Advanced prostate cancer presenting as a huge abscess

Prostatic abscess is a rare urological disease. It is not easily diagnosed based on the history, physical examination, laboratory data, and imaging studies. Patients with prostatic abscess and those with prostate cancer can have similar presenting signs and symptoms, such as lymphadenopathy and abnormal prostate-specific antigen values. A 67-year-old man without any underlying diseases presented with acute prostatitis. Transrectal ultrasonography was performed 14 days after initiation of antibiotic therapy revealed a fluid-containing irregular mass. Doppler ultrasonography showed high vascularity around the margin of the mass. Advanced prostate cancer with necrosis was found in tissue from transurethral resection of the prostate (TURP). His symptoms improved a lot after TURP and he accepted androgen deprivation therapy in the outpatient clinic. Although ultrasound-guided needle aspiration remains the mainstream treatment for prostatic abscess, TURP should be considered in patients with complicated prostate abscess or suspected prostatic carcinoma.     

Staphylococcus aureus prostatic abscess and subdural empyema: a case report

Introduction and objectivesTo report one case of prostatic abscess and subdural empyema by Staphylococcus aureusMethodsWe describe the case of a 51 year old male patient who was diagnosed of prostatic abscess and subdural empyema by Staphilococcus aureus. We use clinical presentation and physical exploration based on rectal digital examination, as diagnostic approach method. And computerized axial tomography and transrectal ultrasonography, which allows the guided needle drainage of the abscess, as diagnostic confirmation methodsResultsThe clinical picture resolved with the transrectal ultrasonography guided needle aspiration of the abscess and conservative treatment with antibiotics and urinary diversionConclusionsProstatic abscess is an uncommon entity nowadays. Provided the great variety of symptoms, a great degree of clinical suspicion is needed for the diagnosis, and once it is got it, immediate aggressive treatment must be initiated. Transrectal ultrasonography allows not only the diagnosis, but also the drainage of the abscess. The culture of the obtained material identifies the etiological agent and the most specific antibiotic therapy     

前列腺脓肿外科处理的系统评价

目的：系统评价近10年前列腺脓肿诊治,为临床提供参考。方法：检索PubMed2000．0l～2011．04前列腺脓肿诊治文献,纳入合格文献,系统评价其外科处理。结果：病例数≥5例16个研究纳入行定量荟萃分析,均为回顾性病例分析,研究质量低。总计311例（5～77）患者,年龄分布10天～83岁,发病低龄化。病原体包括真菌、细菌两类,后者以G＋球菌（葡萄球菌属）为主,次为p杆菌（克雷伯菌属）,少见病原体亦有发病．地区差异明显。易感因素概括为局部与全身因素两类,分别以糖尿病、肝硬化与下尿路操作、尿路感染最常见。诊断涉及症状评估、体格检查、病原体鉴定、影像学检查（TRUS、骨盆CT、MRI）等。治疗包括一般处理、抗生素疗法与外科引流。手术径路有经皮经会阴、经直肠与经尿道。经会阴／经直肠行EUS、TRUS或c’F引导下细针穿刺抽吸、留置导管引流或切开引流;经尿道行TUR、TURP或TuIP引流;穿刺抽吸失败转为经尿道或经会阴切开引流;部分病例行尿流改道。无对比研究而未能比较何种术式更优。除死于严重并发症外,均结局良好。结论：应基于临床评估,结合TRUS／盆腔CT与实验室检查确诊前列腺脓肿。抗生素使用宦有病原学依据。视具体情况个体化处理：保守治疗;EUS、TRUS或CT引导下穿刺抽吸、留置导管引流;经尿道微创引流;若脓肿穿破前列腺包膜或肛提肌宜经会阴切开引流。外科引流以“准确、彻底、无残留”为原则。术后应密切随访。     

前列腺脓肿2例报告及近10年国内文献复习

目的:结合2例前列腺脓肿病例及文献复习,评估我国前列腺脓肿的新特点。方法:报告2例前列腺脓肿病例,以前列腺脓肿作为关键词或篇名检索中国期刊全文数据库及万方数据数字化期刊全文数据库1997～2006年的资料,进行荟萃分析。结果:2病例既往均无糖尿病史但均有血糖升高,1例发病前曾行下尿路器械检查。2例均表现为显著排便困难,会阴疼痛伴有高热,外周血白细胞均不高,尿常规检查无感染表现。病例1通过MRI确诊,脓肿破溃至尿道经用抗生素痊愈;病例2通过经直肠B超及CT确诊,经直肠B超穿刺引流后治愈。荟萃分析结果表明,糖尿病、留置尿管或尿道器械操作是前列腺脓肿的主要致病因素,致病菌主要是金黄色葡萄球菌和大肠埃希菌,临床表现主要是膀胱刺激症状、排尿困难及会阴疼痛,多数患者经B超确诊,需行穿刺引流或开放手术引流。结论:现阶段前列腺脓肿表现不典型、可疑病例应及时行经直肠B超或CT检查确诊,B超引导下脓肿穿刺引流简便有效。     

Liver abscess: a clinicopathological analysis of 82 cases

Liver abscesses are a common pathology in India, but a strategy for effective treatment has not been established. Eighty-two patients with liver abscess were studied over a 4-year period. Clinical features, ultrasound findings, laboratory studies, and outcome of therapy were evaluated. Treatment options were antibiotics alone, needle aspiration, catheter drainage, or open surgical drainage; 51.2% of all abscesses were amebic, 23.2% were pyogenic, and 25.6% had unknown causes. A total of 75.6% of the abscesses were solitary, with 62.2% confined to the right lobe. Pyogenic abscesses were more likely to have anemia, leukocytosis, and deranged liver function. Amebic abscesses tended to have a larger volume. Patients undergoing catheter drainage showed a more rapid reduction in initial abscess volume, whereas resolution of the abscess cavity took longer with antibiotic therapy alone. Ultrasound-guided needle aspiration and catheter drainage are safe and effective in the management of liver abscess. Drug therapy alone may be useful only in select cases.     

Primary melioidotic prostatic abscess: presentation,diagnosis and management

Introduction: In South‐East Asia and Northern Australia, melioidosis (infection with Burkholderia pseudomallei) is a known cause of severe community‐acquired sepsis. However, melioidosis presenting primarily as prostatic abscesses is very rare. Methods: The presenting features, investigations and management outcome of five patients who developed melioidotic prostatic abscesses from 1997 to 2000 were reviewed in the present study. Results: The mean age at presentation was 53 years (range: 29?69). Old age and diabetes mellitus were predisposing factors. All patients had a fever of at least 38.5°C and presented with obstructive urinary symptoms culminating in urinary retention. Presence of prostatic abscess was demonstrated by transrectal ultrasound in all cases. The abscesses were drained with transurethral resection of the prostate. One patient required re‐resection while another patient developed severe septic shock requiring intensive care and ­inotropic support. There was no mortality in our series. Conclusions: Elderly diabetic men presenting with fever and urinary tract obstruction in endemic areas may harbour an unusual but potentially life threatening melioidotic prostatic abscess. Transrectal ultrasound and bacteriological confirmation are mandatory. Prompt surgical drainage coupled with appropriate antibiotics are keys to a favourable outcome.     

Ultrasound versus digitally directed prostatic needle biopsy

During an 8-month period 55 patients with suspected but unproved prostatic carcinoma were entered randomly into a study designed to evaluate the effectiveness of ultrasound-directed transperineal needle biopsy of the prostate. Each patient was biopsied with and without ultrasound assistance; the method used first was determined randomly. Of the 15 patients diagnosed as having adenocarcinoma only 9 were proved by conventional transperineal biopsy, whereas ultrasound-guided biopsy was accurate in all 15 patients (p less than 0.005). Transrectal ultrasound guidance significantly improves the yield of transperineal needle biopsy when it is performed for suspected malignancy.     

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.     

原位肝移植术后肝脓肿的原因和处理

目的：探讨原位肝移植术(OLT)后肝脓肿的病因及治疗选择。 方法：分析4年间行OLT 558 例术后1~18 个月发生肝脓肿10 例(1.8％)的原因。结果：7 例为术后胆道并发症,2 例为肝癌复发灶射频消融术（RFA）后,1 例为不明原因感染。主要临床表现有发热、肝功能损害、低蛋白血症和贫血等。诊断主要根据临床表现及超声或CT 检查。治疗方法主要包括脓肿抽吸引流、PTCD胆道内外引流、抗感染和支持治疗及再次肝移植。 10 例中6 例通过肝脏穿刺引流治愈,2 例通过再次肝移植治愈,2 例死于脓毒血症;治愈率为80.0％。结论：OLT 后发生肝脓肿地原因复杂,可能与胆管吻合口狭窄或梗阻、胆道缺血坏死、肝癌复发灶介入治疗、肝动脉血栓或狭窄和激素冲击治疗等有关。OLT 后肝脓肿的预后较差,早期诊断和治疗是关键。     

Prostatic abscess due to Candida with no systemic manifestations

Prostatic abscess due to fungi is a rare condition. It is generally secondary to systemic disease in immunosuppressed patients. It usually occurs with affection of other organs in a septic patient. Only in exceptional cases does it occur isolatedly. We present the case of a prostatic abscess due to Candida albicans with no systemic manifestations. The diagnosis is helped by transrectal ultrasound, which allows to differentiate this condition from nonabscessed acute prostatitis. The treatment of choice is ultrasound-guided transrectal needle aspiration after antibiotic therapy has been started. As with abscesses of bacterial origin, an ultrasonographic follow-up is required due to the possibility of persistence or recurrence.     

Diagnostic and treatment of prostatic cancer (author's transl)]

The diagnosis of prostatic cancer must be proved by biopsy. Transrectal fine needle biopsy and punch biopsy are also useful methods for the outpatient clinic. Besides X-ray examination scanning angiography and lymphography may be used to identify metastases. Combined antiandrogenic therapy is still the treatment of choice and is based on endocrinologic analysis of testosterone, LH levels and testosterone-binding beta-globulin. Radionuclids (32P, 89Sr) should be used for treating metastases of the bone. Chemotherapeutic substances showed unsatisfactory results. Radical prostatectomy can only be performed in 5 to 10% of all patients with prostatic cancer to metastases in T1 and T2 cases. Since 1965 the radiation therapy (linear accelerator or (60Co-source) gives more hope. We treat patients free from metastases with a 60Co-source (right and left lateral 120-degree arc rotational therapy with 5000 rads over 5 weeks) combined with hormonal therapy. The therapeutic effect is checked by fine needle aspiration biopsy.     

Aspiration of breast abscess under ultrasound guidance: outcome obtained and factors affecting success

OBJECTIVE: To assess ultrasonographically (US) guided needle aspiration of breast abscesses as an alternative to surgical incision and drainage. METHODS: In our prospective study, 30 patients with 31 breast abscesses (one patient had bilateral breast abscess) underwent percutaneous breast abscess drainage under US guidance with local anaesthesia and oral antibiotics between 1 January 2004 and 31 March 2005. These patients consisted of 16 (53.3%) non-lactating and 14 (46.7%) lactating women, with ages ranging from 18 to 68 years (median, 28 years). The racial distribution comprised 26 (86.7%) Malays, three (10%) Chinese and one (3.3%) Indian. All patients had the chief complaint of breast swelling and 25 (83.3%) had breast pain. Clinically, 28 (93.3%) were found to have a palpable mass. Nine (30%) lesions were in the upper outer quadrant of the left breast. US diameters ranged from 1 to 15 cm (median, 4 cm). The pus volumes varied from 1 to 200 mL (median, 14 mL). RESULTS: Fifteen (50%) patients required only a single aspiration, 10 required multiple aspirations and five required incision and drainage. Those patients in whom needle aspiration failed had multiloculated lesions irrespective of abscess volume and size. CONCLUSION: Needle aspiration with ultrasound guidance is an effective treatment for breast abscess irrespective of abscess volume and size.     

Transrectal ultrasonography in the diagnosis and staging of carcinoma of the prostate

Transrectal prostatic ultrasonography is a potentially valuable means to evaluate the prostate of men with suspected carcinoma. We studied 118 patients with this modality before histological evaluation of the prostate (20 underwent radical prostatectomy, 75 core needle biopsy and aspiration cytology, and 23 transurethral resection of the prostate). Transrectal ultrasonography was more efficient than digital rectal examination in the staging of carcinoma of the prostate before radical prostatectomy. The value of transrectal ultrasonography in the diagnosis of prostatic cancer in men with an abnormal-feeling prostate on digital rectal examination is less certain, since 10 of 75 patients (13 per cent) in this group had a falsely positive scan. The predictive value of a scan positive for malignancy was 37 per cent. Further refinements in the technique of transrectal prostatic ultrasonography are needed to realize fully the diagnostic potential of this imaging modality.     

Transurethral resection of prostatic abscess under sonographic guidance

Transrectal ultrasound may establish the diagnosis of prostatic abscess in an ambiguous clinical setting. Transurethral resection (deroofing) is the treatment preferred by many clinicians, yet intraoperative complete abscess obliteration may be difficult to confirm endoscopically. We report on a patient with a complex prostatic abscess endoscopically resected under transrectal ultrasound guidance. Adequacy of treatment was proved pathologically.     

Transrectal ultrasound-guided ethanol sclerotherapy for Müllerian duct cyst accompanied with ejaculatory duct obstruction]

OBJECTIVE: To evaluate the efficacy and safety of transrectal ultrasound-guided ethanol sclerotherapy in the treatment of Müllerian duct cyst accompanied with ejaculatory duct obstruction. METHODS: Under the transrectal ultrasound guidance, 3 cases of prostate Müllerian duct cyst were treated by 20 G needle puncture and ethanol injection, and closely followed up by ultrasonic monitored on follow-up examinations. RESULTS: All the cysts involuted completely 6 months after the treatment. Symptoms caused by ejaculatory duct obstruction were relieved in all the patients. No severe complications occurred. CONCLUSION: Transrectal ultrasound-guided ethanol sclerotherapy is an effective and safe method for the treatment of Müllerian duct cyst accompanied with ejaculatory duct obstruction.     

超声引导下无水乙醇硬化治疗伴有射精管梗阻症状的苗勒管囊肿

目的:评价经直肠超声引导下无水乙醇硬化治疗伴有射精管梗阻症状的苗勒管囊肿的安全性和有效性,探讨该方法的临床价值。方法:对3例伴有射精管梗阻症状的前列腺苗勒管囊肿行超声引导下20 G针穿刺无水乙醇硬化治疗,超声随访评价疗效。结果:治疗后6个月全部囊肿均消失,超声检查射精管梗阻解除,无严重并发症发生。结论:超声引导下的无水乙醇硬化治疗安全有效,可成为临床治疗伴有射精管梗阻症状的前列腺苗勒管囊肿的新方法。     

Prostatic abscesses. A review]

We review the literature to the diagnosis and therapeutic aspect of prostatic abscess. The prostatic abscess having become an uncommon disease. The diagnosis of prostatic abscess has been nearly made by transrectal ultrasound and computed tomography scan. The best diagnostic method is considered to be the transrectal ultrasound. The choice therapy was intravenous antibiotic, and drainage by ultrasound guided transperineal percutaneous puncture.     

Transbronchial needle aspiration under direct endobronchial ultrasound guidance of PET-positive isolated mediastinal adenopathy in patients with previous malignancy

Background  The diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of isolated mediastinal lymphadenopathy in patients with previous malignancy is not well defined. Positron emission tomography scanning has been proven to be a significant advance, but false-positive results are common. The purpose of this prospective and controlled study was to assess the yield of endobronchial ultrasound-guided transbronchial needle aspiration to reveal mediastinal lymph node metastases in patients with previous malignancy and possible mediastinal involvement on computed tomography and positron emission tomography. Methods  Seventy-three lymph nodes were tested by transbronchial needle aspiration on 48 consecutive patients, each patient underwent to mediastinoscopy or thoracoscopy immediately after needle aspiration for histological confirmation. A cytological sampling adequate for diagnosis was obtained in 45 patients (93.7%); the three cases of inadequate sampling resulted as negative for cancer. Results  The endobronchial ultrasound guided transbronchial needle aspiration gives a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 97.4%, 100%, 100%, 87.5%, and 97.7% respectively. Disease prevalence was 84.4%. All the endoscopic procedures were well tolerated and no immediate complications were recorded. Conclusions  Transbronchial needle aspiration under endobronchial ultrasound guidance is a valuable technique for cytological diagnosis of isolated mediastinal lymphadenopathy in patients with history of malignancy. Tissue sampling by invasive surgical procedures (mediastinoscopy or thoracoscopy) remains mandatory in case of inadequate or negative transbronchial needle aspiration cytology. This work has been performed at Thoracic Surgery and Lung Transplant Unit, Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Padiglione Zonda, Via F. Sforza 35, 20122 Milan, Italy.     

Spinal epidural abscess successfully treated with percutaneous,computed tomography-guided,needle aspiration and parenteral antibiotic therapy: case report and review of the literature

OBJECTIVE AND IMPORTANCE: We describe a case of a posterior spinal epidural abscess that was successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy. CLINICAL PRESENTATION: A 48-year-old man experienced acute pain in the paralumbar region for 1 week, followed by gait disturbance and micturition difficulty. Laboratory studies demonstrated leukocytosis and hyperglycemia. Blood cultures yielded Staphylococcus aureus. Magnetic resonance imaging scans of the thoracolumbar spine revealed a posterior spinal epidural abscess located between L2 and the lower cervical spine. INTERVENTION: The patient's low back pain persisted despite 10 days of antibiotic therapy. Therefore, percutaneous, computed tomography-guided, needle aspiration was performed. The low back pain was relieved dramatically and immediately after the procedure. The spinal epidural abscess completely resolved after 6 weeks of antibiotic treatment. CONCLUSION: Surgical decompression and antibiotic therapy are the treatments of choice for patients with spinal epidural abscesses. Selected patients may be treated nonsurgically. Rarely, percutaneous drainage of the abscess has been reported to be helpful. Our case suggests that percutaneous, computed tomography-guided, needle aspiration might be a rational alternative to surgical decompression for treatment of spinal epidural abscesses.     

Management of postoperative pelvic lymphoceles

Lymphoceles following pelvic surgery are not rare events. The management of this postoperative complication in 18 patients included needle aspiration, external drainage, and intraperitoneal marsupialization. The following diagnostic and therapeutic approach is recommended: ultrasonographic definition of the lymphocele; excretory urography to assess upper urinary tract obstruction; observation of small, nonobstructing, asymptomatic lymphoceles; needle aspiration for diagnosis confirmation; intraperitoneal marsupialization for noninfected, large lymphoceles that are obstructing the upper urinary tract or are symptomatic; and incision and drainage of small or infected lymphoceles.