospective study. ANIMALS: Forty-four client-owned dogs. METHODS: Dogs with sterile PCs with at least 6 months of follow-up were included. Clinical variables, type of surgery, complications, recurrences, and outcomes (telephonic interviews or rechecks) were recorded. RESULTS: Extra- and intraparenchymal cysts were diagnosed in 29 and 11 dogs, respectively. Four dogs had both types. Extraparenchymal cysts were treated by partial resection and omentalization (n = 22) and complete resection (n = 7). Drainage and intracapsular omentalization were performed in all dogs with intraparenchymal cysts. The four dogs with both types of cyst were treated by omentalization. Resolution was documented in 39/44 dogs (88.6%). Intraoperative complications occurred in one dog (urethral tear). Major complications resulting in death occurred in three dogs (oliguric kidney injury, cardiac arrhythmia, and persisting urinary tract obstruction). Minor complications (n = 10) consisted of temporary urinary incontinence (n = 2), permanent urinary incontinence (n = 5), urinary retention (n = 2), and dysuria (n = 1). Recurrence occurred in two dogs with extraparenchymal cysts. Median long-term follow-up was 528 days (range, 250-730 days). Thirty-nine dogs had no signs associated with prostatic disease at long-term follow-up. CONCLUSION: Partial or complete resection and/or omentalization of sterile PCs led to resolution of clinical signs in most dogs, although postoperative urinary incontinence was frequent. IMPACT: This study is the largest case series relative to canine sterile PCs treated surgically and provides evidence on the prognosis and rate of complications.
Subject(s)
Cysts/veterinary , Dog Diseases/surgery , Prostatic Diseases/veterinary , Animals , Cysts/surgery , Dogs , Male , Neoplasm Recurrence, Local/veterinary , Postoperative Complications/veterinary , Prognosis , Prostatic Diseases/surgery , Prostatic Neoplasms/surgery , Prostatic Neoplasms/veterinary , Retrospective Studies , Treatment Outcome , Urethral Diseases/veterinary , Urinary Incontinence/veterinaryABSTRACT
Prostate abscess (PA) is an uncommon prostatic infection, with risk factors including indwelling catheters, acute or chronic prostatitis, bladder outlet obstruction, voiding dysfunction, recent urologic instrumentation (especially transrectal prostate biopsy), chronic kidney disease (CKD), diabetes mellitus (DM), human immunodeficiency virus (HIV), intravenous drug use (IVDU), and hepatitis C. Treatment of PA consists of antibiotics and abscess drainage via transurethral resection (TUR) or image-guided transrectal or transperineal drainage. Numerous studies have demonstrated that TUR of PA has a higher success rate and shorter hospital length of stay when compared to image-guided drainage. Despite this, TUR of PA is a relatively uncommon surgery with few useful recommendations on how to best perform this procedure. We demonstrate the TUR surgical technique for drainage of a 6 cm loculated PA in a 44-year-old man with active IVDU and hepatitis C. The patient presented with progressive voiding symptoms, urinary retention, and leukocytosis. Given the size, loculated nature of the abscess, and its proximity to the prostatic urethra, we decided to proceed to the operating room for surgical drainage as opposed to image-guided transrectal drainage. Herein we describe the trans urethral technique. He clinically improved postoperatively and repeat imaging 4 days later showed decreased abscess size. Transurethral drainage of a PA is a safe, efficient, and effective treatment option. Treatment approach should depend on abscess size, location, and presence of loculations. Combining different endourologic techniques and instruments may be necessary.
Subject(s)
Abscess/surgery , Prostatic Diseases/surgery , Adult , Humans , Male , Urethra , Urologic Surgical Procedures, Male/methodsABSTRACT
OBJECTIVES: Demonstrate the treatment of prostatic abscess with a minimally invasive method - abscess puncture with aspiration of purulent fluid and injection of an antibiotic into abscess cavity. MATERIALS AND METHODS: Diagnosis of prostatic abscess of 23 patients using ultrasonography, computed tomography and magnetic resonance imaging of the pelvic region. 19 patients with the abscess within the prostatic capsule were treated with perineal percutaneous puncture method with aspiration of the abscess fluid and injection of antibiotics into cavity. For 4 patients with prostatic abscess and purulent paraprostatitis we performed incision and drainage of purulent cavity with open transperineal access. RESULTS: Single abscess puncture was enough to normalize health status of 15 patients. In 4 cases additional puncture was required in 4-5 days after the first manipulation. All the patients recovered and were discharged from the clinic in 7-8 days. Patients after abscess incision and drainage stayed in hospital for 10-14 days. In 1-3 months after the surgery, imaging methods revealed a high-density lesion in prostate whatever the method was used. DISCUSSION: Treatment response was controlled by imaging methods. 2 days after puncture 4 patients had a lesion with liquid content larger than 50% of the initial purulent lesion size. Repeated puncture was performed in this patients. CONCLUSION: Abscess puncture with aspiration of fluid is an effective method of treatment when prostatic abscess is within the capsule. In cases of purulent paraprostetitis incision and drainage of an abscess cavity is needed.
Subject(s)
Abscess , Prostatic Diseases , Abscess/diagnostic imaging , Abscess/surgery , Drainage , Humans , Male , Prostatic Diseases/diagnostic imaging , Prostatic Diseases/surgery , UltrasonographySubject(s)
Cysts , Prostatic Diseases , Child , Cysts/diagnostic imaging , Cysts/surgery , Humans , Male , Prostatic Diseases/surgery , Saccule and Utricle , UrethraABSTRACT
OBJECTIVES: To report our single-center experience of the management of children with prostatic utricle cysts. METHODS: We retrospectively analyzed 15 children who were incidentally found to have a prostatic utricle cyst and were admitted to our department between October 2013 and August 2020. Clinical characteristics and management were collected and catalogued. RESULTS: Recurrent genitourinary tract infections were the most frequent complaint, and two-thirds of patients also had hypospadias. A connection between the posterior urethra and the prostatic utricle cyst was found in all cases. Two patients directly had their progressively enlarging prostatic utricle cyst resected laparoscopically. Endoscopic techniques were used in 13 patients, two of whom underwent laparoscopic excision for repeated symptoms. The mean (range) follow-up period was 34.9 (2-82) months. No recurrences were observed in four patients who underwent prostatic utricle cyst excision and eight patients who received endoscopic treatment. Three patients had recurrent symptoms after endoscopic treatment and were managed by nonsurgical treatment. CONCLUSIONS: Prostatic utricle cyst is a rare disease which can cause recurrent genitourinary tract infections. Extra attention should be paid to evaluation for prostatic utricle cyst in children with external genital anomalies. Retrograde urethrogram and magnetic resonance imaging are useful tools with which to distinguish prostatic utricle cyst from other cystic lesions that are located in the midline pelvis in male patients. Individualized treatment is appropriate when considering fertility preservation, recurrences and malignancy. Laparoscopic excision is feasible for symptomatic and large prostatic utricle cyst. Regular long-term monitoring is recommended for all patients with prostatic utricle cyst.
Subject(s)
Cysts , Prostatic Diseases , Child , Cysts/diagnostic imaging , Cysts/surgery , Humans , Male , Neoplasm Recurrence, Local , Prostatic Diseases/surgery , Retrospective Studies , Saccule and Utricle , UrethraABSTRACT
LuTectomy is an open-label phase 1/2 nonrandomised clinical trial evaluating the dosimetry, efficacy, and toxicity of the lutetium-177-radiolabelled small molecule PSMA-617 in men with high-risk localised/locoregional advanced prostate cancer with high prostate-specific membrane antigen expression who are undergoing radical prostatectomy and pelvic lymph node dissection.
Subject(s)
Prostatectomy , Prostatic Diseases/surgery , Dipeptides , Heterocyclic Compounds, 1-Ring , Humans , Male , Prostate-Specific AntigenABSTRACT
PURPOSE OF REVIEW: To evaluate emerging evidence and practical applications of thulium-fiber laser (TFL) for genitourinary soft tissue disease and urinary stone disease treatment. RECENT FINDINGS: A systematic review was developed using the PubMed, ScienceDirect, Wiley, SpringerLink and Mary Ann Liebert Scopus databases between 2012 and 2020 years, using the PRISMA statement. We analyzed recent publications including in vitro and in humans outcomes of surgery using TFL. This new laser technology can be used in soft tissue diseases and stones present in the genitourinary system. Most of the comparisons are made with the Ho:YAG laser, using completely different settings. Nevertheless, TFL is safe, feasible and effective in the management of urologic diseases, showing superiority to Ho:YAG even in some studies. SUMMARY: The introduction of pulsed TFL technology has enabled the ablation of stones at rates comparable to or better than currently existing lasers in vitro, while also potentially reducing stone retropulsion. TFL is effective in treating genitourinary soft tissue diseases, including benign prostatic hyperplasia, and early data indicate that it may be effective in the treatment of urinary stone disease. More clinical studies are needed to better understand the indications for this novel technology and clarify its position in the urologic endoscopy armamentarium.
Subject(s)
Lasers, Solid-State , Lithotripsy, Laser , Prostatic Diseases/surgery , Soft Tissue Neoplasms/surgery , Urolithiasis/surgery , Urologic Neoplasms/surgery , Carcinoma, Renal Cell/surgery , Endoscopy , Humans , Lasers, Solid-State/therapeutic use , Male , Thulium/therapeutic useABSTRACT
INTRODUCTION: Calculi encountered in the lower urinary tract typically reside within the bladder, less often in the urethra. In this video, we present a minimally invasive endoscopic approach for removal of the largest total stone volume in the lower urinary tract reported in the literature to date. METHODS: A 25-year-old male (body mass index 61 kg/m2) with neurogenic bladder presented with urosepsis and acute kidney injury secondary to obstructive uropathy. Computerized tomography (CT) of the abdomen and pelvis demonstrated bilateral severe hydroureteronephrosis, a 4.2-cm bladder stone, and 3 urethral stones, including a 7.7-cm prostatic urethral stone and 2 membranous urethral stones (Fig. 1). Urgent bilateral percutaneous nephrostomy tubes were placed. The patient elected for endoscopic management. RESULTS: The patient was placed in the supine lithotomy position. His buried penis and narrow urethra only accommodated a 16-French flexible cystoscope. Multiple stones were encountered in the membranous urethra. A 60-W SuperPulse Thulium Fiber laser at 2 J and 30 Hz was utilized to dust the urethral stones efficiently. Simultaneous ultrasound-guided percutaneous access into the bladder was obtained and ultrasonic lithotripsy via shockpulse was used to clear the bladder stone and prostatic stone from above. Total stone treatment time was 240 minutes. Suprapubic and urethral catheters were placed at the conclusion. Postoperative day 1 CT scan confirmed stone-free status and he was discharged postoperative day 2. Outpatient nephrostogram demonstrated patency of bilateral ureters and nephrostomy tubes were removed. CONCLUSION: Higher morbidity procedures including open or laparoscopic approaches have been described for management of large lower urinary tract stones. In this video, we demonstrate a minimally invasive approach of combined simultaneous antegrade and retrograde lithotripsy to achieve a stone-free status in this morbidly obese and complicated patient.
Subject(s)
Calculi/surgery , Cystoscopy/methods , Prostatic Diseases/surgery , Urethral Diseases/surgery , Urinary Bladder Calculi/surgery , Urinary Calculi/surgery , Adult , Calculi/pathology , Humans , Male , Prostatic Diseases/pathology , Urethral Diseases/pathology , Urinary Bladder Calculi/pathology , Urinary Calculi/pathologyABSTRACT
Background/aim: This study aimed to examine serum paraoxonase 1 and 3 (PON1 and PON3) activities in benign and malignant diseases of the prostate, to determine lipid profile and malondialdehyde (MDA) levels, and to investigate changes in levels following robotic-assisted laparoscopic radical prostatectomy (RALRP). Materials and methods: A total of 137 patients, including a control group, were enrolled in the study and assigned into four groups. Group 1 (n = 33) consisted of patients previously undergoing RALRP with no recurrence, group 2 (n = 36) consisted of patients diagnosed with prostate cancer (PCa) and undergoing RALRP, and group 3 (n = 34) consisted of patients diagnosed with benign prostatic hyperplasia. The control group (n = 34) consisted of healthy individuals. Serum low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, cholesterol, prostate-specific antigen (PSA), PON1, PON3, and MDA values were measured. In addition, group 2 MDA, PON1, PON3, and PON1/HDL levels were investigated preoperatively and at the first month postoperatively. Results: Significant changes were found in PON1, PON3, and MDA levels. PON1 and PON3 levels decreased significantly in patients with PCa, while MDA levels increased. PON1 and PON3 increased postoperatively in the PCa group, while MDA decreased. BPH group PON1, PON3, and MDA levels were higher than those of the control group. Conclusion: An increase in free oxygen radicals in the body or a decrease in endogenous antioxidant enzyme levels can result in malignant and benign diseases of the prostate. Surgical excision of malignant tissue in PCa causes a decrease in oxidative stress.
Subject(s)
Aryldialkylphosphatase/blood , Laparoscopy/methods , Prostatectomy/methods , Prostatic Diseases/blood , Prostatic Diseases/surgery , Robotic Surgical Procedures/methods , Aged , Aryldialkylphosphatase/genetics , Humans , Male , Malondialdehyde/blood , Middle Aged , Prostate/surgery , Prostatic Diseases/geneticsABSTRACT
Parallel to establishment of diagnostic surveillance protocols for detection of prostatic diseases, novel treatment strategies should be developed. The aim of the present study is to evaluate the feasibility and possible side effects of transrectal, MRI-targeted intraprostatic steam application in dogs as an established large animal translational model for prostatic diseases in humans. Twelve healthy experimental, intact, male beagle dogs without evidence of prostatic pathology were recruited. An initial MRI examination was performed, and MRI-targeted steam was applied intraprostatically immediately thereafter. Serum levels of C-reactive protein (CRP), clinical and ultrasonographic examinations were performed periodically following the procedure to assess treatment effect. Four weeks after treatment, all dogs underwent follow-up MRI examinations and three needle-core biopsies were obtained from each prostatic lobe. Descriptive statistics were performed. MRI-guided intraprostatic steam application was successfully performed in the study population. The first day after steam application, 7/12 dogs had minimal signs of discomfort (grade 1/24 evaluated with the short-form Glasgow Composite Measure Pain Scale) and no dogs showed any sign of discomfort by day 6. CRP elevations were detected in 9/12 dogs during the first week post steam application. Mild to moderate T2 hyperintense intraparenchymal lesions were identified during follow-up MRI in 11/12 dogs four weeks post procedure. Ten of these lesions enhanced mild to moderately after contrast administration. Coagulative necrosis or associated chronic inflammatory response was detected in 80.6% (58/72) of the samples obtained. MRI-targeted intraprostatic steam application is a feasible technique and displays minimal side effects in healthy dogs as translational model for human prostatic diseases. This opens the possibility of minimally invasive novel treatment strategies for intraprostatic lesions.
Subject(s)
Ablation Techniques/methods , Magnetic Resonance Imaging/methods , Prostate/surgery , Prostatic Diseases/surgery , Animals , Dogs , Feasibility Studies , Male , Prostate/diagnostic imaging , Prostatic Diseases/diagnostic imaging , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/surgery , Steam/analysisABSTRACT
A 51-year-old diabetic man diagnosed with prostatic abscess underwent its drainage twice. Following surgery he developed fever and right-sided painless visual loss due to endophthalmitis. To rule out its endogenous source CT scan was done which showed multisystem aetiology and complications. His pelvic CT and CT cystogram revealed postsurgical urethral injury along with urinary extravasation, perineal and pelvic soft tissues air densities with fat stranding ascribed to Fournier gangrene, air in distended urinary bladder due to emphysematous cystitis and right common iliac vein air containing septic thrombus. CT chest spotted bilateral multiple septic pulmonary emboli. These radiological findings were promptly handled by uro-surgical team followed by alliance with other relevant departments. With hasty surgical drainage/debridement, urological restoration of urinary obstruction, aggressive broad spectrum antibiotics, anticoagulation and radiological follow-ups the patient withstood multisystem lethal complications and come up with excellent outcome except evisceration.
Subject(s)
Abscess/surgery , Fournier Gangrene/diagnostic imaging , Prostatic Diseases/surgery , Pulmonary Embolism/diagnostic imaging , Sepsis/diagnostic imaging , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , Debridement , Diabetes Complications/diagnostic imaging , Diabetes Complications/therapy , Drainage/adverse effects , Fournier Gangrene/etiology , Fournier Gangrene/therapy , Humans , Male , Middle Aged , Pulmonary Embolism/complications , Pulmonary Embolism/therapy , Sepsis/complications , Sepsis/therapy , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
OBJETIVO: El objetivo de este trabajo ha sido evaluar la adecuación de la profilaxis antibiótica y su relación con la incidencia de infección de sitio quirúrgico (ISQ) en pacientes sometidos a cirugía de próstata. MATERIAL Y MÉTODOS: Estudio de cohortes prospectivo, realizado de enero de 2009 a septiembre de 2016. Se evaluó la adecuación global al protocolo de profilaxis antibiótica y de cada apartado de la profilaxis (inicio, vía de administración, antibiótico de elección, duración y dosis). Se describieron los porcentajes de adecuación. Se calculó la incidencia de infección tras un periodo máximo de 30 días de incubación. Se evaluó la adecuación entre adecuación de la profilaxis e ISQ mediante el riesgo relativo (RR). RESULTADOS: Se incluyeron 595 pacientes en el estudio. La adecuación global fue del 93,8%. La mayor causa de incumplimiento fue el inicio de la profilaxis con un 3,0%. La incidencia de infección de sitio quirúrgico fue del 1,0%. No se encontró relación entre la inadecuación de la profilaxis antibiótica y la infección de sitio quirúrgico (RR = 1,01; IC95%: 1,00-1,02). No se encontró relación en el riesgo de infección entre la cirugía laparoscópica y la cirugía abierta (RR = 0,37; IC95%: 0,08-1,98). CONCLUSIONES: La adecuación de la profilaxis antibiótica fue alta. La incidencia de infección de sitio quirúrgico fue baja y la adecuada cumplimentación de la profilaxis antibiótica en la cirugía de próstata permite reducir la incidencia de infección de sitio quirúrgico
OBJECTIVES: To assess the adherence to the antibiotic prophylaxis protocol in patients undergoing prostate surgery and evaluate the effect of antibiotic prophylaxis on surgical site infections (SSI). MATERIAL AND METHODS: A prospective cohort study was carried out between January 2009 and September 2016. The global compliance with the antibiotic prophylaxis protocol was evaluated studying the items: time of onset, route of administration, antibiotic prescribed, duration and dose. Percentages of adequacy are described. The incidence of infection was calculated after 30 days of follow-up. Relationship between the adequacy to the protocol and the surgical site infection are described with the relative risk. RESULTS: A total of 595 patients were studied. The global adequacy was 93.8%. The leading cause of inadequacy was the time of onset 3%. The incidence of surgical site infection was 1%. No relationship between the inadequacy of antibiotic prophylaxis and surgical site infection (RR = 1.1%; 95%CI: 1.0-1.2) was found. No relationship between the procedure (laparoscopic or open surgery) and surgical site infection (RR = 0.4%; 95%CI: 0.1-1.9) was found. CONCLUSIONS: The adequacy of antibiotic prophylaxis was high. The incidence of surgical site infection was low and compliance of antibiotic prophylaxis contributes to diminish surgical site infection incidence
Subject(s)
Humans , Male , Middle Aged , Aged , Surgical Wound Infection/prevention & control , Prostatic Diseases/surgery , Prostatectomy/methods , Antibiotic Prophylaxis , Gentamicins/administration & dosage , Cefazolin/administration & dosage , Prospective Studies , Cohort Studies , Clinical Protocols , Prostatectomy/adverse effects , Risk Factors , Prostatectomy , IncidenceABSTRACT
Periprostatic abscess is a rare complication of hydrogel spacers in radiotherapy for prostate cancer. We present the case of a 61-year-old man who developed this condition. Abdominopelvis CT scan revealed a 54×35×75 mm collection in the location of the SpaceOAR, for which ultrasound-guided transperineal percutaneous drainage of the periprostatic abscess was performed. The patient remains well with serial CT scans showing near resolution of the collection.