Fístula recto-prostática. Una presentación inusual de un absceso prostático / Rectoprostatic fistula: Unusual presentation of a prostatic abscess

OBJETIVO: Comunicar el caso y la iconografía de una fístula recto-prostática como forma de presentación de un absceso prostático y revisar brevemente la literatura sobre el diagnóstico y tratamiento de esta patología.MÉTODOS: Varón de 69 años con pluripatología de base que en el contexto de una infección urinaria febril presenta al tacto rectal un orificio en celda prostática apreciándose en TAC y colonoscopia, un absceso prostático fistulizado a recto.RESULTADOS: Ante el drenaje espontáneo del absceso se optó por el tratamiento conservador con sueroterapia y antibioterapia.CONSCLUSIONES: El absceso prostático es una entidad de difícil diagnóstico por su baja prevalencia y su sintomatología inespecífica. Desde la aparición de los antibióticos son cada vez menos los casos que fistulizan o abren espontáneamente a estructuras vecinas como uretra o recto(AU)

OBJECTIVE: To present the case and iconography of a rectoprostatic fistula as a form of presentation of a prostatic abscess and to review the literature on the diagnosis and treatment of this pathology.METHODS: 69-year-old male with multiple pathologic conditions who presents an orifice in the prostatic fossa on digital rectal examination in the scenario of a urinary tract infection with fever. CT scan and colonoscopy showed a prostatic abscess fistulizing to rectum.RESULTS: Due to spontaneous drainage of the abscess, conservative treatment with intravenous fluid therapy and antibiotics was chosen.CONSCLUSIONS: Prostatic abscess is often difficult to diagnose because of its low prevalence and unspecific symptomatology. Since the introduction of antibiotics, cases in which abscess fistulises or opens spontaneously to neighboring structures like urethra or rectum have decreased(AU)

[Optimisation of early diagnosis of prostatic diseases in megapolis setting].

One of the aims in the strategy of Moscow health service is perfection of early diagnosis of urological diseases. Examination of about 1.500000 males over 50 years was conducted in 2002-2007. The number of PSA tests rose 5-fold for 5 years. The number of ultrasonographies and transrectal ultrasonic investigations of the prostate rose from 21650 (2002) to 128890 (2007), the number of polyfocal biopsies--from 2165 (2002) to 12219 (2007). The rate of detection of prostatic diseases increased from 1146 cases per 100000 adult male population (1999) to 2097 (2007). Chronic prostatitis was registered in 17.8%, prostatic adenoma in 29.6% examinees, new cases of prostatic cancer were detected in 0.86% examinees. Standard prostatic cancer morbidity rose from 30.4 to 47.0 per 100000 male population. Percentage of early detected prostatic cancer increased from 42.9% in 2000 to 62% in 2007, detection of prostatic cancer stage III-IV reduced from 27.3% in 2000 to 16.6% in 2007. Thus, new prophylactic measures improved efficacy of outpatient urological service, raised rate of detection of chronic prostatitis, prostatic adenoma, prostatic cancer

An analysis of deaths related to urological surgery, reviewed by the State Coroner: a case for cardiac vigilance before transurethral prostatectomy.

OBJECTIVES: To ascertain the frequency of in-hospital deaths after urological surgery in a compulsory reporting setting, and to identify the contributing and potentially reversible factors involved in patients who had had transurethral resection of the prostate (TURP). METHODS: We reviewed all hospital deaths reported to the State Coroner from Coronial Services Victoria (CSV), Australia, in 2000-2002 to identify those instances associated with urological surgery. These cases were then analysed using methods developed by CSV. Resources available included medical records, police reports, government data on operative procedures and autopsy results. RESULTS: There were 20 in-hospital deaths after urological surgery identified for the 3-year period; most related to pre-existing comorbidities, predominantly ischaemic heart disease. Two episodes of hospital-acquired infection, two instances of technical complication of surgery contributing to death, and one pulmonary embolus were identified. Numerically the largest group of deaths after surgery was patients having TURP, and these deaths represented 0.05% (nine of 17 044) of all TURPs in this period. Most in this group (eight) had an acute myocardial infarction. CONCLUSION: Death after urological surgery appears to be uncommon; assessing patients for coronary artery disease before urological surgery, particularly TURP, closer cardiovascular monitoring after surgery, and rapid transfer to a coronary care unit if required, may further reduce mortality.

Long-term survival of stage A prostate carcinoma, atypical hyperplasia/adenosis and BPH.

Between 1972 and 1986, 134 patients with stage A carcinoma of the prostate (CAP) were diagnosed at a single Veterans Administration medical centre and followed annually by the hospital tumour registry. Seventy-four were classified as stage A1, defined as non-palpable, well-differentiated CAP, regardless of amount, found unexpectedly on transurethral resection of the prostate (TURP). Twenty-eight were classified as stage A2, defined as non-palpable, moderately or poorly differentiated CAP, regardless of amount, found unexpectedly on TURP. The remaining 32 were reclassified as atypical hyperplasia/adenosis (AH/A) rather than CAP. The survival of each group was compared with the survival of a control group from the same medical centre who had TURPs showing histologically proven benign prostatic hyperplasia (BPH). Survival and tumour progression were similar for patients with stage A1 CAP, AH/A and BPH. Furthermore, patients with stage A1 CAP, with or without therapy, had similar survivals as patients with BPH in each age group (under 65, 65-74 and over 74 years). Stage A2 CAP was associated with a significantly worse survival and more tumour progression. Within stage A1 CAP and stage A2 CAP the percentage of chips with CAP or the amount of CAP removed did not affect survival.

Prevalence and outcome of renal impairment at prostatectomy.

Of 382 patients undergoing prostatectomy in Oxford in 1985 the prevalence of renal impairment (defined as plasma urea > 14 mmol/l or plasma creatinine > 200 mumol/l) was 8%; prostatectomy patients had significantly higher plasma ureas than age-matched patients undergoing herniorrhaphy and cholecystectomy in the same hospitals in the same year. A review of the case records of men with renal impairment showed that case history could not predict renal impairment. Although few case notes gave follow-up information, it was evident from the information available that recovery of renal function after prostatectomy did not occur invariably. Renal impairment in men undergoing prostatectomy represents substantial and unrecognised morbidity.

Prostatectomy: patients' perception and long-term follow-up.

We have reviewed 500 consecutive prostatectomies with a follow-up period of between 5 and 8 years; 184 surviving patients were sent a questionnaire and patients with residual urinary symptoms were interviewed, examined and a flow rate was performed. The operative mortality rate was 0.5%. Patients who presented with retention of urine had a high mortality rate in the first 3 years after the operation. Thirty-six per cent of surviving patients with chronic retention and 24% of those who underwent elective prostatectomy had residual urinary symptoms at the time of the study. Of patients who were sexually active pre-operatively, 34% felt that the operation was responsible for a deterioration in their sex lives. The incidence of retrograde ejaculation was 93%. It was concluded that prostatectomy is a safe operation with good patient acceptability. Patients with symptoms of prostatism require careful evaluation before prostatectomy and sexually active patients should be warned of the risks of impotence and decreased satisfaction due to retrograde ejaculation.