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。     

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.     

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.     

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.     

Prostatic abscess after transrectal ultrasound guided biopsy.

We report a case of a diabetic man who had bilateral prostatic abscesses after ultrasound guided biopsy of the prostate. As is typical of prostatic abscesses, the diagnosis was not evident at presentation. We discuss the morbidity of transrectal biopsy and recommend consistent antimicrobial prophylaxis. We also recommend transrectal ultrasound in the diagnosis of such abscesses, and support the standard treatment of drainage and parenteral antimicrobial therapy. We anticipate that the incidence of prostatic abscess will increase due to the increasing number of men undergoing transrectal biopsy in the current age of transrectal ultrasound guided biopsy.     

Diagnosis and treatment of patients with prostatic abscess in the post‐antibiotic era

We reviewed the pathogenesis, clinical presentation, treatment options and outcomes of prostatic abscess in the post‐antibiotic era, focusing on how patient risk factors and the emergence of multidrug‐resistant organisms influence management of the condition. A MEDLINE search for “prostate abscess” or “prostatic abscess” was carried out. Prostate abscess is no longer considered a consequence of untreated urinary infection; now, men with prostatic abscess are typically debilitated or immunologically compromised, with >50% of patients having diabetes. In younger men, prostatic abscess can be the initial presentation of such chronic conditions. In older men, prostatic abscess is increasingly a complication of benign prostatic hyperplasia or prostate biopsy. Diagnosis is based on a physical examination, leukocytosis, leukocyturia and transrectal ultrasound, with magnetic resonance imaging serving as the preferred confirmatory imaging modality. Treatment of prostatic abscess is changing as a result of the emergence of atypical and drug‐resistant organisms, such as extended‐spectrum β‐lactamase‐producing enterobacteriaceae and methicillin‐resistant Staphylococcus aureus. As many as 75% of infections are resistant to first‐generation antibiotics, necessitating aggressive therapy with broad‐spectrum parenteral antibiotics, such as third‐generation cephalosporins, aztreonam or antibiotic combinations. A total of 80% of patients require early surgical drainage, frequently through a transurethral approach. In the post‐antibiotic era, prostatic abscess is evolving from an uncommon complication of urinary infection to a consequence of immunodeficiency, growing antibiotic resistance and urological manipulation. This condition, primarily affecting patients with chronic medical conditions rendering them susceptible to atypical, drug‐resistant organisms, requires prompt aggressive intervention with contemporary antibiotic therapy and surgical drainage.     

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.     

Percutaneous drainage of prostatic abscess

The treatment results of 2 patients with prostatic abscess who underwent perineal percutaneous drainage under transrectal ultrasonographic guidance are described. Both patients were treated definitely and without complications. It is concluded that the use of transrectal ultrasound during the procedure increases the effectivity and safety of treatment.     

Prostatic abscess in the newborn: an unrecognized source of urosepsis

We present a 10-day-old boy who developed fulminant urosepsis. At autopsy, he was found to have a prostatic abscess as his sole source of infection. We reviewed the 12 previous reported cases of prostatic abscess in newborns and present factors that may suggest the diagnosis. The treatment and outcome in each of the cases are also presented.     

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.     

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.     

Endoscopic treatment of multiple prostatic calculi causing urinary retention

Although prostatic calculi are relatively common, the etiology of these stones is not clear. We report a case with multiple prostatic calculi causing urinary obstruction and a concomitant bladder stone. We treated these stones endoscopically. We found a lot of different sized stones endoscopically, some protruding into the urethra, some filling different cavities on the prostate. So these cavities suggest prostatic calculi may occur related to intraprostatic reflux in the congenital or acquired diverticulum of the prostatic tissue. In addition, the stone composition of the bladder and prostatic stones was the same. All of these results show that the origin of bladder and prostatic stones can be the same. This case also supports a theory of intraprostatic reflux and urine stasis.     

Emphysematous prostatic abscess with rectoprostatic fistula

Emphysematous prostatic abscess is a rare but relatively serious infectious disease, and its association with rectoprostatic fistula is extremely unusual. The reported risk factors for this condition include diabetes mellitus, immunosuppression, and prostate surgery. We report a rare case of emphysematous prostatic abscess successfully treated by transurethral drainage. Nonetheless, a rectoprostatic fistula was found postoperatively. The fistula healed spontaneously without fasting or fecal diversion after suprapubic cystostomy and placement of a urethral catheter. This case highlights the importance of surgical drainage for the treatment of an emphysematous prostatic abscess and that conservative treatment can be a safe and effective approach for an associated rectoprostatic fistula.     

Tubercular prostatic abscess as a complication of intravesical bacillus Calmette–Guérin immunotherapy

We report a case of tubercular prostatic abscess in a patient who had undergone intravesical bacillus Calmette-Guérin immunotherapy for bladder carcinoma in situ. The abscess required surgical drainage and antituberculous treatment.     

Transrectal ultrasound in monitoring response to treatment of prostate disease

Transrectal ultrasound provides a safe method for repeated assessments of the prostate gland in the follow-up of prostatic cancer. Changes in the echo pattern of the gland may be observed following treatment, but these may be difficult to interpret. The capsule may be restored; the tumor may appear smaller, and in some cases, ultrasound identification of the tumor may become impossible. The total gland volume decreases with chemotherapy and hormonal manipulation (subcapsular orchidectomy or drug-induced). The volume generally decreases after radiotherapy but may show a transient increase if there is some associated radiation proctitis. The rate of decrease of total prostatic volume has not been established as a reliable indicator of the subsequent prognosis. Future studies should assess whether sequential measurements of the tumor volume rather than the total prostatic volume may be a more useful guide to prognosis.     

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     

Prostatic malacoplakia associated with prostatic abscess: diagnosis and treatment

Prostatic malacoplakia associated with prostatic abscess is an extremely rare disease. We present a case of prostatic malacoplakia presenting as a prostatic and seminal vesicle abscess in a patient with diabetes. The diagnosis and management are discussed, and the literature is reviewed.     

Transrectal ultrasonography

Transrectal ultrasonography is useful in assessing prostatic size, locally staging patients with prostatic carcinoma, and monitoring tumor response to endocrine therapy. New instrumentation provides the ability to perform needle biopsies under ultrasound guidance and potentially may be useful in the placement of radioactive seeds for treatment of localized malignancies.     

Cryptococcal prostatic abscess associated with the acquired immunodeficiency syndrome.

A case of cryptococcal prostatic abscess in a 28-year old man with the acquired immunodeficiency syndrome is presented. This is a unique presentation of a cryptococcal prostatic infection and of a prostatic abscess. The diagnosis and management are discussed, and the literature is reviewed.