Incidentally detected tuberculous prostatitis with microabscess

ABSTRACT Tuberculous prostatitis is a rare and often overlooked entity that may mimic prostatic adenocarcinoma on imaging exams, especially multiparametric magnetic resonance imaging (MRI) of the prostate. Detection of a prostatic abscess is a clue to the correct diagnosis.

Effects of prostatic inflammation on LUTS and alpha blocker treatment outcomes

Purpose To evaluate the association between prostatic inflammation and lower urinary tract symptoms (LUTS), and to identify the effects of prostatic inflammation on the treatment with an alpha blocker. Materials and Methods 111 Participants who were aged ≥ 50 years, the presence of LUTS (maximal flow rate < 20 m/s, IPSS ≥ 11), and an elevated PSA level (3-20ng/mL) were treated with tamsulosin 0.2mg once daily for 3 months after prostate biopsies. Prostatic inflammation was scored as none (0), mild (I), moderate (II), or marked (III). LUTS parameters including urine flow rates, IPSS, PSA, and prostate volume were evaluated. Results Inflammation grading resulted in 25, 60, and 26 patients that were grade 0, I, and II, respectively. Lower grade inflammation was related to higher urine flow rate at baseline. Patients with higher inflammation grades had larger prostate volumes, larger total and transitional zone volumes, and higher PSA levels. Overall, urine flow rates and residual urine volume were improved after 3 months of alpha blocker therapy. Eighty percent of patients with grade 0 inflammation, 73% of patients with grade I inflammation, and 92.3% of patients with grade II inflammation showed improvement of LUTS after treatment. Longer duration of treatment was related to a decreased chance of improvement of LUTS. Patients with increased IPSS voiding subscales could be predictive of improvement of LUTS. Conclusions Patients with high grade inflammation had lower flow rates and higher prostatic volumes than patients with low grade inflammation. Inflammation grade did not affect the outcomes of alpha blocker treatment. .

Correlation of hepatitis C and prostate cancer, inverse correlation of basal cell hyperplasia or prostatitis and epidemic syphilis of unknown duration

PURPOSE: The accuracy of prostate specific antigen (PSA) to detect prostate cancer has not yet been determined. Autopsy evidence suggests one-third of men have evidence of prostate cancer. Correlation between prostate cancer and sexually transmitted infection is indeterminate. MATERIALS AND METHODS: A retrospective database was created of all men who underwent transrectal ultrasound guided prostate biopsy over 3 years. Men were 49 percent African or African Caribbean, and 51 percent Central or South American. Information about prostate specific antigen, cholesterol, hepatitis A, B and C, human immunodeficiency virus, syphilis, tuberculin skin testing and histology were collected. RESULTS: Hepatitis C antibody detection correlated with prostate cancer OR 11.2 (95 percent CI 3.0 to 72.4). The odds of prostate cancer increased annually (p = 0.0003). However, no correlation was found between prostate cancer and the following: PSA, biopsy date, repeat biopsy, more than 12 cores at biopsy, total cholesterol, high density lipoprotein, triglycerides, low density lipoprotein, risk measure reported with free and total PSA, hepatitis B surface antibody, high grade prostatic intraepithelial neoplasia or atypical small acinar proliferation. Histologic prostatitis and basal cell hyperplasia were inversely correlated with prostate cancer. Syphilis of unknown duration occurred in 17 percent of men with indeterminate correlation to prostate cancer. CONCLUSION: In inner city men of African and African-Caribbean, or Central and South American descent, prostate specific antigen levels did not correlate with prostate cancer. Hepatitis C antibody detection correlates significantly with prostate cancer. One prostate biopsy is sufficient to diagnose statistically significant prostate cancer. Histologic prostatitis and basal cell hyperplasia decrease odds of prostate cancer. Atypical small acinar proliferation may not correlate to prostate cancer and is pending further investigation. Men should be screened for epidemic syphilis of unknown duration.

Transcutaneous electrical nerve stimulation (TENS) in the symptomatic management of chronic prostatitis/chronic pelvic pain syndrome: a placebo-control randomized trial

OBJECTIVE: The aim of the study was to investigate the therapeutic efficacy of transcutaneous electrical nerve stimulation (TENS) in the symptomatic management of chronic prostatitis pain/chronic pelvic pain syndrome. DESIGN: A pretest, posttest randomized double blind design was used in data collection. PARTICIPANT: Twenty-four patients diagnosed with chronic prostatitis- category IIIA and IIIB of the National Institute of Health Chronic Pain (NIH-CP) were referred for physiotherapy from the Urology department. Intervention: Pre treatment pain level was assessed using the NIH-CP (pain domain) index. The TENS group received TENS treatment, 5 times per week for a period of 4 weeks (mean treatment frequency, intensity, pulse width and duration of 60Hz, 100µS, 25mA and 20 minutes respectively). The Analgesic group received no TENS treatment but continued analgesics; the Control group received no TENS and Analgesic but placebo. All subjects were placed on antibiotics throughout the treatment period. Outcome measures: Post-treatment pain level was also assessed using NIH-CP pain index. RESULT: Findings of the study revealed significant effect of TENS on chronic prostatitis pain at p < 0.05. CONCLUSION: TENS is an effective means of non-invasive symptomatic management of chronic prostatitis pain.

[ assessment of risk factors for prostate cancer in Mazandaran province, Iran]

Prostate cancer is the most commonly diagnosed cancer in men and it is the second leading cause of cancer deaths among men after lung cancer. Therefore, this study was done to assess of risk factors for prostate cancer in Mazandaran province, Iran. A matched case-control study was conducted on 104 prostate cancer patients and 104 controls in Mazandaran province during 2005. The addresses of the patients were obtained using the cancer registry information existed in Babol research center in Iran. The data were collected using a questionnaire by in-person interview of cases and their controls and were analyzed using STATA [8.0]. Univariate condition logistic regression showed that age, prostatitis, drinking alcohol, using chopoghe, family history of prostate cancer, having other cancer, intensity of activity, time of job activity were found to be the risk factors although higher BMI and execreise were protective for prostate cancer [P<0.20]. In multivariate analysis, after adjusting for the effect of the confounders, prostatitis, age, alcohol consumption and family history of prostate cancer were found to the most important risk factors. This study identified prostatitis, age, alcohol consumption and family history of prostate as the independent risk factors for prostate cancer. We suggest that men after the age of 60 should be screened for prostate cancer annually

Uso de antibióticos y riesgo de complicación infecciosa en biopsias prostáticas transrectales: estudio de casos y controles / Use of antibiotic and risk of infectious complications in transrectal ultrasound-guided prostatic biopsy: case-control study

La biopsia prostática transrectal ecoguiada es un procedimiento bien tolerado y con un bajo nivel de complicaciones. Éstas suelen ser hemorrágicas o infecciosas. Debido a una tasa inusualmente elevada de complicaciones infecciosas, decidimos caracterizar a este grupo de pacientes. Estudio de casos y controles. Se analizan 233 biopsias prostáticas transrectales realizadas entre el 1 de agosto de 2003 y el 31 de mayo de 2004, todas con anestesia local periprostática. Los pacientes recibieron preparación con ciprofloxacino (2 dosis de 500 mg previo al examen y 8 dosis posterior a éste) y enema fleet (2 aplicaciones previo al examen). Cuarenta y tres pacientes habían recibido previamente este antibiótico como tratamiento por distintas causas. Se registraron complicaciones en 9 pacientes (3,9 por ciento). Hubo 2 casos de orquiepididimitis, 1 de sepsis sin foco clínico y 6 casos de prostatitis aguda. En dos de estos últimos se registró un cuadro séptico concomitante. El promedio global de hospitalización fue de 5,4 días. El promedio de punciones fue de 14,3 para los pacientes con complicaciones y de 13,4 para los no complicados (p=0,15). En los 9 pacientes con complicaciones infecciosas, los urocultivos y/o hemocultivos arrojaron una Escherichia coli. Seis de ellos habían estado expuestos al ciprofloxacino por 10 o más días durante los 2 meses previos a la biopsia. Las complicaciones infecciosas fueron significativamente más prevalentes entre los pacientes previamente expuestos al ciprofloxacino que en aquellos no expuestos (p=0,0001; OR 10,1). Todas las cepas encontradas, excepto en un paciente, demostraron ser resistentes al ciprofloxacino. A su vez, todas ellas, excepto una, eran sensibles a las cefalosporinas de 3a generación. No se registró resistencia a los carbapenems. La sensibilidad a los aminoglicósidos y sulfas fue variable en cada caso. Las infecciones post biopsia pueden constituir un cuadro grave. En estos casos, el germen más frecuentemente encontrado es la E. coli y su resistencia al ciprofloxacino es alta. El uso previo de este fármaco se asocia a un importante riesgo de complicación infecciosa. En estos pacientes, debiera considerarse un esquema alternativo de profilaxis antibiótica.

Hemospermia: review of the management with 5 years follow-up.

OBJECTIVE: To review our experience with hemospermia and a long term follow-up. MATERIAL AND METHOD: Medical records of patients with hemospermia treated at the Division of Urology, Ramathibodi Hospital between 1993 and 1995 were reviewed. Clinical presentation, investigation, diagnosis, treatment, outcomes and long term follow-up were noted. RESULTS: Sixty-eight patients were found and completed follow-up to 5 years. The mean age was 40 years (range 28-62). Physical examination including DRE and urine examinations were done in all of the cases. Special investigations such as PSA, TRUS, IVP and cystourethroscopy were performed in selected cases. Prostatitis was found in 27.9 per cent, tuberculosis in 4.4 per cent, sexually related causes in 5.8 per cent and idiopathic in 61 per cent No malignancy was found in this study. Hypertension was found in 7.3 per cent of the patients. Thirty-two per cent had recurrent episodes of hemospermia. Specific treatment was used only for prostatitis and tuberculosis. No specific treatment was used for the idiopathic group. CONCLUSIONS: Hemospermia is a benign condition. Most of the causes were from idiopathic and inflammation. Only simple investigation was needed and treatment was recommended depending on the diagnosis and no specific treatment was needed for idiopathic cause.

Cryptococcal prostatitis in a patient with chronic lymphocytic leukemia.

Cryptococcosis is a systemic mycosis usually affecting patients of immunodeficiency i.e. transplants recipients, patients on chemotherapy for neoplastic diseases and in those suffering from human immunodeficiency virus infection. We report a 52-year old male suffering from chronic lymphocytic leukemia (CLL) on chemotherapy who presented with fever and features of prostatism. Cryptococcus neoformans infection (CN) was diagnosed on aspiration of a prostatic nodule. Subsequent investigations revealed a disseminated involvement by cryptococcus. The case represents an unusual presentation of disseminated cryptococcosis.

Imagenología en el estudio diagnóstico de la infertilidad masculina / Imaging in the diagnostic study of male infertility

El progreso de la imagenología de alta resolución como la ecotomografía endocavitaria prostática (ETR) y la aparición de la resonancia nuclear magnética (RNM) han relegado a un segundo plano a la vesículodeferentografía (VDG). Dado que la RNM está lejos del alcance de la mayoría de los andrólogos, se analiza la experiencia con el uso de la ETR y VDG en la evaluación de 17 pacientes que consultan por infertilidad de factor masculino. Ambas técnicas imagenológicas resultan útiles, complementarias y no excluyentes. Deben estar disponibles y en conocimiento de todo andrólogo

Prevalence of bacterial prostatitis in benign prostatic hyperplasia.

To define the prevalence of bacterial prostatitis and urinary tract infection (U.T.I) among benign prostatic hyperplasia patients (B.H.P) undergoing prostatectomy trans urethral resection of prostate (T.U.R.P.), 100 consecutive patient has their preoperative and post-operative urine cultures along with tissue culture of the resected prostatic tissue. Our data suggests that significant incidence (42%) of bacterial growth in prostatic tissue-occurs in patients with B.H.P. Pre-existing U.T.I. is not a reliable indicator by which this group could be identified pre-operatively and prostatic infection could be treated.

value of prostatic biopsy in the diagnosis of chronic prostatitis

68 patients diagnosed clinically as having chronic prostatitis were studied together with 12 controls who were not complaining of any symptoms that may suggest prostate. Twelve cases proved to have other pathological lesions not related to prostatitis [one had stone bladder, 5 had bladder neck obstruction and 6 had chronic cystitis]. In the remaining 56 patients sexual and urinary symptoms together with pain were the main complaints with the sexual symptoms being the commonest. 75% of our patients were married and more than73% of them were between the age of 30 and 45 years. Prostatic fluid examination showed the presence of more than 15 pus cells/HPF in 67.85% of the patients. Bacteriological culture was positive in only 22 patients [39.3%]. It revealed Staph aureus in 21.4%; B.coli in 14.3% and other forms in 3.57% of the total number of patients.Histopathological findings showed no evidence of inflammation in 76.8% of cases, bacterial infection in 16.1% and the remaining 7.1% had bilharzial infection. Transperineal prostatic biopsy is a safe and relatively accurate method of diagnosis but it should not be done routinely.It should be reserved for of cases persistent symptoms and negative growth, for suspected granulomatous or allergic prostatitis of and for cases with palpable nodule or on suspicion of malignancy