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Baker JB, Balu AR, Rajeswaran S, Patel SJ, Goldstein SD, Donaldson JS. Percutaneous Drainage of Pediatric Pulmonary Abscesses: An Effective Therapy. J Pediatr Surg 2024; 59:1725-1729. [PMID: 38834410 DOI: 10.1016/j.jpedsurg.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Pulmonary abscess is a complication of lung infection with localized necrosis and purulent cavity formation. Pulmonary abscesses are typically managed using antibiotic therapy with anatomic surgical resection reserved as a rescue. Percutaneous drainage is considered relatively contraindicated in some centers due to perceived risk of bronchopleural fistula. However, drain placement has been frequently employed at our institution. The purpose of this study was to review and describe our longitudinal experience. METHODS Medical records of children diagnosed with lung abscess and treated with percutaneous drainage from 2005 through 2023 were reviewed. Patient clinical parameters, follow-up imaging, and clinical outcomes were evaluated. RESULTS Percutaneous drainage (n = 24) or aspiration alone (n = 4) under imaging guidance was performed by interventional radiologists for 28 children with lung abscesses. A single catheter (8-12 Fr) was deployed in the pulmonary abscess cavity and remained for a median of 6 days (IQR: 6-8 days). The median hospital stay was 10 days (IQR: 8.8-14.8 days). The technical success rate for percutaneous drainage or aspiration of primary pulmonary abscesses was 100% (26/26). Two children were later diagnosed with secondarily infected congenital pulmonary airway malformations that were both successfully drained and ultimately surgically resected. The abscess cavities resolved in all patients and catheters were removed upon clinical, radiographic, and laboratory improvement. Complications included the presence of two bronchopleural fistula, both of which were treated with immediate pleural drain placement. CONCLUSION Percutaneous drainage of pulmonary abscesses is an effective therapeutic option in children and can be considered alongside antibiotics as part of the initial treatment for pulmonary abscesses. Bronchopleural fistula can occur, but at a lower frequency than previously reported. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Joe B Baker
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Abhinav R Balu
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - Sameer J Patel
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Seth D Goldstein
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - James S Donaldson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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2
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Kranz J, Bartoletti R, Bruyère F, Cai T, Geerlings S, Köves B, Schubert S, Pilatz A, Veeratterapillay R, Wagenlehner FME, Bausch K, Devlies W, Horváth J, Leitner L, Mantica G, Mezei T, Smith EJ, Bonkat G. European Association of Urology Guidelines on Urological Infections: Summary of the 2024 Guidelines. Eur Urol 2024; 86:27-41. [PMID: 38714379 DOI: 10.1016/j.eururo.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND AND OBJECTIVE Urological infections significantly impact the wellbeing and quality of life of individuals owing to their widespread occurrence and diverse clinical manifestations. The objective of the guidelines panel was to provide evidence-based guidance on the diagnosis, treatment, and prevention of urinary tract infections (UTIs) and male accessory-gland infections, while addressing crucial public health aspects related to infection control and antimicrobial stewardship. METHODS For the 2024 guidelines on urological infections, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences. KEY FINDINGS AND LIMITATIONS Key recommendations emphasise the importance of a thorough medical history and physical examination for patients with urological infections. The guidelines stress the role of antimicrobial stewardship to combat the rising threat of antimicrobial resistance, providing recommendations for antibiotic selection, dosing, and duration on the basis of the latest evidence. CONCLUSIONS AND CLINICAL IMPLICATIONS This overview of the 2024 EAU guidelines offers valuable insights into managing urological infections and are designed for effective integration into clinical practice. PATIENT SUMMARY The European Association of Urology has issued an updated guideline on urological infections. The guidelines provide recommendations for diagnosis, treatment, and prevention, with a particular focus on minimising antibiotic use because of the increasing global threat of antimicrobial resistance.
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Affiliation(s)
- Jennifer Kranz
- Department of Urology and Pediatric Urology, RWTH Aachen University, Aachen, Germany; Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle, Germany.
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Franck Bruyère
- Department of Urology, CHRU Bretonneau, Tours, France; Université Francois Rabelais, PRES Centre Val de Loire, Tours, France
| | - Tommaso Cai
- Department of Urology, Santa Chiara, Regional Hospital, Trento, Italy
| | - Suzanne Geerlings
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Bela Köves
- Department of Urology, University of Szeged, Szeged, Hungary
| | - Sören Schubert
- Max von Pettenkofer Institute, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | | | - Florian M E Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Kathrin Bausch
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Wout Devlies
- Department of Urology, UZ Leuven, Leuven, Belgium
| | - József Horváth
- BKMK SZTE ÁOK Okt. Kh. Urológiai Osztálya, Kecskemét, Hungary
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Tunde Mezei
- Department of Urology, Telemark Hospital, Skien, Norway
| | - Emma J Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Gernot Bonkat
- alta Uro AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry, University of Basel, Basel, Switzerland
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3
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Yang Y, Shigemura K, Maeda K, Moriwaki M, Chen KC, Nakano Y, Fujisawa M. The harmful effects of overlooking acute bacterial prostatitis. Int J Urol 2024; 31:459-463. [PMID: 38239011 DOI: 10.1111/iju.15390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 12/26/2023] [Indexed: 05/05/2024]
Abstract
Prostatitis is a major urological disease affecting 25%-50% of men over their lifetime. However, prostatitis is often overlooked in nonurologic departments due to its sometimes indeterminate symptoms. In this review, we describe how to recognize and treat acute bacterial prostatitis, which manifests as a clinical problem in other departments as well as urology, to help prevent this disease from being overlooked. There are several possible negative effects of not recognizing acute bacterial prostatitis (ABP). First, initial treatment can fail. In the hyperacute phase, common antibiotics are often effective, but in rare cases, such antibiotics may not be effective. In addition, once ABP progresses to form a prostate abscess, potentially avoidable surgical interventions are often needed. A second issue is the transition to chronic prostatitis. If chronic bacterial prostatitis progresses, treatment requires long-term antibiotic administration and the response rate is not high. Some patients may have to deal with urinary tract infections for the rest of their lives. Finally, there is the problem of overlooking the underlying disease. ABP is rare in healthy adult men without underlying disease, including sexually transmitted diseases as well as benign prostatic hyperplasia, urinary stones, and malignant tumors, and may not be obvious. When examining patients with fever of unknown origin, it is necessary to exclude not only infectious diseases but also collagen diseases and malignant tumors. If there are any doubts, we recommend a rectal exam and consultation with a urologist.
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Affiliation(s)
- Youngmin Yang
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Katsumi Shigemura
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
- Department of International Health, Kobe University Graduate School of Health Sciences, Kobe, Hyogo, Japan
| | - Koki Maeda
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Michika Moriwaki
- Department of International Health, Kobe University Graduate School of Health Sciences, Kobe, Hyogo, Japan
| | - Kuan-Chou Chen
- Department of Urology, Taipei Medical University Shuang Ho Hospital, Taipei, Taiwan
| | - Yuzo Nakano
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Scholtz D, Hooshyari A, Vermeulen LP, Ordones FV. Transperineal drainage of prostate abscesses: A minimally invasive, low-risk management strategy that yields satisfactory results. BJUI COMPASS 2024; 5:207-216. [PMID: 38371211 PMCID: PMC10869666 DOI: 10.1002/bco2.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/30/2023] [Accepted: 10/24/2023] [Indexed: 02/20/2024] Open
Abstract
Objectives In this narrative review, we aim to present two cases of transperineal drainage of prostate abscesses with a good clinical outcome. Furthermore, we reviewed the literature on this treatment approach and aim to propose a minimally invasive protocol for managing this rare condition. Patients and Methods Our patients are 33- and 61-year-old males who both underwent uncomplicated transperineal drainage of prostate abscess with the use of a Precision Point device with rapid clinical improvement and complete resolution of the abscess within the follow-up period. We used PubMed to conduct a literature search and included and evaluated 16 relevant case reports and case series in which the authors utilized transperineal drainage techniques for prostatic abscesses. Results Our first patient was young and very unwell with sepsis and a pulmonary embolism. He had a complex abscess extending through the prostate to the left pelvic side wall. Trans-gluteal drainage of the pelvic side-wall collection was required in addition to transperineal drainage of the prostate abscess. After drainage and a prolonged course of antibiotics, he achieved resolution of the abscess by 7 weeks with ejaculatory function intact. Our second patient who was very keen on the preservation of ejaculatory function had multiple small abscesses and underwent transperineal drainage. He had significant interval improvement of his abscess burden at the 4-week follow-up and complete resolution at the 6-month follow-up. The total number of cases in the literature on our review is 22, with considerable variability in how the authors managed the prostate abscesses that underwent transperineal drainage, including variability in their follow-up time frame, choice of imaging modality, duration of antibiotic treatment, drain placement, and use of irrigation solutions (including antibiotics) into the abscess cavity. Furthermore, the sizes of the prostate abscesses were not consistently reported. Given the small sample size and variability in management from different authors, it was not possible to draw any statistical analysis. Conclusion Transperineal prostate abscess drainage combined with prolonged antibiotic therapy provides a less invasive alternative to treating prostate abscesses for those who which to preserve ejaculatory function and avoid the other adverse events of transurethral de-roofing. In itself, it can achieve complete resolution of abscess. It provides the benefit of drainage under real-time imaging; for percutaneous drain placement; prevents urethral injury; retrograde ejaculation; and can be done under local anaesthetic which is preferable for the unstable patient. The utility of the procedure may be limited by the complexity of the abscess or whether it has extended beyond the prostate. The patient should always be informed that further drainage via percutaneous methods or transurethral methods may be necessary if their clinical condition does not improve. We recommend this procedure be offered as an alternative to transurethral methods in younger patients and those who would like to preserve ejaculatory function. Furthermore, we highly encourage a prolonged course of antibiotic therapy and interval follow-up with clinical review of symptoms and imaging to confirm resolution.
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Affiliation(s)
- David Scholtz
- Urology DepartmentTauranga Public HospitalTaurangaNew Zealand
| | - Ali Hooshyari
- Urology DepartmentTauranga Public HospitalTaurangaNew Zealand
| | - Lodewikus Petrus Vermeulen
- Urology DepartmentTauranga Public HospitalTaurangaNew Zealand
- Surgery DepartmentUniversity of AucklandAucklandNew Zealand
| | - Flavio Vasconcelos Ordones
- Urology DepartmentTauranga Public HospitalTaurangaNew Zealand
- Surgery DepartmentUniversity of AucklandAucklandNew Zealand
- Botucatu School of MedicineSão Paulo State University – UNESPSão PauloBrazil
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5
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Liang F, Cao J, Qin L, Zhang X. Giant Prostate Abscess: A Case Report and Literature Review. Am J Mens Health 2023; 17:15579883231219570. [PMID: 38130088 DOI: 10.1177/15579883231219570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Prostate abscess, a rare condition often associated with prostate bacterial infections, often occurs in immunosuppressive individuals and manifests as fever and lower urinary tract symptoms. Clinical practice lacks standardized diagnostic and treatment protocols for prostate abscesses, resulting in predominantly empirical approaches with uncertain outcomes. This study presents a case of a giant prostate abscess, diagnosed in a patient exhibiting fever, lower urinary tract symptoms (including dysuria, urinary frequency, urgency, and weakness), and anal pain. The diagnosis was confirmed through prostate magnetic resonance imaging and transrectal color ultrasound examinations. Treatment included targeted anti-infective therapy (based on the urine culture results), urine flow diversion (suprapubic bladder puncture stomy), ultrasound-guided perineal puncture drainage of the prostatic abscess, intermittent abscess cavity irrigation, and urethral electroprostatectomy. The patient experienced a complete recovery and significantly improved quality of life. This successful case underscores several key points: (1) the importance of targeted anti-infective therapy based on etiological findings in prostate abscess treatment; (2) early urine flow diversion, precise puncture drainage, and intermittent abscess cavity irrigation may be one of crucial elements in abscess management; (3) the potential significance of transurethral prostate resection following abscess resolution in preventing recurrence. It is hoped that this case report offers new valuable insights for diagnosing and treating prostate abscesses. Slightly different from previous treatment experience, we extra used early urine diversion, intermittent abscess cavity irrigation, and etiological electroprostatectomy, which might also hold promise as potential therapies.
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Affiliation(s)
- Fuchao Liang
- Department of Urology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Jun Cao
- Department of Urology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Linghui Qin
- Department of Urology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Xuejun Zhang
- Department of Urology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
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Brehm TJ, Trautner BW, Kulkarni PA. Acute and Chronic Infectious Prostatitis in Older Adults. Infect Dis Clin North Am 2023; 37:175-194. [PMID: 36805012 DOI: 10.1016/j.idc.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Acute and chronic bacterial prostatitis are clinically significant entities that can be difficult to diagnose and appropriately treat. Herein, we review when to suspect these clinical conditions, how to diagnose them, and how to effectively treat them based on the extant literature. Our aim was to equip the practicing clinician with the ability to proficiently diagnose and manage acute and chronic bacterial prostatitis, particularly in older patients.
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Affiliation(s)
- Tyler J Brehm
- Department of Medicine, Section of General Internal Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX 77030, USA
| | - Prathit A Kulkarni
- Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA; Department of Medicine, Infectious Diseases Section, Baylor College of Medicine, Houston, TX 77030, USA.
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7
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Tesdal L, Morath K. [65/m with very painful and impaired micturition : Preparation for the medical specialist examination: part 23]. Urologe A 2021; 61:76-80. [PMID: 34739567 DOI: 10.1007/s00120-021-01665-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Lisa Tesdal
- Klinikum Sindelfingen-Böblingen, Kliniken Sindelfingen, Urologische Klinik, Klinikverbund Südwest, Arthur- Gruber-Straße 70, 71065, Sindelfingen, Deutschland.
| | - Kristin Morath
- Klinikum Sindelfingen-Böblingen, Kliniken Sindelfingen, Urologische Klinik, Klinikverbund Südwest, Arthur- Gruber-Straße 70, 71065, Sindelfingen, Deutschland
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8
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AAUS guideline for acute bacterial prostatitis 2021. J Infect Chemother 2021; 27:1277-1283. [PMID: 34116910 DOI: 10.1016/j.jiac.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/12/2021] [Accepted: 06/01/2021] [Indexed: 11/20/2022]
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9
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Infection with capsular genotype K1-ST23 hypervirulent Klebsiella pneumoniae isolates in Japan after a stay in East Asia: Two cases and a literature review. J Infect Chemother 2021; 27:1508-1512. [PMID: 34088602 DOI: 10.1016/j.jiac.2021.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022]
Abstract
Disseminated community-acquired infections caused by the hypervirulent Klebsiella pneumoniae (hvKp) among relatively healthy individuals in East Asia have been reported in recent years. Isolate of the capsular genotype K1, belonging to sequence type (ST) 23, is the most common causative agent of this disease. We experienced two cases of K1-ST23 infection with a travel history in East Asia, and hvKp infection was diagnosed after entering or returning to Japan. Case 1 was a 45-year-old Myanmar seaman with a history of ischemic heart disease who developed a fever on board and was transported to Japan via Shanghai and Taiwan. He had multiple disseminated lesions due to K. pneumoniae; other symptoms included liver abscess, intraocular inflammation, intraventricular thrombosis, brain abscess, and bloodstream infection. Along with antimicrobial treatment, drainage of liver abscesses and surgery for intraocular inflammation and intraventricular thrombosis were required. The patient was discharged 93 days after admission, with little improvement in the visual acuity. Case 2: A 29-year-old Japanese man with no underlying disease developed a prostate abscess and bloodstream infection caused by K. pneumoniae after a trip to Korea. However, he improved only with antimicrobial treatment. K. pneumoniae in both cases were identified to have the rmpA gene, with capsular genotypes K1 and ST23. Further, both cases were considered to have been infected with hvKp during their stay in East Asia. In conclusion, it is important to suspect disseminated disease and perform a systemic search, taking into account that hvKp may be present in cases of Klebsiella infection acquired from East Asia.
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10
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Pishdad R, Sullivan S, Mohammadi O. Abcès de la prostate. CMAJ 2021; 193:E706-E707. [PMID: 33972230 PMCID: PMC8157995 DOI: 10.1503/cmaj.200470-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Reza Pishdad
- Département de médecine interne (Pishdad, Sullivan), Rutgers New Jersey Medical School, Newark, N.J.; Département de médecine interne (Mohammadi), Aventura Hospital and Medical Center, Miami, Fla.
| | - Sean Sullivan
- Département de médecine interne (Pishdad, Sullivan), Rutgers New Jersey Medical School, Newark, N.J.; Département de médecine interne (Mohammadi), Aventura Hospital and Medical Center, Miami, Fla
| | - Oranus Mohammadi
- Département de médecine interne (Pishdad, Sullivan), Rutgers New Jersey Medical School, Newark, N.J.; Département de médecine interne (Mohammadi), Aventura Hospital and Medical Center, Miami, Fla
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11
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Shakur A, Hames K, O'Shea A, Harisinghani MG. Prostatitis: imaging appearances and diagnostic considerations. Clin Radiol 2021; 76:416-426. [PMID: 33632522 DOI: 10.1016/j.crad.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/14/2021] [Indexed: 02/07/2023]
Abstract
Acute and chronic inflammation of the prostate gland can be attributed to several underlying aetiologies, including but not limited to, bacterial prostatitis, granulomatous prostatitis, and Immunoglobulin G4-related prostatitis. In this review, we provide an overview of the general imaging appearances of the different types of prostatitis, their distinguishing features and characteristic appearances at cross-sectional imaging. Common imaging pitfalls are presented and illustrated with examples.
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Affiliation(s)
- A Shakur
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - K Hames
- Department of Radiology, Hamilton General Hospital, 237 Barton Street E, Hamilton, Ontario, L8L 2X2, Canada
| | - A O'Shea
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - M G Harisinghani
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
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12
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Pishdad R, Sullivan S, Mohammadi O. Prostatic abscess. CMAJ 2021; 193:E290. [PMID: 33619070 PMCID: PMC8034352 DOI: 10.1503/cmaj.200470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Reza Pishdad
- Department of Internal Medicine (Pishdad, Sullivan), Rutgers New Jersey Medical School, Newark, NJ; Department of Internal Medicine (Mohammadi), Aventura Hospital Medical Center, Miami, Fla.
| | - Sean Sullivan
- Department of Internal Medicine (Pishdad, Sullivan), Rutgers New Jersey Medical School, Newark, NJ; Department of Internal Medicine (Mohammadi), Aventura Hospital Medical Center, Miami, Fla
| | - Oranus Mohammadi
- Department of Internal Medicine (Pishdad, Sullivan), Rutgers New Jersey Medical School, Newark, NJ; Department of Internal Medicine (Mohammadi), Aventura Hospital Medical Center, Miami, Fla
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Abstract
PURPOSE OF REVIEW We conducted a review of the literature describing the most up-to-date diagnosis and treatment options of chronic bacterial prostatitis. RECENT FINDINGS Recurrence after oral antimicrobial therapy is common, due in part to the rising rates of antimicrobial resistance and inability to completely clear the offending bacteria from the prostate following prostatitis. Recent literature has described various treatment options for chronic bacterial prostatitis refractory to conventional antimicrobial agents, including the use of alternative agents such as fosfomycin, direct antimicrobial injections into the prostate, surgical removal of infected prostatic tissue, chronic oral antibiotic suppression, and an emerging novel therapy utilizing bacteriophages to target antibiotic resistant bacteria. Management of chronic bacterial prostatitis, especially recurrence after oral antimicrobial treatment, remains challenging. This review highlights an urgent need for further evidence assessing the efficacy and safety of treatment modalities for chronic bacterial prostatitis refractory to conventional oral antimicrobials.
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14
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Khudhur H, Brunckhorst O, Muir G, Jalil R, Khan A, Ahmed K. Prostatic abscess: A systematic review of current diagnostic methods, treatment modalities and outcomes. Turk J Urol 2020; 46:tud.2020.19273. [PMID: 32479256 PMCID: PMC7360156 DOI: 10.5152/tud.2020.19273] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/26/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Prostatic abscesses (PAs) are an uncommon urologic presentation with widely varying approaches in their diagnoses and management. This study, therefore, aims to systematically review the literature of PAs to identify common clinical presentations, evaluate currently utilized diagnostic and treatment modalities, and assess their outcomes. MATERIAL AND METHODS A systematic review of the literature was performed using the MEDLINE and EMBASE databases, from January 1968 to June 2019. Outcome measures extracted from identified articles included age, the underlying disease, identified pathogens, diagnostic tool utilized, treatment used, and various subsequent clinical outcomes. RESULTS The literature search yielded 683 articles, with a final twelve included in the review, representing a total of 210 patients. Transrectal ultrasonography (TRUS) was the most commonly used imaging tool used to identify PAs in all twelve studies. The PAs were treated with conservative antibiotic treatment in seven studies. Transurethral resection of the prostatic abscess (TURP) was utilized in eight studies with an average abscess size of 3.87 cm (3.0-4.0 cm) and with an average hospital stay of 10.22 days in those undergoing TURP. Transperineal aspiration was seen in five studies and offered a less invasive treatment modality. Finally, TRUS-guided needle aspiration was seen in seven studies with an average hospital stay of 23.25 days. This was the longest of any identified modalities with an additional high rate of abscess recurrence. CONCLUSION Diagnosis and treatment practices of PAs remain widely varied in the literature due to a lack of clear guidelines. Based on the current evidence, we provide recommendations of treatment based on abscess size, patient age, and clinical condition. While smaller abscesses may be suited to antibiotic or TRUS-guided aspiration, transurethral approaches should be considered for larger and more complex abscesses. However, the current evidence remains poor with further research required to determine the optimum treatment modalities for patients.
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Affiliation(s)
- Hasan Khudhur
- Department of Urology, King’s College Hospital, London, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, UK
| | - Gordon Muir
- Department of Urology, King’s College Hospital, London, UK
| | - Rozh Jalil
- Department of Urology, King’s College Hospital, London, UK
| | - Azhar Khan
- Department of Urology, King’s College Hospital, London, UK
| | - Kamran Ahmed
- Department of Urology, King’s College Hospital, London, UK
- MRC Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, UK
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15
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Weiss CR, Bailey CR, Hohenwalter EJ, Pinchot JW, Ahmed O, Braun AR, Cash BD, Gupta S, Kim CY, Knavel Koepsel EM, Scheidt MJ, Schramm K, Sella DM, Lorenz JM. ACR Appropriateness Criteria® Radiologic Management of Infected Fluid Collections. J Am Coll Radiol 2020; 17:S265-S280. [PMID: 32370971 DOI: 10.1016/j.jacr.2020.01.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 11/20/2022]
Abstract
Infected fluid collections are common and occur in a variety of clinical scenarios throughout the body. Minimally invasive image-guided management strategies for infected fluid collections are often preferred over more invasive options, given their low rate of complications and high rates of success. However, specific clinical scenarios, anatomic considerations, and prior or ongoing treatments must be considered when determining the optimal management strategy. As such, several common scenarios relating to infected fluid collections were developed using evidence-based guidelines for management. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Eric J Hohenwalter
- Panel Chair, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jason W Pinchot
- Panel Vice-Chair, University of Wisconsin, Madison, Wisconsin
| | | | - Aaron R Braun
- St. Elizabeth Regional Medical Center, Lincoln, Nebraska
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Samir Gupta
- Rush University Medical Center, Chicago, Illinois; American College of Surgeons
| | - Charles Y Kim
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Kristofer Schramm
- University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
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16
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Xiong S, Liu X, Deng W, Zhou Z, Li Y, Tu Y, Chen L, Wang G, Fu B. Pharmacological Interventions for Bacterial Prostatitis. Front Pharmacol 2020; 11:504. [PMID: 32425775 PMCID: PMC7203426 DOI: 10.3389/fphar.2020.00504] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/31/2020] [Indexed: 12/16/2022] Open
Abstract
Prostatitis is a common urinary tract condition but bring innumerable trouble to clinicians in treatment, as well as great financial burden to patients and the society. Bacterial prostatitis (acute bacterial prostatitis plus chronic bacterial prostatitis) accounting for approximately 20% among all prostatitis have made the urological clinics complain about the genital and urinary systems all over the world. The international challenges of antibacterial treatment (emergence of multidrug-resistant bacteria, extended-spectrum beta-lactamase-producing bacteria, bacterial biofilms production and the shift in bacterial etiology) and the transformation of therapeutic strategy for classic therapy have attracted worldwide attention. To the best of our knowledge currently, there is not a single comprehensive review, which can completely elaborate these important topics and the corresponding treatment strategy in an effective way. This review summarizes the general treatment choices for bacterial prostatitis also provides the alternative pharmacological therapies for those patients resistant or intolerant to general treatment.
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Affiliation(s)
- Situ Xiong
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Zhengtao Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Yulei Li
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Yechao Tu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
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Dariushnia SR, Mitchell JW, Chaudry G, Hogan MJ. Society of Interventional Radiology Quality Improvement Standards for Image-Guided Percutaneous Drainage and Aspiration of Abscesses and Fluid Collections. J Vasc Interv Radiol 2020; 31:662-666.e4. [PMID: 32061521 DOI: 10.1016/j.jvir.2019.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 12/26/2022] Open
Affiliation(s)
- Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, Georgia.
| | - Jason W Mitchell
- Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida
| | - Gulraiz Chaudry
- Division of Interventional Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Mark J Hogan
- Department of Radiology, Section of Vascular and Interventional Radiology, Nationwide Children's Hospital, Columbus, Ohio
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18
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Wakabayashi Y, Jubishi D, Okamoto K, Ikeda M, Tatsuno K, Mizoguchi M, Sato T, Okugawa S, Moriya K. A rare case of a prostatic abscess, bacteremia and chronic granulomatous disease associated with Klebsiella pneumoniae. J Infect Chemother 2019; 25:365-367. [PMID: 30642769 DOI: 10.1016/j.jiac.2018.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/06/2018] [Accepted: 11/15/2018] [Indexed: 11/24/2022]
Abstract
Chronic granulomatous disease (CGD) is a primary immunodeficiency disease characterized by severe recurrent infections such as pneumonia, liver and skin infections. However, prostatic abscesses are rare as only two cases have been reported thus far. We present the case of a 41-year-old patient with CGD who was admitted to the hospital with fever and subsequently, Klebsiella pneumoniae was identified on blood culture. Abdominal computed tomography revealed a prostatic abscess. He improved with intravenous antibiotics and drainage of the abscess. After he was taken off the intravenous antibiotics and started on an oral agent, he was discharged from the hospital. We confirmed a reduction in the prostatic abscess size and continued the antibiotic therapy for 52 days. A prostatic abscess is an uncommon disease being diagnosed at a median age of 49 years. Sometimes it is discovered in patients with fever of unknown origin and might be considered as an infection site of CGD patients.
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Affiliation(s)
| | | | - Koh Okamoto
- Department of Infectious Diseases, The University of Tokyo
| | - Mahoko Ikeda
- Department of Infectious Diseases, The University of Tokyo; Department of Infection Control and Prevention, The University of Tokyo
| | - Keita Tatsuno
- Department of Infection Control and Prevention, The University of Tokyo
| | - Miyuki Mizoguchi
- Department of Infection Control and Prevention, The University of Tokyo
| | - Tomoaki Sato
- Department of Infection Control and Prevention, The University of Tokyo
| | - Shu Okugawa
- Department of Infectious Diseases, The University of Tokyo
| | - Kyoji Moriya
- Department of Infectious Diseases, The University of Tokyo; Department of Infection Control and Prevention, The University of Tokyo
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19
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Affiliation(s)
- Tze-Chen Chao
- Division of Urology, Taipei Tzu Chi Hospital, the Buddhist Tzu Chi Medical Foundation; School of Medicine, Budhist Tzu Chi University, Hualien, Taiwan
| | - Stephen Shei-Dei Yang
- Division of Urology, Taipei Tzu Chi Hospital, the Buddhist Tzu Chi Medical Foundation; School of Medicine, Budhist Tzu Chi University, Hualien, Taiwan
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20
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Abdelmoteleb H, Rashed F, Hawary A. Management of prostate abscess in the absence of guidelines. Int Braz J Urol 2017; 43:835-840. [PMID: 28379661 PMCID: PMC5678513 DOI: 10.1590/s1677-5538.ibju.2016.0472] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/27/2016] [Indexed: 02/07/2023] Open
Abstract
In contemporary practice, the number of patients presenting with prostatic abscess have significantly declined due to the widespread use of antibiotics. However, when faced with the pathology, prostatic abscess tends to pose a challenge to clinicians due to the difficulty of diagnosis and lack of guidelines for treatment. Treatment consists of an array of measures including parenteral broad-spectrum antibiotic administration and abscess drainage.
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Affiliation(s)
| | | | - Amr Hawary
- Great Western Hospital, Swindon, United Kingdom
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21
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Marcon J, Stief CG, Magistro G. [Urinary tract infections : What has been confirmed in therapy?]. Internist (Berl) 2017; 58:1242-1249. [PMID: 29038902 DOI: 10.1007/s00108-017-0340-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Urinary tract infections (UTIs) affect approximately 150 million people worldwide per year, causing annual health costs of over three billion dollars just in the USA. Every second woman experiences at least one UTI in her lifetime, with every one in four experiencing recurrence. Uncomplicated infections like single or recurrent cystitis and pyelonephritis can be distinguished from complicated disease. UTIs in men can spread to the male glands, causing prostatitis and epididymitis. Antibiotic therapy is the standard procedure for UTIs. However, the extensive and sometimes irrational use of antibiotics for the treatment of infections has led to an increase in the incidence of multiresistant pathogens in recent years. Therefore, preventive nonantibiotic approaches are of great interest. This article provides an overview of the current management of urological infections as well as an outline of nonantibiotic preventive treatment modalities.
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Affiliation(s)
- J Marcon
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - C G Stief
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - G Magistro
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
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22
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Belanger GV, VerLee GT. Diagnosis and Surgical Management of Male Pelvic, Inguinal, and Testicular Pain. Surg Clin North Am 2016; 96:593-613. [PMID: 27261797 DOI: 10.1016/j.suc.2016.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pain occurs in the male genitourinary organs as for any organ system in response to traumatic, infectious, or irritative stimuli. A knowledge and understanding of chronic genitourinary pain can be of great utility to practicing nonurologists. This article provides insight into the medical and surgical management of subacute and chronic pelvic, inguinal, and scrotal pain. The pathophysiology, diagnosis, and medical and surgical treatment options of each are discussed.
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Affiliation(s)
- Gabriel V Belanger
- Division of Urology, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA
| | - Graham T VerLee
- Maine Medical Partners Urology, 100 Brickhill Avenue, South Portland, ME 04106, USA.
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Tonolini M, Ippolito S. Cross-sectional imaging of complicated urinary infections affecting the lower tract and male genital organs. Insights Imaging 2016; 7:689-711. [PMID: 27271509 PMCID: PMC5028337 DOI: 10.1007/s13244-016-0503-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/17/2016] [Accepted: 05/24/2016] [Indexed: 01/08/2023] Open
Abstract
Complicated urinary tract infections (C-UTIs) are those associated with structural or functional genitourinary abnormalities or with conditions that impair the host defence mechanisms, leading to an increased risk of acquiring infection or failing therapy. C-UTIs occur in patients with risk factors such as neurogenic dysfunction, bladder outlet obstruction, obstructive uropathy, bladder catheterisation, urologic instrumentation or indwelling stent, urinary tract post-surgical modifications, chemotherapy- or radiation-induced damage, renal impairment, diabetes and immunodeficiency. Multidetector CT and MRI allow comprehensive investigation of C-UTIs and systemic infection from an unknown source. Based upon personal experience at a tertiary care hospital focused on the treatment of infectious illnesses, this pictorial essay reviews with examples the clinical features and cross-sectional imaging findings of C-UTIs affecting the lower urinary tract and male genital organs. The disorders presented include acute infectious cystitis, bladder mural abscesses, infections of the prostate and seminal vesicles, acute urethritis and related perineal abscesses, funiculitis, epididymo-orchitis and scrotal abscesses. Emphasis is placed on the possible differential diagnoses of lower C-UTIs. The aim is to provide radiologists greater familiarity with these potentially severe disorders which frequently require intensive in-hospital antibiotic therapy, percutaneous drainage or surgery. Teaching Points • Complicated urinary tract infections occur in patients with structural or functional risk factors. • CT and MRI comprehensively investigate complicated urinary infections and sepsis from unknown sources. • Infections of the urinary bladder, prostate, seminal vesicles, urethra and scrotum are presented. • Emphasis is placed on differential diagnoses of complicated lower urogenital infections. • Unsuspected urinary infections may be detected on CT performed for other clinical reasons.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Sonia Ippolito
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy
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ACR Appropriateness Criteria Radiologic Management of Infected Fluid Collections. J Am Coll Radiol 2015; 12:791-9. [DOI: 10.1016/j.jacr.2015.04.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 04/25/2015] [Indexed: 12/26/2022]
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Abstract
PURPOSE To describe an unusual case of endogenous Klebsiella endophthalmitis associated with prostatic abscess in an immunocompetent patient. CASE REPORT A 59-year-old previously healthy man presented with rapidly progressive retinal vasculitis in the left eye. He received an empirical antibiotic and antiviral agent intravenously followed by oral prednisolone until the etiology was identified; however, intraocular inflammation in the left eye continued to worsen, followed by the development of subretinal abscess in the contralateral eye. Finally, a diagnosis of endogenous Klebsiella endophthalmitis associated with prostatic abscess was made through a culture of the vitreous acquired by diagnostic vitrectomy. However, we could not save the vision of the left eye despite the intensive treatment with intravenous and intravitreal injections of antibiotics. CONCLUSIONS Rapidly progressive retinal vasculitis could be an initial sign of endogenous Klebsiella endophthalmitis even in an immunocompetent patient.
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Jiménez-Pacheco A, Jiménez-Pacheco A, Verdú-Martínez M, López-Luque A. Drenaje transperineal ecodirigido de un absceso prostático. A propósito de un caso y revisión de la literatura. Rev Int Androl 2015. [DOI: 10.1016/j.androl.2014.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Lee CH, Ku JY, Park YJ, Lee JZ, Shin DG. Evaluation of holmium laser for transurethral deroofing of severe and multiloculated prostatic abscesses. Korean J Urol 2015; 56:150-6. [PMID: 25685303 PMCID: PMC4325120 DOI: 10.4111/kju.2015.56.2.150] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/02/2014] [Indexed: 12/02/2022] Open
Abstract
Purpose Our objective was to evaluate the use of a holmium laser for transurethral deroofing of a prostatic abscess in patients with severe and multiloculated prostatic abscesses. Materials and Methods From January 2011 to April 2014, eight patients who were diagnosed with prostatic abscesses and who underwent transurethral holmium laser deroofing at Pusan National University Hospital were retrospectively reviewed. Results Multiloculated or multifocal abscess cavities were found on the preoperative computed tomography (CT) scan in all eight patients. All patients who underwent transurethral holmium laser deroofing of a prostatic abscess had successful outcomes, without the need for secondary surgery. Of the eight patients, seven underwent holmium laser enucleation of the prostate (HoLEP) for the removal of residual adenoma. Markedly reduced multiloculated abscess cavities were found in the follow-up CT in all patients. No prostatic abscess recurrence was found. Transient stress urinary incontinence was observed in three patients. The stress urinary incontinence subsided within 3 weeks in two patients and improved with conservative management within 2 months in the remaining patient. Conclusions Transurethral holmium laser deroofing of prostatic abscesses ensures successful drainage of the entire abscess cavity. Because we resolved the predisposing conditions of prostatic abscess, such as bladder outlet obstruction and prostatic calcification, by simultaneously conducting HoLEP, there was no recurrence of the prostatic abscesses after surgery. We recommend our method in patients requiring transurethral drainage.
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Affiliation(s)
- Chan Ho Lee
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
| | - Ja Yoon Ku
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
| | - Young Joo Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jeong Zoo Lee
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
| | - Dong Gil Shin
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
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Kim JH, Yang WJ, Kim TH. Klebsiella pneumonia-induced prostate abscess: How to work it up? Can Urol Assoc J 2014; 8:E841-4. [PMID: 25485013 DOI: 10.5489/cuaj.2155] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTON Klebsiella pneumonia (KP) is related to a metastatic phenomenon from the originally affected primary organ. About 28% of patients with pyogenic liver abscess arising from KP suffer from metastatic complications. This study was done to define the clinical features of KP-induced prostate abscess. METHODS A total of 14 patients were diagnosed with prostate abscess based on clinical, laboratory examination and abdominopelvic computed tomography (CT) scan from 2007 to 2013. RESULTS Among these 14 patients, KP was the dominant causative microorganism in 6 patients (42.9%), followed by Esherchia coli in 2, Pseudomonas aeroginosa in 1, methicillin-resistant Staphyolcoccus aureus in 1, and no growth in either the urine or blood culture in 4. Four (66.7%) of the 6 KP induced-prostate abscess had other concurrent abscess sites besides the prostate: liver in 3, kidney in 1, and perianal area with endogenous endophthalmitis that ended in loss of vision in 1 patient. CONCLUSIONS We report on the clinical features of KP-induced prostate abscess based on a small number of patients, which is the main limitation of our study. We believe that if the causative organism of a prostate abscess was KP, more workup would be needed to rule out the presence of an abscess in other organs, especially in the liver. Abdominopelvic CT scan would be a proper imaging modality.
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Affiliation(s)
- Jae Hoen Kim
- Department of Urology, Soonchunhyang University, College of Medicine, Seoul, South Korea
| | - Won Jae Yang
- Department of Urology, Soonchunhyang University, College of Medicine, Seoul, South Korea
| | - Tae Hyong Kim
- Infection Urology, Soonchunhyang University, College of Medicine, Seoul, South Korea
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Wagenlehner FME, Pilatz A, Bschleipfer T, Diemer T, Linn T, Meinhardt A, Schagdarsurengin U, Dansranjavin T, Schuppe HC, Weidner W. Bacterial prostatitis. World J Urol 2013; 31:711-6. [PMID: 23519458 DOI: 10.1007/s00345-013-1055-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 03/06/2013] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES The prostatitis syndrome is classified into bacterial prostatitis (acute and chronic), chronic pelvic pain syndrome and asymptomatic prostatitis. The aim of this report is to review current management standards for bacterial prostatitis. METHODS A research was performed on literature dealing with acute and chronic bacterial prostatitis. RESULTS There is a consensus on diagnostic management of bacterial prostatitis comprising microbiological sampling of midstream urine in acute bacterial prostatitis and performance of a bacterial localisation test in chronic bacterial prostatitis. Approximately 10 % of acute bacterial prostatitis cases eventually develop into chronic bacterial prostatitis and further 10 % into chronic pelvic pain syndrome. Bacterial isolates causing acute bacterial prostatitis are highly virulent strains comprising an array of different virulence factors. Presumably, the additional ability of isolates to form biofilms might be one factor amongst others to facilitate development of chronic bacterial prostatitis. Therapy for infectious prostatitis is standardised with antibiotics as the primary agents, empirically administered in acute prostatitis and after susceptibility testing in chronic bacterial prostatitis. Fluoroquinolones exhibit more favourable pharmacological properties; therefore, fluoroquinolones have been recommended as first-line agents in the treatment for chronic bacterial prostatitis. Antibiotic resistance to fluoroquinolones, however, is increasing and is posing significant clinical problems. Further studies on alternative antibiotics active within the prostate are therefore needed both for prophylaxis in transrectal prostate biopsy, for example, and for therapy of chronic bacterial prostatitis. CONCLUSIONS Bacterial prostatitis has developed into well-managed entities with increasing antimicrobial resistance being the most severe drawback of yielding therapeutic success.
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Affiliation(s)
- Florian M E Wagenlehner
- Clinic of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Rudolf-Buchheim-Str. 7, 35385, Giessen, Germany.
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Zarzycki G, Bar K, Długosz M, Starownik R. Minimally invasive treatment of prostatic abscess - percutaneous transvesical drainage. Cent European J Urol 2012; 65:224-6. [PMID: 24578968 PMCID: PMC3921809 DOI: 10.5173/ceju.2012.04.art10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 04/04/2012] [Accepted: 04/13/2012] [Indexed: 11/22/2022] Open
Abstract
We currently treat prostatic abscess with minimally invasive methods, most frequently with transurethral (TURP) or transrectal drainage under visual control with TRUS. We present an example of prostatic abscess drainage by percutaneous and transvesical means under the control of ultrasonography (USG). With a 9F single-stage drainage kit, the prostatic abscess was punctured through the abdominal skin and bladder in one step. We found this method to be straightforward for urology and safe for the patient.
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Affiliation(s)
| | - Krzysztof Bar
- Department of Urology and Urological Oncology of the Medical University of Lublin, Poland
| | - Marek Długosz
- Department of Urology Hospital in Ostrowiec Świętokrzyski, Poland
| | - Radosław Starownik
- Department of Urology and Urological Oncology of the Medical University of Lublin, Poland
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Arrabal-Polo MA, Jimenez-Pacheco A, Arrabal-Martin M. Percutaneous drainage of prostatic abscess: case report and literature review. Urol Int 2011; 88:118-20. [PMID: 21934282 DOI: 10.1159/000330934] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 07/11/2011] [Indexed: 11/19/2022]
Abstract
The incidence of prostatic abscess is 0.5% in relation to all prostate pathologies and usually occurs in patients with diabetes or with some degree of immunosuppression. The case of a male patient, 84 years old, with a history of arterial hypertension and mild renal failure, presenting high fever, prostate syndrome, genital edema and constipation is reported. He was diagnosed with prostate abscess via transrectal ultrasonography (TRUS). Treatment was started with empirical meropenem and a puncture of the abscess was performed transperineally under TRUS guidance placing an 8-Fr nephrostomy tube for 36 h. The patient was discharged 48 h after the puncture with a good prognosis. TRUS-guided transperineal drainage is a safe, adequate and effective treatment for prostate abscess, and allows the placement of drainage for several hours thereby avoiding the communication between the abscessed cavity and the urethra or rectum. Therefore, after having reviewed the literature, we consider this approach suitable for drainage.
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Quality Improvement Guidelines for Percutaneous Drainage/Aspiration of Abscess and Fluid Collections. J Vasc Interv Radiol 2010; 21:431-5. [DOI: 10.1016/j.jvir.2009.12.398] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 11/11/2009] [Accepted: 12/09/2009] [Indexed: 01/31/2023] Open
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34
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Lorenz JM, Funaki BS, Ray CE, Brown DB, Gemery JM, Greene FL, Kinney TB, Kostelic JK, Millward SF, Nemcek AA, Owens CA, Reinhart RD, Rockey DC, Silberzweig JE, Vatakencherry G. ACR Appropriateness Criteria on percutaneous catheter drainage of infected fluid collections. J Am Coll Radiol 2010; 6:837-43. [PMID: 19945038 DOI: 10.1016/j.jacr.2009.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 08/17/2009] [Indexed: 12/20/2022]
Abstract
Abnormal fluid collections occur throughout the body and represent a wide range of pathologies, including abscesses, pseudocysts, cysts, lymphoceles, seromas, bilomas, hematomas, urinomas, and infected neoplasms. Appropriate management often depends on clinical presentation, location, type of collection, early response to treatment, and the presence of complicating factors such as fistulas, septations, and increased viscosity. Physicians should carefully review clinical and imaging findings and make evidence-based recommendations for the best treatment, which may include antibiotics, needle aspiration, percutaneous drainage, endoscopic drainage, or surgical drainage. This paper addresses percutaneous catheter drainage and alternative treatment options for the management of fluid collections and is the result of evidence-based consensus by the ACR Appropriateness Criteria Expert Panel on Interventional Radiology.
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Affiliation(s)
- Jonathan M Lorenz
- University of Chicago Hospital, Department of Radiology, Chicago, Illinois 60637, USA.
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Wagenlehner FME, Weidner W, Naber KG. Therapy for prostatitis, with emphasis on bacterial prostatitis. Expert Opin Pharmacother 2007; 8:1667-74. [PMID: 17685884 DOI: 10.1517/14656566.8.11.1667] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The prostatitis syndrome is classified in bacterial prostatitis as confirmed or suspected infection and chronic pelvic pain syndrome (CPPS). Bacterial prostatitis is a disease entity that is diagnosed clinically and by evidence of inflammation and infection localised to the prostate. According to the duration of symptoms, bacterial prostatitis is described as either acute or chronic. Acute bacterial prostatitis can be a serious infection and administration of high doses of bactericidal antibiotics are required. In chronic bacterial prostatitis, and if infection is strongly suspected in CPPS, a fluoroquinolone should be administered initially for 2 weeks. Antibiotics should only be continued for a total of approximately 4-6 weeks, if pre-treatment cultures are positive and/or the patient has reported positive effects from the treatment. Patients with CPPS are treated empirically with various medical and physical modalities. Until now, despite the existence of some scientifically valid studies, no definite recommendations have been made because patients with CPPS are most likely to represent a heterogeneous group of diseases and therapeutic outcome is always uncertain.
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Affiliation(s)
- Florian M E Wagenlehner
- Justus-Liebig-University, Clinic for Urology and Pediatric Urology, Giessen, Giessen, Germany.
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Kuo PH, Huang KH, Lee CW, Lee WJ, Chen SJ, Liu KL. Emphysematous Prostatitis Caused by Klebsiella pneumoniae. J Formos Med Assoc 2007; 106:74-7. [PMID: 17282974 DOI: 10.1016/s0929-6646(09)60219-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Emphysematous prostatitis is a rare condition that is characterized by gas and abscess accumulation in the prostate. We report a 60-year-old man with emphysematous prostatitis caused by Klebsiella pneumoniae. He had a history of recently diagnosed diabetes mellitus and a 16-year history of alcoholic liver cirrhosis. He was admitted due to fever, dysuria and difficult urination. Physical examination revealed lower abdominal tenderness and prostatic fluctuance on digital examination. Leukocytosis, pyuria and elevated C-reactive protein were found. Abdominal radiography disclosed a collection of abnormal air pockets in the lower pelvic cavity and computed tomography scans corroborated the existence of extensive air collection in the prostate. Under the impression of emphysematous prostatitis, the patient was successfully treated with transurethral incision of the prostate and antibiotics for 6 weeks; there were no urinary sequelae during 6 months of follow-up.
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Affiliation(s)
- Pei-Hsun Kuo
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Serrano Frago P, Allepuz Losa C, Fantova Alonso A, Marco Valdenebro A, Allué López M, Rioja Sanz LA. Actualidad en manejo de abcesos prostáticos: a propósito de un caso. Actas Urol Esp 2006; 30:720-2. [PMID: 17058619 DOI: 10.1016/s0210-4806(06)73524-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The existence of prostate abscess as bad evolution of an acute protatitis is not very frequent due to the correct handling of the urinary infections by means of suitable antibiotics, in spite of the presence of inmunosupresion situations that can favor their appearance. It is our intention to review the performance in these situations because of a case that by means of minimal invasive therapy by transperineal percutaneous puncture obtained complete improvement.
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Affiliation(s)
- P Serrano Frago
- Servicio de Urología, Hospital Universitario Miguel Server, Zaragoza.
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