前列腺脓肿的诊断和治疗的体会(附2例报告)

目的 通过报告2例前列腺脓肿病例的病例特点、诊疗经过以及文献复习,提高对现阶段前列腺脓肿的认识和诊疗水平.方法 报告2例患者的详细临床资料,并检索、复习CNKI期刊全文数据库1994～2010年的病例报道,进行荟萃分析.结果 2例患者均经穿刺治疗后复发而改用经尿道前列腺电切术治疗,手术效果好,随访3个月未复发.荟萃分析结果显示以往报告的病例有55.4%的患者需反复穿刺.结论 前列腺脓肿多采用B超引导下经直肠/会阴脓肿穿刺引流术治疗.然该治疗方式一次穿刺治愈率较低,经尿道前列腺电切术治疗前列腺脓肿可作为前列腺脓肿的首选治疗方法.     

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12例诊疗分析

目的 总结前列腺脓肿患者的临床表现及影像学特点,提升诊断符合率,同时为临床治疗提供一定的参考.方法 回顾2006年2月至2014年9月本院12例诊断为前列腺脓肿患者的既往病史、临床表现、实验室检查及影像学表现特点,总结其诊疗特点及临床疗效.结果 最常见的临床表现及体征为寒颤、发热及尿路刺激症状;9例尿培养阳性,培养结果以大肠杆菌为主(7/9),穿刺液培养亦以大肠杆菌为主(8/9),其中4例行经直肠超声引导下前列腺穿刺引流术及5例行经尿道前列腺脓肿电切去顶引流术,术后予以抗感染而控制病情;术后随访3个月,其中单纯抗感染治疗复发2例.结论 直肠指诊、PSA、经直肠超声及CT检查有助于尽早诊断前列腺脓肿,CT可准确反应脓肿的大小、位置及分隔情况,可作为诊断前列腺脓肿的常规检查;超声引导下穿刺引流或经尿道前列腺脓肿电切去顶引流术可有效控制病情.     

穿刺加板蓝根注射液冲洗治疗前列腺脓肿6例

穿刺加板蓝根注射液冲洗治疗前列腺脓肿６例程广明尹峰刘培东前列腺脓肿少见，治疗多经会阴或直肠切开引流，我院１９８４～１９９５年共收治６例，均行前列腺穿刺加板蓝根注射液冲洗治愈，报告如下。１资料与方法１．１一般资料本组前列腺脓肿患者６例，年龄３７～５４岁...     

阴茎脓肿1例报告及近20年国内外文献复习

目的报告1例阴茎脓肿病例并复习国内外文献,阐明阴茎脓肿的特点。方法结合1例阴茎脓肿病例,检索PubMed数据库、中国期刊全文数据库及万方数据知识服务平台1995年至2015年的相关资料,进行荟萃分析。结果本病例主要临床表现为阴茎痛性肿块,伴有膀胱刺激征,彩超未能确诊,穿刺肿块抽吸出脓液后行切开引流术,术后两周痊愈。荟萃分析结果表明,不洁性交、淋病、泌尿系手术是主要的风险因素,致病菌主要是奈瑟淋球菌、大肠埃希菌,临床表现主要为阴茎肿痛、发热、寒战、脓性分泌物等,多数患者由彩超确诊,抗感染及脓液引流是有效的治疗方法。结论阴茎脓肿的表现比较典型,必要时使用CT、MRI检查以确诊及明确脓肿形成的部位,对选择引流脓液的方法有重要意义。     

18例前列腺脓肿微创治疗分析

目的:探讨前列腺脓肿微创治疗方式和时机选择。方法:回顾性分析2017年2月至2022年7月收治18例前列腺脓肿患者的临床资料,分析其临床特点、治疗方式的选择及其疗效。结果:18例患者中1例因脓肿自行破溃痊愈,17例患者经超声引导穿刺后14例痊愈,3例未愈患者经尿道脓肿去顶治疗痊愈。结论:经直肠超声引导穿刺治疗前列腺脓肿疗效显著,对于难治性(复发、多灶、穿刺引流效果欠佳)或者位置邻近尿道的前列腺脓肿,为缩短病程和减轻医疗负担,可考虑首选经尿道脓肿去顶治疗。     

经会阴和经直肠途径前列腺穿刺活检并发症的比较分析

目的:比较经直肠及经会阴前列腺穿刺活检术并发症的发生率,研究发生原因及处理方法.方法:统计北京医院1998～2007年间前列腺穿刺的患者,检索CNKI中国期刊全文数据库2000～2007年间发表有关前列腺穿刺活检术的文献,对并发症数据进行分析比较.结果:北京医院780例经直肠前列腺穿刺活检并发症发生率:肉眼血尿46.3%、血便8.7%、直肠出血0.5%、泌尿生殖系统感染0.9%、排尿困难0.6%、急性尿潴留0.6%、发热1.9%和血管迷走神经反射0.1%.检索前列腺穿刺相关文献共11篇,经直肠组7篇,经会阴组4篇.总例数分别为:2 244例和1 068例.两种穿刺方法阳性率分别为:32.7%和27.4%,差异无统计学意义(P>0.05).两组并发症发生率经直肠组显著多于经会阴组(P<0.01).结论:经直肠与经会阴两种穿刺方式阳性率相似.经会阴前列腺穿刺的并发症少于经直肠前列腺穿刺.     

超声造影结合直肠B超在经会阴前列腺穿刺活检中的应用（附87例报告）

目的：探讨微泡造影剂结合经直肠多普勒超声（contrastenhancedtransrectualultrasound,CE-TRUS）在经会阴前列腺穿刺活检中的临床意义。方法：对87例前列腺疾病患者在CE-TRUS后行经直肠B超引导下经会阴前列腺穿刺活检,穿刺标准依据2007年新修订的《中国泌尿外科疾病诊断治疗指南》确定．先行彩色多普勒超声检查。了解并记录前列腺局灶性病变部位、大小、数目、回声特征及彩色多普勒血流等情况。结果：87倒确诊为前列腺癌和前列腺增生者分别为52例和35例,两者比较差异无统计学意义（P=0．617）。而以PSA≤20ng／ml和PSA〉20ng／ml为标准行分层分析,发现PSA≤20ng／ml者在CE-TRUS引导下经会阴前列腺穿刺阳性率高（P=0．041）。结论：CE-TRUS后经直肠B超引导下行经会阴前列腺穿刺活检是诊断前列腺癌的重要方法;PSA≤20ng／ml者结合CDTRUS行前列腺穿刺活检能提高前列腺癌穿刺阳性率。     

前列腺黏液腺癌2例报告及文献复习

目的：探讨前列腺黏液腺癌的病理和诊疗特点。方法：回顾性分析我院1995年1月～2011年3月收治的2例前列腺黏液腺癌患者的临床资料,并结合文献复习,分析其特点。结果：2例患者年龄分别为73和84岁,因不同程度的排尿困难入院。1例误诊为前列腺增生,行经尿道前列腺电切术;另1例直肠指检、B超、CT、MRI及PSA检查均提示为前列腺癌,行穿刺活检后确诊,根据患者全身状况行硬膜外麻醉下经尿道前列腺电切术,以改善排尿症状,术后病理检查回报为前列腺黏液腺癌,免疫组织化学检查有较特异性表现。术后给予抗雄激素治疗等。结论：前列腺黏液腺癌在前列腺癌中罕见,没有特征性的临床表现,确诊主要依靠病理和免疫组织化学检查;治疗方法可采用根治性前列腺切除术。     

应用深静脉穿刺针穿刺引流肝脓肿47例体会

1987年7月至1996年12月我院采用深静脉穿刺计经皮穿刺肝脓肿置管引流法，治疗直经＞5．0cm的肝脓肿患者47例，其方法简便，疗效满意，现报道如下。亚临床资料本组47例，男32例，女15例，年龄10～75岁，平均42岁。本组病例均经B超或CT检查，结果：单发脓肿历例（74．5％），多发脓肿12例（25．5％）；脓肿直径为5．5－18．0cm；脓肿位于右肝33例，左肝12例，左右肝2例。47例患者均在B超引导下，采用深静脉穿刺针行肝脓肿穿刺置管引流，其脓液行细菌培养。结果：细菌性肝脓肿38例，阿米巴肝脓肿9例。经该法治疗，全组病例均痊愈，平均留管时…     

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     

Ultrasound-guided needle aspiration in prostatic abscess

OBJECTIVES: To review the clinical presentation of prostatic abscess and to assess the usefulness of ultrasound-guided needle aspiration as a treatment option for this condition. METHODS: Between October 1984 and November 1997, prostatic abscess was diagnosed in 31 patients. The average age was 60 years (range 29 to 79). Prostate ultrasound was performed using either a hypogastric or transrectal approach. Initial therapy included ultrasound-guided needle aspiration in 24 (77.4%), transurethral resection of prostate (TURP) in 5 (16.1%), or conservative management with antibiotic therapy. During follow-up, ultrasound examinations and urine cultures were performed on an outpatient basis. RESULTS: Past medical history most often included previous urinary infection (15 patients, 48%) and bladder outlet obstruction (13 patients, 42%). Sixty-one percent of patients presented with irritative voiding symptoms at the time of diagnosis. Ultrasound-guided needle aspiration resolved 83.3% of cases; 2 patients needed a second procedure. Three patients required TURP for drainage and 2 to remove an obstruction after abscess resolution. CONCLUSIONS: A high degree of suspicion is needed to diagnose prostatic abscess clinically. Transrectal ultrasound is necessary for the differential diagnosis. Transrectal ultrasound-guided needle aspiration is a technically simple and effective therapeutic procedure with no morbidity and, in case of failure, may be repeated or a drainage TURP may be undertaken.     

Emphysematous prostatic abscess: diagnosis and treatment

We report an unusual case of an emphysematous prostatic abscess. Prostatic abscess is a difficult clinical diagnosis associated with lower urinary tract symptomatology and frequently diabetes mellitus. Computerized axial tomography and transrectal or transurethral ultrasonography can assist in making a specific diagnosis. Definitive treatment is complete surgical drainage, which is achieved by transurethral resection of the prostate. Wide spectrum, adjuvant antibiotic therapy should be given to assure coverage of anaerobic bacteria.     

Transrectal longitudinal ultrasonography of prostatic abscess

A definite diagnosis of prostatic abscess sometimes is difficult to make. We report 2 cases of prostatic abscess diagnosed with the aid of transrectal longitudinal ultrasonography by electronic linear scanning. Transperineal aspiration of the abscesses was performed easily and correctly with this echographic technique.     

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.     

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.     

Case of lower urinary tract symptoms caused by urothelial papilloma-inverted type as diagnosed by transrectal ultrasonography at voiding

A 54-year-old male visited our hospital, complaining of lower urinary tract symptoms (LUTS) such as loss of urinary force following the unsuccessful treatment using an alpha1-blocker. Transabdominal ultrasonography performed for measuring postvoid residual urine volume incidentally detected a solid tumor at the bladder neck. In addition, transrectal ultrasonography at voiding confirmed the tumor to obstruct prostatic urethra during voiding. Pathological diagnosis of the tumor resected transurethrally was urothelial papilloma-inverted type. Following the operation, LUTS improved markedly. Voiding TRUS was of clinical use for the definitive diagnosis of the etiology of LUTS.     

Transrectal ultrasound and fine needle aspiration for malacoplakia of the prostate

Clinically, malacoplakia of the prostate gland may mimic prostatic carcinoma. We report a case of prostatic malacoplakia in which transrectal ultrasound of the prostate was most compatible with carcinoma. However, fine needle aspiration cytology and biopsy revealed the classical histopathological features of malacoplakia so that a correct diagnosis could be made.