Contemporary management of prostatic abscess: Our experience.

Introduction: Prostatic abscess is a serious urological problem that needs immediate attention due to its high morbidity and mortality in absence of appropriate treatment. The objective of our study is to evaluate the efficacy and safety of various modalities of management of prostatic abscess: medical management (MM), transrectal ultrasound-guided aspiration (TRUS-GA), and transurethral deroofing (TU-DR. Methods: This retrospective study was done in a tertiary care center after taking approval from the institutional review board. Conservative management was done by oral or parenteral medications. Transrectal ultrasound GAs were performed under local anesthesia with an 18-gauge two-part needle. Collapse of cavity was seen in "real time" on TRUS. TU-DR of the prostate was done by 26 French continuous irrigation monopolar resectoscopes. The aspirated pus was sent for microbiological investigation. Results: TRUS-guided aspiration was performed in 20 patients, TU-DR in five patients, and conservative management in 15 patients. The mean volume of abscess aspirated by TRUS guidance was 13 cc (range 8-50 cc) with single-time aspiration in 85% of cases. Re-aspiration was done in 3 patients. The mean volume of abscess was 33.2 cc (range: 25-40 cc) in TU-DR group and 1.2 cc (range 0.5-2.0 cc) in the MM group. The predominant organism isolated was Escherichia coli (48%). Clinical improvement was seen in 97.5% of cases. Conclusion: We suggest TRUS-GA for symptomatic patients with abscess size more than 2 cc and TU-DR if TRUS-GA fails or is contraindicated.

A prospective, multi-center, open-label, single-arm phase 2b study of autologous adult live cultured buccal epithelial cells (AALBEC) in the treatment of bulbar urethral stricture.

PURPOSE: To evaluate the safety and efficacy of autologous adult live cultured buccal epithelial cells (AALBEC) in treatment and management of bulbar urethral stricture in men. METHODS: This was a prospective, multi-center, open-label, single-arm phase 2b study. A total of 18 male patients with bulbar urethral stricture of at least 1 - 4 cm in length were enrolled in the study. All 16 patients had AALBEC implanted and were included in the safety set. Change in total American Urology Association (AUA) symptom score, urinary flow rates assessed by uroflowmetry and a requirement for surgery after 24 weeks from baseline were determined in patients. Data of treatment efficacy were analyzed. RESULTS: The AUA score at baseline was 21 (3.9) that showed a statistically significant reduction starting from week 2 [8 (4.4), p = 0.0001] which sustained until week 24 [2 (1.2), p = 0.0005]. Overall mean total AUA symptom score was reduced by 90.5% after the treatment. Significant reductions from baseline at week-24 were also observed in voiding time (92.5 (47.3) vs. 51.9 (17.4) s, p = 0.0046) and flow time [86.9 (48.2) vs. 47.9 (19.6) s, p = 0.0052]. All patients showed absence of any significant adverse events. CONCLUSION: Significant improvement was seen in the AUA symptom score and uroflowmetry parameters and no patients required surgery during 24 weeks post-treatment. It can be concluded that AALBEC is a safe and effective treatment for bulbar urethral stricture of 1 - 4 cm length to improve the quality of life and the physiological function of urethra.

Localization and restaging of carcinoma prostate by 68Gallium prostate-specific membrane antigen positron emission tomography computed tomography in patients with biochemical recurrence.

INTRODUCTION: Radical prostatectomy (RP) and radical radiotherapy (RT) are well established primary curative options for localized prostate cancer. Despite technical improvements, prostate-specific antigen (PSA)-recurrence after RP and RT is a common clinical scenario. We aimed to assess the role of 68Gallium (68Ga) prostate-specific membrane antigen positron emission tomography computed tomography (PSMA PET/CT) in patients with biochemical recurrence of prostate cancer after RP or RT for the detection and localization recurrent and metastatic disease. MATERIALS AND METHODS: We ambispectively (70 retrospective and 100 prospective) analyzed the data of men with biochemical recurrence post-RP and post-RT who were evaluated by 68Ga PSMA PET/CT at our institute. We aimed to assess the relationship between serum PSA levels and the probability of having a positive scan in patients with recurrent prostate cancer. RESULTS: The study included 170 men, all had adenocarcinoma of the prostate, 124/170 had previous RP and 46/170 had prior RT. The median serum PSA in the RP group was 1.8 ng/ml and 5.2 ng/ml in the RT group. In the post-RP cohort, the detection rate of 68Ga PSMA PET/CT was 39.3% for PSA 0.2 to <0.5 ng/ml, 47.3% for PSA 0.5 to <1 ng/ml, 68.4% for PSA 1 to <2 ng/ml and 93.1% for PSA ≥2 ng/ml. In the post-RT group, the detection rate was 88.8% for PSA 2 to <4 ng/ml and 100% for PSA ≥4 ng/ml. CONCLUSIONS: 68Ga PSMA PET/CT provides a novel imaging modality for the detection of prostate cancer recurrence and metastases at low posttreatment PSA levels, which may help in directing appropriate salvage treatments.

Successful cloning of a superior buffalo bull.

Somatic cell nuclear transfer (SCNT) technology provides an opportunity to multiply superior animals that could speed up dissemination of favorable genes into the population. In the present study, we attempted to reproduce a superior breeding bull of Murrah buffalo, the best dairy breed of buffalo, using donor cells that were established from tail-skin biopsy and seminal plasma. We studied several parameters such as cell cycle stages, histone modifications (H3K9ac and H3K27me3) and expression of developmental genes in donor cells to determine their SCNT reprogramming potentials. We successfully produced the cloned bull from an embryo that was produced from the skin-derived cell. Growth, blood hematology, plasma biochemistries, and reproductive organs of the produced cloned bull were found normal. Subsequently, the bull was employed for semen production. Semen parameters such as CASA (Computer Assisted Semen Analysis) variables and in vitro fertilizing ability of sperms of the cloned bull were found similar to non-cloned bulls, including the donor bull. At present, we have 12 live healthy progenies that were produced using artificial insemination of frozen semen of the cloned bull, which indicate that the cloned bull is fertile and can be utilized in the buffalo breeding schemes. Taken together, we demonstrate that SCNT can be used to reproduce superior buffalo bulls.

Uncommon Penio-Scrotal Metastases of Prostate Cancer Detected on 68Ga PSMA PET/CT.

A 68-year-old man, a known case of carcinoma prostate (Gleason score 4 + 4), status post transurethral resection of prostate cancer and radiotherapy, on hormonal treatment with rising prostate-specific antigen 9.0 ng/mL and penile swelling underwent Ga-PSMA PET/CT scan for metastatic workup and restaging. The study revealed abnormal tracer uptake in the prostatic bed region, the pelvic and inguinal lymph nodes, and metastases to the glans of penis and scrotum. The penile and scrotal lesion was proved to be metastatic adenocarcinoma from prostate on fine-needle aspiration cytology.

Ovarian response of prepubertal Murrah heifers to exogenous GnRH.

The aim of the current study was to evaluate the ovarian follicular response to GnRH at two dose levels in prepubertal Murrah buffalo heifers during hot-humid months. Heifers received 10 µg (Group A, n=7) or 20 µg (Group B, n=6) of GnRH during the growing phase of the dominant follicle (DF>6mm), as identified by pretreatment regular ultrasound scanning. A similar dose was repeated approximately 30 days later, again coinciding with another growing DF. Post-treatment ovarian activity was studied by alternate day transrectal ultrasonography until 25 days post-second GnRH. In both groups, three types of response were recorded: formation of a corpus luteum (CL), luteinization of the follicle wall, i.e. luteinized follicle (LF) or no response (NR). Pooled data at GnRH injections revealed that the DF diameter in relation to the type of response in Group A heifers was, NR: 6.83 ± 0.17 (n=3), LF: 8.10 ± 0.67 (n=6) and CL: 8.88 ± 0.96 mm (n=5), while respective values in Group B heifers were 8.68 ± 0.44 mm (n=4), 9.37 ± 0.46 (n=6) and 8.95 ± 0.55 mm (n=2). The pattern of response was more evident in Group A but unpredictable in Group B. Corpora lutea developed in response to both the GnRH injections were short-lived. Mean maximum diameter of LFs in Groups A and B were 16.07 ± 0.99 and 16.58 ± 1.20 mm respectively and wave duration of these follicles in both groups was 23.33 ± 1.67 and 25.33 ± 1.12 days, respectively. None of the heifers commenced cyclicity following regression of the CL or LF.