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。     

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...     

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.     

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.     

经会阴前列腺穿刺与经直肠前列腺穿刺活检在前列腺癌诊断的初探

目的 对比经会阴与经直肠前列腺穿刺活检在前列腺癌诊断中的阳性率及并发症。方法 回顾分析2017年1月到2019年12月行前列腺穿刺活检的病例,经直肠组187例,经会阴组68例。结果 经直肠组阳性穿刺率为34.7%,经会阴组阳性穿刺率为29.4%,两组无统计学差异（P>0.05）。穿刺后经直肠组和经会阴组的血尿发生率分别为40.1%、42.6%,尿潴留发生率分别为6.9%、7.3%,直肠出血发生率分别为1.1%、0%,差别无统计学意义（P>0.05）。穿刺后经直肠组和经会阴组的会阴肿胀的发生率分别为2.6%、13.2%,两组有统计学差异（P<0.05）。结论 超声引导下经直肠、经会阴前列腺穿刺活检均为前列腺癌诊断的有效方法。两者穿刺阳性率无明显差异,但并发症各有特点。     

苗勒管囊肿48例诊治分析

目的 探讨苗勒管囊肿的诊断和治疗方法.方法 回顾性分析1993年1月至2007年12月诊治的48例苗勒管囊肿患者资料.1993年1月至1997年12月共诊治8例,多因慢性前列腺炎症状就诊并行经直肠超声(TRUS)检查.7例较小囊肿行TRUS引导下经会阴穿刺抽吸囊液,1例较大囊肿行开放手术切除囊肿.2002年1月至2007年12月共诊治40例,多因梗阻性无精子症就诊,均行TRUS检查,其中12例行MRI检查.39例较小囊肿行经尿道囊肿切开引流,1例较大囊肿行腹腔镜下苗勒管囊肿切除.结果 1993年1月至1997年12月所诊治的8例患者术后6个月随访只有1例复发,再次行经尿道囊肿切开引流后治愈.2002年1月至2007年12月所诊治的40例患者术后3个月复查TRUS,未见有囊肿复发.术后6个月随访,39例梗阻性无精子症患者中,10例配偶顺利怀孕,其余29例中9例精液中出现精子.1例19岁患者术后症状消失.结论 苗勒管囊肿多因慢性前列腺炎症状和梗阻性无精子症就诊.TRUS是诊断苗勒管囊肿的首选检查,MRI则能提供更精确的信息.经尿道苗勒管囊肿切开引流术为苗勒管囊肿的有效治疗手段,对于较大的囊肿腹腔镜下囊肿切除是较好的选择.     

术前导尿降低经直肠前列腺活检术中尿道损伤

目的研究术前导尿对经直肠前列腺穿刺活检术中尿道损伤发生的作用。方法经直肠前列腺穿刺活检患者100例,其中50例术前留置导尿管,其余50例不留置导尿,通过观察术后血尿情况,进而对比两组患者术中尿道损伤发生率。结果术前留置导尿患者肉眼血尿发生率为28%（14/50）,不留置导尿患者为60%（30/50）,两者差异显著。结论术前留置导尿能够降低经直肠前列腺穿刺活检术中尿道损伤的发生。     

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。     

经直肠超声引导自动活检枪前列腺穿刺260例分析

目的：研究经直肠超声引导自动活检枪前列腺穿刺在诊断早期前列腺癌方面的意义。方法：患者分为两组,第1组230例为经每年一次PSA筛选,PSA＞4μg/L而进行直肠指检（DRE）和经直肠超声引导自动活检枪穿刺（TRUS）加活检的澳大利亚患者;第2组30例为DRE有可疑结节而进行TRUS加活检的国内病例。结果：经直肠超声引导自动活检枪前列腺穿刺所获标本取材全部优良,符合病理诊断的要求。第1组检出前列腺癌82例,其中T2a期以内80例,T2b2例,不典型增生19例;第2组检出前列腺癌8例,其中1例属于T2b,已行根治性前列腺切除术,另外7例至少在T3期以上。所有患者穿刺后未发生严重并发症。结论：经直肠超声引导自动活检枪前列腺穿刺是确诊早期前列腺癌的重要的方法,而且并发症少,值得推广。     

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。     

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.     

Periprostatic abscess. Unusual complication of transurethral prostatectomy.

Many large series analyzing the results and complications of transurethral prostatectomy have failed to mention the occurrence of periprostatic abscess. A case is described which followed perforation of the posterior capsule at the time of transurethral prostatic resection. This complication was successfully managed by transperineal needle aspiration and high-dosage antibiotic therapy.     

经直肠超声引导下精囊穿刺灌注治疗顽固性血精长期疗效观察

目的:评价经直肠超声(TRUS)引导下经会阴精囊穿刺灌注抗生素治疗顽固性血精的长期疗效。方法:入选12名患者,年龄(36.4±10.8)岁,病程(13.9±6.4)个月。取得前列腺按摩液(EPS)并进行细菌培养。在TRUS引导下经会阴穿刺抽吸影像异常侧精囊液(SVF)进行细菌培养。根据EPS细菌培养和药敏试验结果选择抗生素,细菌培养阴性者选择广谱抗生素,在TRUS引导下穿刺精囊进行灌洗和冲洗。1个月后复查时如血精未消失,则再次穿刺灌药。以后每3个月随访1次。结果:TRUS发现精囊和/或射精管异常影像者9例,包括精囊和/或射精管扩张7例;精囊壁增厚3例;精囊壁钙化或精囊结石3例;副中肾管囊肿1例。7例SVF培养阳性,其中耐甲氧西林金黄色葡萄球菌4例,耐甲氧西林凝固酶阴性葡萄球菌、大肠埃希菌、奇异变形杆菌各1例。随访10例,随访时间(31.4±5.7)个月,中位时间31.5个月。治疗后从未复发3例,曾经复发7例;末次随访时2例仍有持续发作,8例未发作。结论:TRUS引导下精囊穿刺灌注抗生素治疗顽固性血精有一定疗效。     

顽固性血精病因和治疗初探

目的 :探讨顽固性血精的病因特点和影响治疗的因素 ,评价经直肠超声 (TRUS)引导下经会阴穿刺抽吸精囊液和灌注抗生素诊治顽固性血精的有效性。　方法 :入选 12例病人 ,平均年龄 (36 .4± 10 .8)岁 ,平均病程 (13.9± 6 .4 )个月。病人先行前列腺按摩 ,取得前列腺液 (EPS)并进行细菌培养。在TRUS引导下经会阴穿刺抽吸影像异常侧精囊液 (SVF)进行细菌培养和细胞学检查。根据EPS细菌培养和药敏试验结果选择抗生素 ,如细菌培养阴性则选择广谱抗生素 ,在TRUS引导下穿刺精囊进行灌注和冲洗。 1个月后复查时如血精未消失 ,则再次穿刺灌药。以后每 3个月随访 1次。　结果 :B超发现精囊异常影像位于左侧 4例 ,右侧 3例 ,双侧 2例 ,未见异常 3例。异常影像包括 :精囊或 和射精管扩张 7例 ;精囊壁增厚 3例 ;精囊壁钙化或精囊结石 3例 ;副中肾管 (M櫣ｌｌｅｒｉａｎｄｕｃｔ)囊肿1例。 7例SVF培养阳性 :耐甲氧西林金黄色葡萄球菌 (MRSA) 4例 ,耐甲氧西林凝固酶阴性葡萄球菌 (MRCNS)、大肠埃希菌、奇异变形杆菌各 1例。此 7例病人中 5例SVF和EPS细菌培养结果相同。在TRUS引导下经会阴穿刺精囊灌注抗生素并冲洗 ,7例灌注 1次 ,5例灌注 2次。随访 10例 ,平均 (16 .7± 5 .9)个月 ,6例未复发 ,4例仍反复发作。　结论 :以     

A prospective study of transperineal prostatic block for transurethral needle ablation for benign prostatic hyperplasia: the Emory University Experience.

PURPOSE: We evaluate the feasibility, effectiveness and role of transperineal prostate block in providing anesthesia during minimally invasive radio frequency thermal therapy of the prostate. MATERIALS AND METHODS: A total of 38 consecutive patients undergoing transurethral needle ablation for symptomatic benign prostatic hyperplasia were entered in this prospective study. All patients received transperineal prostatic block as the main method of anesthesia. A mixture of equal volumes of 1% lidocaine and 0.25% bupivacaine, each with epinephrine (1:100,000 concentration ratio) was used. Pain control during the instillation of transperineal prostatic block and transurethral needle ablation was assessed using a 10-point linear analog pain scale and questionnaire. RESULTS: Median patient age was 65.5 years (range 47 to 79), with 21% of men in the eighth decade of life. Median American Urological Association symptom score was 25.0 (range 14 to 35), bother score was 20.0 (11 to 28), quality of life score was 4.0 (3 to 6) and peak urinary flow rate was 8.9 cc per second (3.5 to 15.7). Median sonographic prostate volume was 35.0 cc (range 17 to 129). Median volume of anesthetic agent used was 40.0 cc (range 30 to 60) per case (1.1 cc solution per 1 cc prostate tissue). No adverse events were encountered. Median pain score was 3.3 (range 1 to 6) during instillation of transperineal prostatic block and 1.0 (0 to 6) during transurethral needle ablation. Transperineal prostatic block proved highly effective and was a satisfactory method of anesthesia during transurethral needle ablation as judged by postoperative questionnaire. No sedation, narcotic or analgesia was required. All procedures were performed in the outpatient cystoscopy suite or office setting without support of an anesthesia team or conscious sedation monitoring. CONCLUSIONS: Transperineal prostatic block is a safe, convenient, effective and satisfactory method of minimally invasive anesthesia for transurethral needle ablation of the prostate in an outpatient office setting. Elderly patients and those at high surgical risk can be treated safely using this approach. Considerable cost saving is seen secondary to omission of charges related to anesthesia team support, recovery room facility and conscious sedation monitoring.     

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。     

Incidental carcinoma of the prostate: significance of staging transurethral resection

We compared the results of staging by a second circumferential transurethral resection and/or transperineal needle biopsy in 42 patients with stage A prostatic adenocarcinoma on initial transurethral resection (defined as tumor of low grade, Gleason sum 2 to 4, and low volume, less than 5 per cent of the specimen or less than 3 foci). Transurethral resection only was done in 16 patients, transperineal needle biopsy only in 2 and both procedures in 24. In the 24 patients who underwent both procedures residual carcinoma was identified by transurethral resection in 6 and confirmed by transperineal needle biopsy in only 1. Thirty-two patients (76 per cent) had no residual carcinoma. Of the 10 patients (24 per cent) with residual carcinoma 5 underwent radical prostatectomy with pelvic lymphadenectomy, 1 had interstitial irradiation with pelvic lymphadenectomy and 1 had pelvic lymphadenectomy only. No lymphatic metastases were detected; persistent carcinoma confined to the prostate was noted in all 5 patients who had undergone radical prostatectomy and 3 of these tumors were upstaged because of higher grade and/or volume. We conclude that residual carcinoma cannot be assessed accurately with transperineal needle biopsy, whereas transurethral resection staging enabled us to define a substantial number of our patients (24 per cent) with persistent disease. Importantly, upstaging by either low volume/high grade or high volume carcinoma was identified in 3 patients at the time of radical prostatectomy. However, the true stage and prognosis of those patients with persistent low volume and low grade prostatic carcinoma remain to be determined.     

Value of transrectal ultrasonography for diagnosis and treatment of prostatic abscess

A new diagnostic and therapeutic application of transrectal ultrasonography (TR-US) is described. TR-US demonstrated one or more well-defined hypoechogenic areas in the prostate gland of 6 patients who presented with clinical signs of urinary tract infection and had only partial response to antibiotic therapy. The presence of a collection of pus in the prostate was confirmed in 4 of 6 patients by transperineal aspiration guided by TR-US, and by prostatic massage or transurethral prostatectomy in the other 2 patients. Ultrasonography also confirmed the resolution of abscesses in 5 patients.