Ultrasound detection of prostatic calculi as a parameter to predict the appearance of hematospermia after a prostate biopsy

ABSTRACT Purpose: We evaluated the correlation between prostate calculi and hematospermia in patients undergoing prostate biopsy, and its impact on sexual activity of patients. Materials and Methods: A single-center prospective randomized study of 212 patients referred for transrectal ultrasound-guided prostate biopsy (TRUSBx) was performed. All patients were divided into two groups: Group A (GA), 106 patients with moderate/marked presence of prostatic calculi visualized by TRUS; Group B (GB), 106 patients with absence/scarce of prostatic calcifications. Patients were handed questionnaires to obtain a validated data on the duration and impact of hematospermia on sexual activity. The anxiety scores were recorded using a visual analogue scale. Results: No significant difference was noted between the two groups when comparing age, preoperative PSA level, prostate volume, and biopsy number, except for digital rectal examination (DRE) findings. Post-biopsy results of patients included in GA revealed that the complication of hematospermia was present in 65.1%, while in GB was present in 39.7% (p<0.001). On multivariate analysis for identifying significant preoperative predictors of hematospermia, which included variables of age, PSA, prostate volume, and prostate cancer were not shown to be significant predictors of hematospermia, except DRE and prostate calculi (p<0.001). The mean anxiety score was 3.7±2.8 in GA and 2.3±1.9 in GB, respectively (p<0.001). Conclusions: Prostatic calculi are an independent predictive factor of severe hematospermia after TRUSBx on the basis of multivariate analysis, but don't affect the positive rate of prostate cancer. Patients should be adequately counselled before TRUSBx to avoid undue anxiety and alterations in sexual activity.

Um método de contagem de pontos adaptado como uma estratégia prática de quantificação do volume do tumor e percentagem do envolvimento da próstata por carcinoma, em produtos de prostatectomia / A method of counting points adapted as a practical strategy for the quantification of tumor volume and percentage involvement by prostate cancer, radical prostatectomy in product

Introdução. É consenso que o laudo anatomopatológico de produtos de prostatectomia radical deve relatar de forma quantitativa a extensão do carcinoma prostático, mas qual o método a ser usado não é consensual. Objetivos. Relatar a experiência de um método de contagem de pontos adaptado em produtos de prostatectomias (n= 143) adaptado de Billis et al., Int Braz J Urol. 2003.29:113-120. Material e métodos. As margens basal e apical foram processadas pelo método do cone. O restante da próstata foi dividido em 12 regiões em forma de quadrantes: cada uma representada com duas secções. Em cada fragmento, oito pontos equidistantes foram marcados diretamente sobre a lamínula com caneta permanente. Os pontos presentes dentro da área do tumor foram contados e expressos na forma de percentagem de envolvimento por carcinoma (PEC) ou como volume do tumor (VT). Estes foram comparados com o método quantitativo mais usual de número de secções envolvidas (NSE). Resultados. Os três métodos apresentaram correlação moderada significante com níveis pré-operatórios de PSA, mas esta foi maior para os métodos baseados na contagem de pontos: NSE (r = 0.32), PEC (r = 0.39) e VT (r = 0.44). Quando estratificados em três categorias, os três métodos mostraram associação com escore de Gleason ≥7, Gleason primário ≥4, invasão angiolinfática e perineural, extensão extraprostática, envolvimento de vesículas seminais e margens positivas. Conclusão. Os três métodos quantitativos estão associados a marcadores morfológicos de progressão do carcinoma da próstata. Os métodos baseados na contagem de pontos proposta apresentam mais forte correlação com níveis pré-operatórios de PSA sérico.

Objective: To evaluate a modified point-count method for quantifying carcinoma in prostatectomy specimens (n=143), adapted from Billis et al., Int Braz J Urol. 2003.29:113-120. Methods: The basal/apical margins were sampled using the cone method. The remainder of the gland was divided into 12 quadrant-shaped regions which had two slices sampled. Eight equidistant points were marked directly on the coverslip over each fragment. The points inside the tumoral areas were counted and expressed as the percentage of prostate gland involvement by carcinoma (PGI) and as the tumor volume (TV). Results: A significant correlation between the preoperative PSA level and each of the three quantitative estimations was found, but it was higher for both values (PGI and TV) obtained using the point-count method, viz.: number of slices involved (NSI) (r = 0.32), PGI (r = 0.39) and TV (r = 0.44). When the data sets were stratified into three categories, all three methods correlated with Gleason scores ≥7, primary Gleason scores ≥4, perineural / angiolymphatic invasion, extraprostatic extension, seminal vesicle invasion and positive margins. Conclusion: All three quantitative methods were associated with morphologic features of tumor progression. The results obtained using the modified point-count method correlated better with the preoperative PSA levels.

Obstrucción de conductos eyaculadores / Ejaculatory duct obstruction

BACKGROUND: Prostatic cysts are rare lesions with a reported incidence from 1 to 7.9%. They have been associated with primary infertility. The main characteristic is the benign course and positive prognosis after correct surgical management. CLINICAL CASES: We present three clinical cases, two with primary infertility and another with a history of primary infertility who presented with recurrent hemospermia and refractory medical treatment. All patients had hypospermia and alteration of the seminal parameters represented by moderate oligospermia (MOS), asteno- and teratozoospermia, in addition to hemospermia in two patients. Diagnosis was confirmed by transrectal ultrasound. Transurethral resection (TUR) of the cyst was performed in two cases and resection of the veru montanum in one, obtaining improvement in the seminal parameters after 1 month of follow-up and acceptable parameters for spontaneous conception at 6 months. CONCLUSIONS: Infertility associated with partially obstructed ejaculatory ducts may be suspected clinically by hypospermia. Transrectal ultrasound is essential to confirm the diagnosis. TUR of this lesion reestablishes the free passage of semen in almost all patients, with potential recovery of fertility 6 months after treatment.

Quiste de retención prostético: una causa rara de retención aguda de orina / Prostatic cyst causing urinary obstruction: report of one case

Las lesiones quísticas localizadas en la línea media de la glándula prostética presentan una incidencia difícil de estimar, debido a que la mayoría son asintomáticas y suelen ser un hallazgo casual durante el estudio de otra patología urológica. Presentamos el caso de un varón de 85 años que en el transcurso de un episodio de retención aguda de orina es diagnosticado de un quiste de retención prostético, y realizamos una revisión de la literatura.

The incidence of medial prostatic cysts is unknown, since most of them are asymptomatic, and usually appear as an incidental finding during the study of other urological disease. We report an 85 years oíd man with a urinary obstruction. Rectal palpation disclosed a mass that was adjacent to the prostate. Magnetic resonance showed a cystic lesión of the right seminal vesicle. The cyst was drained, obtaining 250 mi of fluid and urinary obstruction subsided. After three months of follow up, the patient remains asymptomatic.

Comparación de complicaciones por sangrado en resección transuretral de próstata con y sin participación de residentes / Comparison of complications for bleeding in transurethral resection of prostate with and without participation of residents

Introduction: transurethral resection of the prostate (TURP) is still the gold standard treatment of prostatic obstruction. The objective of the present study is to compare the bleeding complications of TURP with and without the participation of residents. Material and methods: The data was obtained from a prospective protocol that included 200 patients submitted to TURP. Eleven patients were excluded from the study (5,5 percent). No patient was lost from follow-up. Results: Were viewed 189 surgeries, 46 with resident participation (24,3 percent). The operations performed by residents were more prolonged, and required more days with bladder drainage. The following bleeding complications were observed: 1) Bladder catheter washing to solve obstruction by clots: 11,6 percent, 2) Endoscopic revision in severe hematuria: 2,6 percent, 3) Readmission to the hospital in complete urinary retention secondary to clots: 2,1 percent and 4) Blood transfusion: 2,1 percent. The transfusion rate was significantly higher in resident surgeries (6,5 percent versus 0,7 percent, p=0,045), without differences in the other bleeding complications. Conclusion: The rate of bleeding complications is comparable to that recently published. Applying strict criterion for blood transfusion, no difference was observed between the groups. At our institution, the process of teaching and learning TURP does not increase significantly the risk of bleeding complications.

Infravesical Obstruction Due to Benign Intraurethral Prostatic Cyst

We report a case of symptomatic intraurethral prostatic cyst in a 42-yr-old man without clinical evidence of benign prostatic hyperplasia. The intraurethral cyst makes it unique from the all previously reported cases of prostatic cysts located medially within the prostate. Transurethral resection of the cyst with limited resection of the prostatic tissue at the base of the cyst was performed with successful resolution of voiding symptoms.

Prostatic tuberculosis and AIDS.

Tuberculosis of the prostate is rare and is thought to be either due to haematogenous dissemination or secondary to renal infection. We describe, possibly for the first time, two male patients with the acquired immunodeficiency syndrome who had tuberculous abscesses in the prostate discovered at post-mortem examination. Only one of them had mild urinary symptoms and neither had evidence of urogenital tuberculosis before death. We suggest that in a patient with acquired immunodeficiency syndrome tuberculous infection of the prostate should be sought by microscopic examination of the urine, semen and prostatic fluid obtained after massage.

Valoración del sodio plasmático en resección transuretral de próstata / Plasmatic sodium meassurement in prostatic transurethral resection

Las complicaciones que se presentan durante la resección transuretral de próstata se deben a la utilización de líquidos de irrigación, los cuales se absorben y pueden ocasionar una hiponatremia dilucional. por tal motivo, se estudiaron dos grupos de pacientes sometidos a resección transuretral. El primer grupo, integrado por 34 pacientes, no presentaron manifestaciones clínicas de hiponatremia durante la resección transuretral, al medir el sodio plasmático durante el pre y postoperatorio. En el segundo se estudiaron 33 pacientes, los cuales presentaron datos de hiponatremia al medir el sodio pre, trans y postoperatorio. Se encontró que hay hiponatremia dilucional cuando los pacientes presentan las manifestaciones clínicas (p< 0.01) y ésta se corrige al administrar bicarbonato de sodio (p < 0.04). Sin embargo, una hora después de aplicar el medicamento, los niveles de sodio no fueron los óptimos, por lo que en algunos casos es necesaria la administración de una segunda dosis de bicarbonato de sodio. También se encontró hiperkalemia con diferencias estadísticamente significativas (p < 0.005)

Cisto de utrículo prostático como causa de hemospermia / Prostatic utricular cyst as cause of hemospermia

O presente trabalho refere-se a um caso de um paciente portador de cisto de utrículo prostático causando hemospermia, cujo diagnóstico foi elucidado através de exame ultrasonográfico e uretroscopia. O tratamento instituido foi a ressecçäo transuretral