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.     

Conservative treatment of superficial transitional cell carcinoma of prostatic urethra with intravesical BCG

We reviewed 125 male patients treated with a six-week course of intravesical bacillus Calmette-Guerin (BCG) for superficial transitional cell cancer (TCC) of the bladder that was associated with mucosal involvement of the prostatic urethra in 15 cases. In 13 of these cases, there was a sustained complete response in both the bladder and the prostate. Among the other 110 patients, in 14 TCC developed in the prostate from one to fifty-three (mean 15) months after completion of BCG. Six of these 14 had had complete response in the bladder. Recurrent TCC in the prostate was seen in only 4 percent and 6 percent of patients who had prostatic urethritis on cystoscopy and prostatic granulomas on biopsy, respectively. In contrast, recurrence was observed in 14 percent of those without urethritis and in 44 percent of those without granulomas. Transurethral resection of the prostate (TURP) prior to BCG did not appear to influence tumor recurrence in the prostate. However, after BCG, 3 patients with recurrent TCC in the prostate had complete local response after TURP alone. Further, prostatic urethritis (73%) and prostatic granulomas (60%) were more frequent among patients who had TURP prior to BCG than in those without TURP (33% and 27%, respectively). Superficial TCC of the bladder associated with mucosal involvement of the prostatic urethra can be treated successfully with intravesical BCG. In addition, our results suggest that intravesical BCG has a prophylactic effect on tumor recurrence in the prostate, and that TURP may have an important role by removing present disease and by facilitating the development of an effective biologic response to BCG in the prostate. TCC in the prostate is a significant cause of relapse, and frequent surveillance of the prostatic urethra should be performed in conservatively treated patients with superficial bladder cancer.     

Determination of prostatic volume by ultrasonography. A useful procedure in patients with prostatism?

Digital palpation is rather unreliable for estimating the volume of the prostate. Ultrasonographic measurements have been advocated as a more appropriate method. We examined 47 patients ultrasonographically. Of these, 34 underwent a transurethral resection of the prostate (TURP) (ultrasonographic volume 29 patients: prostate less than 60 cm3, 5 patients with cardiovascular problems: prostate greater than 60 cm3) and 13 an open prostatectomy according to Hryntschak (prostate greater than 60 cm3). In all patients ultrasonically determined volumes were compared with the operatively removed volume of prostatic tissue. If the size of the prostate had been estimated by digital palpation only, 12 patients would have undergone the wrong procedure (TURP instead of Hryntschack procedure). Ultrasonographic calculation of the prostatic volume demonstrated that all of these patients could be treated with less risk. After resection or abdominal prostatectomy some prostatic tissue remains. We concluded that there is no clear difference in the incidence of secondary prostatic obstruction (in need of re-TURP) either after abdominal prostatectomy or after TURP.     

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.     

经尿道前列腺剜除术与电切术疗效比较

目的:探讨普通电切镜下经尿道前列腺剜除术与电切术的疗效.方法:对75例前列腺生患者行经尿道前列腺剜除术治疗(TUEP组),110例经尿道前列腺电切术治疗(TURP组).结果:TUEP组术中出血量(前列腺重量<0 g)、手术时间均明显少于TURP组(P<0.05),增生腺体切除重量明显高于TURP组(P<0.05).术后12个月,最大尿流率、国际前列腺症状评分,生活质量评分等组间比较差异无统计学意义(P>0.05).结论:TUEP术与TURP术相比较,TUEP手术安全性更好,术中出血量少(前列腺重量<0 g)手术时间快、切除增生腺体更彻底.     

经尿道前列腺电切、气化术治疗前列腺增生症398例临床分析

目的:探讨经尿道前列腺电切(TURP)及经尿道前列腺气化(TUVP)治疗前列腺增生症的临床疗效。方法:回顾分析1987～1997年182例TURP及1998年～2002年216例TUVP临床资料。结果:疗效满意。TURP组182例,平均手术时间55min±5.7min,并发症发生率4.4％(8/182)。TUVP组216例,平均手术时间43min±4.9min,并发症发生率3.2％(7/216)。结论:TURP和TUVP近年来已成为治疗良性前列腺增生的金标准,具有手术时间短、出血少、创伤小、恢复快等优点,可作为治疗前列腺增生症的首选方法。     

经尿道电切结合间歇性内分泌治疗晚期前列腺癌20例报告

目的：探讨经尿道前列腺电切术(TURP)结合去势后内分泌治疗晚期前列腺癌的临床经验。方法：20例晚期前列腺癌患者行TURP并去势后,根据其术后血清睾酮及PSA水平间歇性进行抗雄激素的内分泌治疗。结果：随访12～60个月,平均28个月,所有患者近期排尿通畅,3例分别于术后36、38、48个月因重新出现排尿困难而再次行TURP治疗。平均生存时间5．3年,带瘤生存3年以上者16例;死亡3例,其中1例死于脑血管意外,2例因全身多处转移衰竭而死亡。结论：TURP结合间歇性内分泌治疗对晚期前列腺癌患者有提高生活质量、降低医疗费用、延长前列腺癌细胞对雄激素的依赖时间等优点,值得临床应用。     

前列腺增生经尿道汽化切割与电切术的疗效比较

目的 :比较经尿道前列腺汽化切割 (TUVP)与电切术 (TURP)治疗良性前列腺增生 (BPH)病人的疗效。　方法 :2 0 6例BPH病人 (术前估计前列腺重量≤ 6 0 g)被随机分成TUVP(97例 )和TURP(10 9例 ) 2组 ,对病人进行为期 12～ 34(平均 2 0 )个月的随访。　结果 :2组术后第 12、2 4个月国际前列腺症状评分 (I PSS)均较术前下降 (P<0 .0 1) ,膀胱残余尿 (PVR)均较术前减少 (P <0 .0 1) ,最大尿流率 (Qmax)均较术前升高 (P <0 .0 1)。　结论 :TUVP和TURP对增生≤ 6 0g的BPH病人均有良好的治疗作用。TUVP较TURP能缩短手术时间和术后置管时间     

Post-brachytherapy transurethral resection of the prostate in patients with localized prostate cancer

PURPOSE: We assessed the rate and results of transurethral resection of the prostate (TURP) in patients previously treated with brachytherapy as monotherapy for localized prostate cancer. MATERIALS AND METHODS: From May 1998 to May 2003, 600 patients with localized prostate cancer were treated with brachytherapy at our institution. Brachytherapy was performed as monotherapy with curative intent for clinically localized prostate cancer without adjuvant treatment in patients with clinical stages T1c (68.4%) or T2a (31.6%) disease. -Iodine and palladium implants were used in 583 and 7 patients, respectively. A real-time interactive implantation technique was used in all but the first 17 patients, who were treated using a preplanned technique. RESULTS: Of the 600 patients 19 (3.1%) underwent TURP after brachytherapy. Among the patients with acute urinary retention the median interval between prostate brachytherapy and urinary retention was 2 months (range 0.5 to 32). No TURP was done within 6 months after implant. The median interval between prostate brachytherapy and TURP was 7 months (range 6 to 41) and median prostate specific antigen (PSA) before TURP was 0.5 ng/ml (range 0.04 to 3.4). In the 19 patients the median weight of resected prostatic tissue was 8 gm (range 2 to 19) and 1 to 11 seeds were removed (median 5). The perioperative and postoperative courses were uneventful. There was no TURP related incontinence. With a median followup of 28 months after brachytherapy (range 7 to 48) no patient had clinical or biochemical evidence of disease progression, and for the group of 19 patients who underwent TURP median serum PSA at the end of followup was 0.38 ng/ml (range 0.03 to 3.4). CONCLUSIONS: After brachytherapy as monotherapy, TURP can be done safely if indicated. In our experience the resection of prostatic tissue along with a limited number of seeds at least 6 months after implantation did not impair PSA based biological and clinical results of brachy-therapy.     

Laser ablation of the prostate in patients with benign prostatic hypertrophy.

Seventeen patients with bladder neck obstruction due to benign prostatic hypertrophy have been treated with the Neodymium: YAG laser. We review our experience since the first patient was treated in September 1990. Using a prototype deflecting gold alloy tip on a quartz laser fibre (Lateralase TM), we ablated obstructing prostatic adenoma and constricting bladder neck tissue. Experience with this technique has enabled a patient population to be defined in whom laser therapy for prostatic obstruction may be effective. The treatment is relatively simple, speedy and attended by virtually no blood loss. Laser ablation therapy may offer some advantages over conventional transurethral resection of the prostate (TURP) in a selected subgroup of patients. The advent of new delivery systems may make laser ablation therapy a practical alternative to TURP.     

经尿道等离子双极前列腺切除术与前列腺电切术的疗效比较

目的比较经尿道等离子体双极电切术(PKRP)与经尿道前列腺汽化电切术(TURP)治疗良性前列腺增生症(BPH)的临床疗效。方法将300例有症状的前列腺增生症(BPH)患者随机分成两组,各150例,分别行PKRP和TURP术,记录患者围手术期和术后3个月复查的有关指标(手术时间、术中出血量、冲洗时间、留管时间、住院时间,国际前列腺症状评分(IPSS),尿流率峰值(Qmax)和生活质量评分(QOL)),并发症(TURS、术中输血、继发出血、尿失禁、膀胱痉挛、尿道狭窄)发生率,对两组数据进行统计学分析。结果 PKRP组出血量、冲洗时间、留管时间和住院时间少于TURP组,两组相比差异有显著性(P0.05),术后3个月,两组患者症状评分、生活质量分析、最大尿流率均比术前明显改善(P0.05),PKRP组并发症发生率为3.3%,低于TURP组的13.3%,两组比较差异有统计学意义(P0.05),所有并发症对症处理恢复正常,两组均无死亡病例。结论 PKRP与TURP均是治疗BPH的有效术式,但PKRP较TURP并发症少,安全性高,是治疗BPH较理想的微创术式。     

Holmium laser enucleation versus transurethral resection of the prostate. Are histological findings comparable?

PURPOSE: We investigated if an adequate histological diagnosis can be made from tissue after holmium laser enucleation of the prostate (HoLEP) and whether it is comparable to transurethral prostate resection (TURP) tissue findings in patients with benign prostatic hyperplasia. MATERIALS AND METHODS: We analyzed 40 HoLEP and 40 age matched TURP tissue specimens from patients who underwent 1 of the 2 procedures between January 2001 and August 2002. Each histological specimen was reviewed by a single pathologist. Preoperative prostate ultrasound volume, total serum prostatic specific antigen and postoperative tissue weight were evaluated. Microscopic histological diagnosis was assessed by standard histological techniques and immunohistochemical evaluation. RESULTS: Patients were comparable in terms of age and preoperative total serum prostate specific antigen. Tissue remaining following the procedure was estimated to be 36.3% of preoperative ultrasound volume after HoLEP and 52.8% after TURP (p <0.001). Incidental adenocarcinoma and high grade PIN of the prostate were diagnosed in a comparable percent of specimens in the 2 groups. Tissue thermal artifacts induced by the laser were mostly due to coagulation. Thus, the alterations were similar to those after TURP. CONCLUSIONS: Tissue quality is altered after HoLEP and TURP. General prostatic architecture was maintained in the majority of HoLEP histological specimens. A moderately higher percent of prostatic tissue obtained by the Ho laser is lost by vaporization and coagulation. Nevertheless, these differences do not seem to alter pathologist ability to detect incidental prostate cancer and PIN.     

The effects of transurethral prostatectomy on serum prostate specific antigen

Serum prostate specific antigen (PSA) was recorded in 75 patients immediately before and after transurethral resection of the prostate (TURP). Fifty-eight patients had benign prostatic hypertrophy (BPH) and 17 had prostatic carcinoma (CaP). In patients with BPH there was a statistically significant rise in PSA immediately following TURP. No such rise was seen in patients with prostatic carcinoma. A statistically significant correlation was identified between the weight of the benign hypertrophic prostate and the baseline pre-operative serum PSA. Because of the effects of TURP on serum PSA it is important to avoid PSA estimations immediately following such surgery. The failure of the malignant prostate to release PSA in significant amounts during TURP suggests that the elevated levels of PSA found in patients with prostatic carcinoma arise not from the local disease but from its metastases.     

Delayed diagnosis of prostate cancer with neuroendocrine differentiation after laser TURP

Laser transurethral resection of the prostate (TURP) is becoming widely used for surgical management of lower urinary tract symptoms from benign prostatic hyperplasia. Yet, one drawback to laser vaporization is the lack of a prostatic tissue sample for pathologic evaluation. We report the case of a 57-year-old man who presented with urinary obstruction, a normal digital rectal examination and a prostate-specific antigen level of 0.44 ng/mL. The patient then underwent transrectal ultrasonography to determine the size of his prostate (60 g). On the basis of these normal findings, laser TURP was performed. The patient's symptoms did not improve after the procedure, and cystoscopy confirmed continued prostatic obstruction. The patient subsequently underwent bipolar TURP, and the pathologic examination of the prostate chips revealed highly aggressive prostate adenocarcinoma with neuroendocrine differentiation. We discuss the potential drawbacks of laser TURP in the diagnosis of clinically undetectable prostate cancer.     

Plasmakinetic resection of the prostate versus standard transurethral resection of the prostate: a prospective randomized trial with 1-year follow-up

The aim of this study was to compare the clinical results of plasmakinetic resection of the prostate (PRP) with standard transurethral resection (TUR) of the prostate (TURP). A total of 240 patients (mean age 63.5; age range 52-90 years), with symptomatic benign prostatic hyperplasia were randomized into two groups and treated with two different techniques (TURP and PRP). We evaluated pre-operative, per-operative and post-operative (first and 12th months) findings of all patients. The mean catheterization time was 3 and 4.5 days in the PRP and standard TURP groups, respectively (P<0.001). We observed the improvements in maximum flow rates in PRP group were significantly higher than TURP group (P<0.001). TUR of the prostate using plasmakinetic energy seems to be a promising treatment alternative to conventional TURP. It has the advantages of low intraoperative and post-operative complications, short convalescence, excellent intraoperative hemostasis, absence of fluid absorption and TUR syndrome.     

Immediate and late complications of transurethral resection of prostate

300 patients with benign prostatic hyperplasia admitted in hospital between 1994 and 1998 were studied. The surgical procedure in 21 patients was TUIP (transurethral incision of prostate), in 18 patients was classic adenomectomy (open prostatectomy), in 58 patients classic TURP (transurethral resection of prostate) and in 203 patients TURP by low pressure (hypopressure). The immediate complications in those patients who underwent endoscopic procedures were bleeding in 18 patients, acute urinary infections in 20 patients, endotoxic shock in 5 patients, epididimytis in 9 patients, urine retention in 4 patients, obstruction of catheters in 10 patients, collection of washing liquid in perivesical space (Retzius) in 3 patients. The late complications were the following: bleeding--4 cases, imperative micturition--12 cases, vesicle neck sclerosis--3 cases, urethral orifice stenosis--16 cases, urethral stricture--3 cases, urinary retention--6 cases, abscess in perivesical space (Retzius)--1 case. After TURP in hypopressure, the complications were less frequent due to a better visualization a more rapid execution of the procedure.     

TURP加综合方法治疗前列腺癌

目的探讨提高对前列腺癌的治疗效果及根治性TURP在前列腺癌中的应用。方法采用TURP及综合方法治疗前列腺癌患者38例。结果全部病例均一次成功，32例随访6～18个月。尿路梗阻症状明显改善或消失。结论TURP加综合治疗能明显提高前列腺癌患者生存质量。     

A prospective randomized study of combined visual laser ablation and transurethral resection of the prostate versus transurethral prostatectomy alone

INTRODUCTION: Visual laser ablation of the prostate (VLAP) has a clinical failure rate of up to 18% which is 3 times higher than transurethral resection of the prostate (TURP) alone. Prolonged spontaneous passage of necrotic debris is the major shortcoming of this method. Therefore combined visual laser-assisted and transurethral prostatectomy was compared to TURP alone. MATERIALS AND METHODS: 105 patients were evaluated in a prospective randomized study comparing TURP alone and VLAP combined with TURP. The patients were evaluated 1, 3 and 12 months after surgery. First VLAP was performed using a neodymium:yttrium-aluminum-garnet laser with the prolase fiber followed by standard resection of the necrotic and remaining prostatic tissue. Treatment efficacy was assessed by the American Urological Association (AUA) symptom score, measurements of peak urinary flow, residual urine volume, intraoperative bleeding, and by the occurrence of intra- and postoperative complications. RESULTS: The use of VLAP and consecutive TURP improved the AUA symptom score, urinary flow and residual volume and was comparable in all patients treated. Intraoperative bleeding was significantly reduced from 522 +/- 45 ml by TURP to 214 +/- 33 ml by VLAP+TURP (p < 0.05). There was a significant improvement in the postoperative values of the parameters observed in both groups. CONCLUSIONS: It appears that the combined method for treatment of benign prostatic hyperplasia reduced the specific intraoperative morbidity of TURP while achieving the same clinical effect as TURP alone.     

经直肠超声引导穿刺活检诊断早期前列腺癌漏诊原因的分析

目的:分析经直肠超声(TRUS)引导下穿刺活检诊断前列腺癌的漏诊原因,减少漏诊率,提高诊断率。方法:80例疑似前列腺癌的良性前列腺增生(BPH)患者行TRUS引导下穿刺活检,结果均为阴性,均行前列腺电切术(TURP),术后标本行病理检查。结果:25例术后病理报告为前列腺癌,漏诊率31.25%(25/80)。其中10例行经会阴前列腺癌根治术、8例行手术去势、7例行药物去势。结论:TRUS引导穿刺活检诊断前列腺癌存在一定的漏诊,多次或多点穿刺活检可以减少漏诊率。     

Urodynamic Outcome after Transurethral Prostatectomy is Related to Percent Area Density of Prostate Smooth Muscle in Patients with Benign Prostatic Hyperplasia

We investigated the relationship between histological composition of the prostate and urodynamic outcome after transurethral resection of the prostate (TURP) in 27 patients with symptomatic benign prostatic hyperplasia (BPH). The histological analysis was performed using computer-assisted quantitative morphometry. Before and after TURP, group-specific urethral resistance factor (URA) was estimated by pressure-flow study. A significant correlation was found (p = 0.01) between the area density of prostate smooth muscle and the improvement in URA. However, no other histological components correlated with the improvement in URA. These facts suggest that the percent area density of prostate smooth muscle in prostatic adenoma appears to be a useful predictive factor for treatment of BPH.