Rectoprostatic fistula: unusual presentation of a prostatic abscess.

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. CONCLUSIONS: Prostatic abscess is often difficult to diagnose because of its low prevalence and unspecific symptomatology. Since the introduction of antibiotics, cases in which abscess fistulas or opens spontaneously to neighboring structures like urethra or rectum have decreased.

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)

[Follow-up of the FlowSecure artificial urinary sphincter]. / Seguimiento del esfínter urinario artificial FlowSecure.

The AMS-800 artificial urinary sphincter has been the only prosthesis available for treatment of stress urinary incontinence refractory to other therapeutic modalities for the past 25 years. The relatively high rate of complications occurring with the AMS-800 device during this time led to introduce a number of changes in its design that resulted in a new prostheses, the FlowSecure artificial sphincter. The FlowSecure artificial urinary sphincter is an adjustable prosthesis filled with normal saline without contrast. Plain X-rays cannot therefore be used for monitoring, and ultrasound is the most adequate radiographic technique for evaluation. In addition to calculating the post-void residue, ultrasound allows for verifying prosthesis status and for calculating the urethral occluding pressure. A detailed clinical history and flow rate measurement should be used together with the ultrasound scan to functionally assess patients with the FlowSecure device in order to determine the need for adjusting system pressure to the minimum pressure required for total continence.

Seguimiento del esfínter urinario artificial FlowSecure / Follow-up of the FlowSecure artificial urinary sphincter

El esfínter urinario artificial AMS-800 ha sido la única prótesis disponible para el tratamiento de la incontinencia urinaria de esfuerzo refractaria a otras modalidades terapéuticas durante los últimos 25 años. La tasa relativamente elevada de complicaciones derivadas de su utilización durante este tiempo provocó una serie de modificaciones en su diseño, lo que dio como resultado la aparición en el mercado del esfínter urinario artificial Flow Secure. El esfínter urinario artificial Flow Secure es una prótesis ajustable rellena de suero salino sin contraste, por lo que la radiografía simple no es útil para su seguimiento; la ecografía es la técnica radiológica más adecuada para su valoración. Además de calcular el residuo posmiccional, la ecografía permite verificar el estado de la prótesis y calcular la presión a la que está siendo sometida la uretra por el esfínter. Al uso de la ecografía debe de añadirse la utilización de flujometría y de una historia clínica detallada. Estos últimos son los elementos adecuados para realizar una valoración funcional correcta del paciente portador de la prótesis, ya que permiten valorar la necesidad de ajustar la presión del sistema a la continencia del paciente, si esto fuera necesario (AU)

The AMS-800 artificial urinary sphincter has been the only prosthesis available for treatment of stress urinary incontinence refractory to other therapeutic modalities for the past 25 years. The relatively high rate of complications occurring with the AMS-800 device during this time led to introduce a number of changes in its design that resulted in a new prostheses, the Flow Secure artificial sphincter. The Flow Secure artificial urinary sphincter is an adjustable prosthesis filled with normal saline without contrast. Plain X-rays cannot therefore be used for monitoring, and ultrasound is the most adequate radiographic technique for evaluation. In addition to calculating the post-void residue, ultrasound allows for verifying prosthesis status and for calculating the urethral occluding pressure. A detailed clinical history and flow rate measurement should be used together with the ultrasound scan to functionally assess patients with the Flow Secure device in order to determine the need for adjusting system pressure to the minimum pressure required for total continence (AU)