Cystitis Cystica Et Glandularis Causing Lower Urinary Tract Symptoms in a 29-Year-Old Male.

We present the case of a 29-year-old male who presented to the office with three years of persistent lower urinary tract symptoms and hematuria. On workup, the patient was determined to have an atypical condition contributing to his symptoms. There are numerous causes of lower urinary tract symptoms that can occur in young men. These symptoms, including frequency, urgency, dysuria, and hematuria, are typically caused by common benign conditions such as urethritis, urolithiasis, and urinary tract infections. Prostatic pathology does not typically manifest in this population. Likewise, a more serious condition such as a mass or carcinoma may contribute to persistent lower urinary tract symptoms and hematuria less often in young men. In our patient, a benign mass later identified as cystitis cystica et glandularis was discovered to be contributing to his reported discomfort.

Identifying the Relation between Catheter-Associated Urinary Tract Infections and the National Distribution of Urologists and Urology Residencies.

Background: Catheter-associated urinary tract infections (CAUTIs) are associated with urinary catheterization. Up to 25% of hospitalized patients may be catheterized during their stay. Urethral catheters are necessary as part of many urologic procedures, but the removal of unnecessary catheters has become more important to reduce infections, healthcare costs, and patient morbidity. Methods: Open access data from the U.S. Centers for Disease Control and Prevention (CDC), United States Census, and the American Urological Association (AUA) Census was obtained, and a linear correlation used to determine relations. Results: A correlation between the number of urologists per hospital and CAUTIs per hospital was found in both the wards and intensive care units (ICU; p < 0.01). A similar relation was found between the number of urology residencies per hospital and CAUTIs per hospital in the wards (p < 0.01), but this was not significant in the ICU (p = 0.15). The number of urology residencies per state was correlated with the number of urologists per state (p < 0.01). No correlation between state population density and hospital number of CAUTIs, urologists, and urology residencies was found. Conclusions: Increased number of urologic procedures and the need for catheterizations likely drives the correlation with urologists and CAUTIs. Despite this, no urologists are on the CDC committee that created CAUTI guidelines. Urologists should be considered for hospital and national committees particularly because they often care for these patients in the outpatient setting.

Does Prostatic Urethral Lift Reduce Urinary Medications? Trends in Medical Treatment Before and After Prostatic Urethral Lift.

Objectives: To analyze medications used to treat urinary symptoms in patients before and after prostatic urethral lift (PUL) and determine if there are any significant relationships between several patient factors and onset of overactive bladder (OAB) symptoms requiring treatment. Methods: A retrospective chart review of 226 patients who underwent PUL was performed. Data were collected on age, urinary medications, voiding questionnaires, and prostate volume from 6 months before to 6 months after the intervention. Patients were broken up into groups for analysis with age <60 age (group 1), age 60-75 years (group 2), and age >75 years (group 3). A t-test was used to obtain p-values of the changes in questionnaire answers and urinary medication use after the procedure. To look for significant linear correlations between variables, a Pearson correlation was obtained and a randomization test was performed to obtain p-values. Results: Significant International Prostate Symptom Score (IPSS) and Quality of Life (QOL) improvements were noted in all groups (p < 0.01). Total medication and Alpha-blocker decrease was significantly correlated with age (p = 0.02 and p < 0.01, respectively). Older groups had a significant increase in Beta 3 agonist usage, with a significant decrease in usage in younger patients preoperatively. However, no significant linear increase was noted with age (p = 0.147). Prostate volume correlated with preoperative alpha-blocker use (p = 0.04). Conclusions: Older patients appear to have a higher incidence of medical treatment for de novo OAB symptoms after PUL. Prolonged medical therapy may delay surgical intervention, and intervention at an earlier age, unrelated to prostate volume, is postulated to be preventative of these symptoms. Further studies are needed to delineate long-term effects of medications, obstruction, and environmental factors that may lead to OAB after the obstruction is treated as well as the effect of early intervention on obstruction.

Metastatic Adenocarcinoma of the Prostate to the Brain Initially Suspected as Meningioma by Magnetic Resonance Imaging.

Brain metastasis from prostate cancer is rare, occurring in less than 1% of metastatic prostate cancer patients. Brain metastasis can cause edema, neurologic symptoms, and may be misdiagnosed as primary brain tumors on imaging. A 68-year-old male presented to the emergency department complaining of headaches, right-sided weakness, multiple falls, and a 45 pounds of unintentional weight loss. Computerized tomography (CT) scan without contrast of the head showed a 3.2 cm right frontal mass with edema suspicious for meningioma. Associated nonspecific bony lesions were found on CT of the abdomen and pelvis. Magnetic resonance imaging (MRI) of the brain showed a 2.8 cm right frontal mass with an enhanced dural tail. Preoperative labs were noteworthy for a hemoglobin of 9.7 and prostate-specific antigen (PSA) of 66.7 ng/ml. Craniotomy with resection of tumor was performed with a frozen sample diagnosed as meningioma. Permanent pathology with stains were positive for PSA and prostatic-specific acid phosphatase (PSAP), making the diagnosis of metastatic prostate adenocarcinoma. Postoperatively, nuclear bone scan showed uptake in the axial skeleton consistent with metastasis. After the diagnosis of metastatic prostate cancer was made, bicalutamide was administered followed by degarelix with plans to transition to leuprorelin one month later. This is to be followed up by whole brain radiation therapy (WBRT). PSA was 118.53 ng/ml three weeks after craniotomy, but prior to androgen deprivation therapy. Metastatic prostate cancer can present with neurological symptoms most commonly following spread to the axial skeleton and impingement of the spinal cord. Metastasis to the brain is rare and is usually associated with vague symptomatology depending on extent and location of the lesion. While brain metastasis can occur in known prostate cancer patients, this case shows that metastasis can occur prior to any formal prostate cancer diagnosis and can be mistaken for meningioma on imaging and frozen sectioning. Practitioners must be vigilant, and precautions should be taken to rule in metastatic prostate cancer as a possible cause for a brain lesion in patients of the appropriate demographics.