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Sonavane SN, Jamale T, Bose S, Basu S. Febrile Immunocompromised Renal Transplant Recipient with Allograft Dysfunction: Detection of an Undiagnosed Prostate Abscess by [ 18 F]FDG-PET/CT along with Treatment Response Monitoring. World J Nucl Med 2024; 23:207-211. [PMID: 39170845 PMCID: PMC11335391 DOI: 10.1055/s-0044-1786705] [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] [Indexed: 08/23/2024] Open
Abstract
The purpose of this report is to provide a comprehensive description of a post-transplant febrile patient's clinical course, complications, surgical procedure, and long-term management including evaluation by 18 F-fluorodeoxyglucose [( 18 F)FDG] positron-emission tomography combined with computed tomography (PET/CT). A 35-year-old male, a postrenal transplant patient, developed chronic allograft dysfunction and presented with fever with chills, with suspicion of acute-on-chronic graft dysfunction, but no infective focus localization on chest X-ray, ultrasonography (USG) whole abdomen, or blood culture. Urine microscopy showed 8 to 10 pus cells/high-power field (hpf) and culture showed Klebsiella pneumoniae and Pseudomonas aeruginosa with low colony count. Culture-sensitive antibiotics were prescribed for 2 weeks, and after 3 weeks febrile episodes relapsed, symptoms progressed, and required emergency hospitalization due to acute painful urinary retention. Proteinuria and no growth were noted in urine analysis, serum creatinine was 5.36 mg/dL, and C-reactive protein was 15.7mg/dL, and remaining parameters were unremarkable. [ 18 F]FDG-PET/CT was considered in order to resolve diagnosis, which revealed abnormal heterogeneous tracer uptake in the enlarged prostate with hypodense areas within, suggesting prostatitis with abscess formation and pyelonephritis in the upper pole of the transplant kidney. USG kidney urinary bladder (KUB) correlation confirmed prostatic abscess and transurethral drainage done, and pus culture revealed Burkholderia pseudomallei . Culture-sensitive intravenous meropenem treatment was given for 3 weeks. At 5 weeks, follow-up [ 18 F]FDG-PET/CT showed low metabolic residual prostate uptake, suggesting a good response with residual infection. Thus, intravenous antibiotics was changed to oral antibiotics for another 6 weeks. His symptoms completely resolved at the end of treatment; however, his graft function worsened, with serum creatinine reaching 6 to 7 mg/dL, and eventually, after 8 months he became dialysis dependent.
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Affiliation(s)
- Sunita Nitin Sonavane
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Parel, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Tukaram Jamale
- Department of Nephrology and Transplant, King Edward Memorial Hospital and Seth GS Medical College, Parel, Mumbai, Maharashtra, India
| | - Sreyasi Bose
- Department of Nephrology and Transplant, King Edward Memorial Hospital and Seth GS Medical College, Parel, Mumbai, Maharashtra, India
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Parel, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
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2
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Stangl F, Wagenlehner F, Schneidewind L, Kranz J. [Urosepsis: pathophysiology, diagnosis, and management-an update]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:543-550. [PMID: 38639782 DOI: 10.1007/s00120-024-02336-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
Urinary tract infections vary widely in their clinical spectrum, ranging from uncomplicated cystitis to septic shock. Urosepsis accounts for 9-31% of all cases of septicemia and is often associated with nosocomial infections. A major risk factor for urosepsis is the presence of obstructive uropathy, caused by conditions such as urolithiasis, tumors, or strictures. The severity and course of urosepsis depend on both the virulence of the pathogen and the patient's specific immune response. Prompt therapy, including antimicrobial treatment and eradication of the infection source, along with supportive measures for circulatory and respiratory stabilization, and adjunctive therapies such as hemodialysis and glucocorticoid therapy, is crucial. Due to demographic changes, an increase in cases of urosepsis is expected-thus, it is of utmost importance for urologists to be familiar with targeted diagnostics and effective treatment.
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Affiliation(s)
- Fabian Stangl
- Universitätsklinik für Urologie, Universität Bern, Bern, Schweiz
| | - Florian Wagenlehner
- Klinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | | | - Jennifer Kranz
- Klinik für Urologie und Kinderurologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland.
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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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4
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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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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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Sugiyama Y, Fujikawa A, Yokokawa S. A case of perforation of the prostatic abscess into the rectum resulting in a rectoprostatic fistula. IJU Case Rep 2023; 6:433-435. [PMID: 37928312 PMCID: PMC10622207 DOI: 10.1002/iju5.12641] [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: 07/10/2023] [Accepted: 09/07/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction A rectoprostatic fistula complicating a prostatic abscess is extremely rare, and there are many uncertainties regarding its treatment and prognosis. Case presentation We present the case of a 68-year-old male who presented with rectal bleeding. Computed tomography reveals a prostatic abscess in contact with the rectum. As conservative treatment with antibiotics resulted in the aggravation of symptoms, we placed a transperineal catheter placement in the prostate, followed by drainage of the abscess through the catheter. The abscess communicated with the rectum, forming a rectoprostatic fistula. Subsequently, a transverse colostomy was performed. The abscess resolved, and no recurrence was observed even after 6 months of drainage. However, the rectal ulceration that resulted in the formation of the fistula persisted, and stoma closure was not achieved. Conclusion In cases of prostatic abscess complicated by rectoprostatic fistula, drainage of the abscess along with colostomy seems essential for a curative approach.
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Affiliation(s)
- Yuichi Sugiyama
- Department of UrologyYokosuka City HospitalYokosukaKanagawaJapan
| | - Atsushi Fujikawa
- Department of UrologyYokosuka City HospitalYokosukaKanagawaJapan
| | - Shuhei Yokokawa
- Department of UrologyYokosuka City HospitalYokosukaKanagawaJapan
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Khan H, Phatak S, Mitra K, Dhote S, Attar W. Imaging Spectrum of Severe Urinary Tract Infection Complications Presenting as a Seminal Vesicle Abscess, Prostatic Abscess, and Renal Abscess in Uncontrolled Diabetes Mellitus: A Case Report. Cureus 2023; 15:e48123. [PMID: 38046726 PMCID: PMC10691900 DOI: 10.7759/cureus.48123] [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] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Urinary tract infections are more common and severe, and they carry worse outcomes for patients with type 2 diabetes mellitus. The infections are typically caused by resistant pathogens, leading to many complications. Various impairments in the immune system, poor metabolic control, and incomplete bladder emptying due to autonomic neuropathy may all contribute to the enhanced risk of urinary tract infections in these patients. We present an imaging spectrum of a severe urinary tract infection presenting as renal, prostatic, and seminal vesicle abscesses in a patient with uncontrolled diabetes mellitus.
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Affiliation(s)
- Huma Khan
- Radiology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Suresh Phatak
- Radiodiagnosis, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Kajal Mitra
- Radiodiagnosis and Imaging, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Sandip Dhote
- Radiology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Wajid Attar
- Radiodiagnosis, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
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8
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Ansari N, Ozgur SS, Bhargava R, Rahman R, Gong B. An Interesting Case of Methicillin-Resistant Staphylococcus aureus Prostate Abscess in an Immunocompetent Patient. Cureus 2023; 15:e43131. [PMID: 37692603 PMCID: PMC10483891 DOI: 10.7759/cureus.43131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Prostate abscess is a rare complication of prostatitis, typically observed in patients with conditions such as immunodeficiency, diabetes, urinary tract abnormalities, and chronic indwelling catheters. Gram-negative bacteria such as Enterobacteriaceae are the most commonly detected organisms in prostate abscesses. Methicillin-resistant Staphylococcus aureus (MRSA) infections are rarely reported. The unique aspect of our case involves MRSA bacteria, further complicated by an MRSA prostate abscess, in a 61-year-old immunocompetent male. The patient, with a past medical history of hypertension and diabetes, presented to the emergency department complaining of nausea and vomiting for four days, with an associated subjective fever and right-sided abdominal pain. A computed tomography (CT) scan of the abdomen/pelvis with contrast showed a prostatic abscess, with abscess/phlegmon extending bilaterally into the seminal vesicles. Urine and blood cultures were positive for MRSA. Initially, Piperacillin/Tazobactam and Vancomycin were initiated. Subsequently, the treatment was switched to Daptomycin. The patient also underwent cystoscopy with urethral dilation, transurethral prostate resection, and unroofing. Although MRSA is not a typical causative agent of prostatitis, it should be considered in the differential diagnosis, especially when clinical improvement cannot be achieved with standard empirical treatment. Timely identification and appropriate treatment (such as drainage and antibiotics) are crucial for both patient survival and the prevention of complications.
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Affiliation(s)
- Nida Ansari
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Sacide S Ozgur
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Rhea Bhargava
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Ryan Rahman
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Bing Gong
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
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9
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Żurowska A, Pęksa R, Bieńkowski M, Skrobisz K, Sowa M, Matuszewski M, Biernat W, Szurowska E. Prostate Cancer and Its Mimics-A Pictorial Review. Cancers (Basel) 2023; 15:3682. [PMID: 37509343 PMCID: PMC10378330 DOI: 10.3390/cancers15143682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/24/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Multiparametric prostate MRI (mpMRI) is gaining wider recommendations for diagnosing and following up on prostate cancer. However, despite the high accuracy of mpMRI, false positive and false negative results are reported. Some of these may be related to normal anatomic structures, benign lesions that may mimic cancer, or poor-quality images that hamper interpretation. The aim of this review is to discuss common potential pitfalls in the interpretation of mpMRI. METHODS mpMRI of the prostates was performed on 3T MRI scanners (Philips Achieva or Siemens Magnetom Vida) according to European Society of Urogenital Radiology (ESUR) guidelines and technical requirements. RESULTS This pictorial review discusses normal anatomical structures such as the anterior fibromuscular stroma, periprostatic venous plexus, central zone, and benign conditions such as benign prostate hyperplasia (BPH), post-biopsy hemorrhage, prostatitis, and abscess that may imitate prostate cancer, as well as the appearance of prostate cancer occurring in these locations. Furthermore, suggestions on how to avoid these pitfalls are provided, and the impact of image quality is also discussed. CONCLUSIONS In an era of accelerating prostate mpMRI and high demand for high-quality interpretation of the scans, radiologists should be aware of these potential pitfalls to improve their diagnostic accuracy.
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Affiliation(s)
- Anna Żurowska
- Second Department of Radiology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Rafał Pęksa
- Department of Pathomorphology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Michał Bieńkowski
- Department of Pathomorphology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Katarzyna Skrobisz
- Department of Radiology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Marek Sowa
- Department of Urology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Marcin Matuszewski
- Department of Urology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Wojciech Biernat
- Department of Pathomorphology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Edyta Szurowska
- Second Department of Radiology, Medical University of Gdańsk, 80-214 Gdańsk, Poland
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10
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Lautenschlager S, Strebel R, Ahmadi K, Birzele J, Gu A, Nowag A, Scherer T, Bieri U. Prostatic Abscesses in a Patient Receiving Tumor Necrosis Factor-Alpha Inhibitor Therapy for Hidradenitis Suppurativa: A Case Report. Cureus 2023; 15:e41820. [PMID: 37575812 PMCID: PMC10423008 DOI: 10.7759/cureus.41820] [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] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
This report is the first to present the case of a patient who developed bacterial abscess-forming prostatitis while undergoing treatment with adalimumab, a tumor necrosis factor-alpha blocking therapy, for hidradenitis suppurativa. A 36-year-old male presented with persistent anogenital pain and dysuria for approximately three weeks. Two days before presentation at the emergency room (ER), a rubber band ligation was performed to address suspected hemorrhoids stages I-II. In the ER, clinical and laboratory examinations suggested acute prostatitis, prompting the initiation of antibiotic therapy. In the absence of an adequate response, magnetic resonance imaging was performed, which identified a complex abscess and fistulation system originating from the right prostatic lobe. Following the insertion of a drain, adalimumab was discontinued, and antibiotic therapy was intensified, resulting in the resolution of the abscess. After six weeks, follow-up showed the patient to be free of symptoms. This case highlights a rare adverse event of patients using immunomodulating medications and may help physicians to manage similar cases in the future. Immunomodulating drugs can lead to the development of prostatic abscesses in young patients, necessitating attentive and careful clinical examination with a low threshold for further diagnostic workup in uncommon case presentations.
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Affiliation(s)
| | - Räto Strebel
- Department of Urology, Cantonal Hospital of Graubünden, Chur, CHE
| | - Khosrow Ahmadi
- Department of Urology, Cantonal Hospital of Graubünden, Chur, CHE
| | - Jan Birzele
- Department of Urology, Cantonal Hospital of Graubünden, Chur, CHE
| | - Alexander Gu
- Department of Urology, Cantonal Hospital of Graubünden, Chur, CHE
| | - Anna Nowag
- Department of Urology, Cantonal Hospital of Graubünden, Chur, CHE
| | - Thomas Scherer
- Department of Urology, University Hospital Zurich, Zurich, CHE
| | - Uwe Bieri
- Department of Urology, Cantonal Hospital of Graubünden, Chur, CHE
- Department of Urology, University Hospital Zurich, Zurich, CHE
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11
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Bermudez M, Epstein SB, Guevara N, Pedraza L, Dahdouh M, Awad I. Prostatic Abscess Secondary to Staphylococcus haemolyticus and Escherichia coli: A Case Report. Cureus 2023; 15:e40406. [PMID: 37456390 PMCID: PMC10348605 DOI: 10.7759/cureus.40406] [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: 05/16/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
A prostate abscess is a rare clinical entity with an incidence of 0.2%-0.5% in males. No case reports exist of Staphylococcus haemolyticus as an etiologic bacterial agent. We report a 59-year-old man with a past medical history of poorly controlled diabetes mellitus and benign prostatic hyperplasia who was hospitalized due to urosepsis and obstruction. A prostatic abscess was discovered and initially treated with intravenous vancomycin and ertapenem. Clinical improvement was apparent within two days following transrectal prostatic abscess drainage. Four weeks of intravenous antibiotics followed. Prostatic abscess cultures grew Staphylococcus haemolyticus and Escherichia coli following tube deployment. To the best of our knowledge, this is the first case reporting Staphylococcus haemolyticus as an organism in a prostate abscess. We regard this as another example of the rising incidence of gram-positive organisms in prostatic abscesses in the post-antibiotic era.
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Affiliation(s)
| | | | | | | | | | - Ihab Awad
- Urology, SBH Health System, New York, USA
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12
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Tariq A, Stewart AG, Desai DJ, Britton S, Dunglison N, Esler R, Roberts MJ. Periurethral abscess etiology, risk factors, treatment options, and outcomes: A systematic review. Curr Urol 2023; 17:100-108. [PMID: 37691985 PMCID: PMC10489258 DOI: 10.1097/cu9.0000000000000159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/23/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives This study aimed to describe patterns of presentation, etiology, risk factors, management, and treatment outcomes of periurethral abscesses using a systematic review framework. Materials and methods After prospective registration on the PROSPERO database (CRD42020193063), a systematic review of Web of Science, Embase, PubMed, and Cochrane scientific databases was performed. Articles published between 1900 and 2021 were considered. Extracted data included symptoms, etiology, medical history, investigations, treatment, and outcomes. Collated data were analyzed using univariate methods. Results Sixty articles met the inclusion criteria reporting on 270 patients (211 male, 59 female) with periurethral abscess. The most common clinical features were pain (41.5%), pyuria (41.5%), dysuria (38.5%), urinary frequency (32.3%), fever (25%), and a palpable mass (23%). Predisposing risk factors included the presence of a sexually transmitted infection or urinary tract infection (55.0%), urethral strictures (39.6%), and recent urethral instrumentation (18.7%). Management approaches included open incision and drainage (64.3%), conservative management with antibiotics (29.8%), and minimally invasive techniques (needle aspiration, endoscopic drainage). Time trend analysis of etiology revealed a decreased incidence of infection (sexually transmitted infection/urinary tract infection, human immunodeficiency virus) and higher incidence of diabetes mellitus and periurethral bulking injections in recent years. Conclusions Periurethral abscesses may display a wide range of clinical features. Presentation, risk factors and underlying etiology vary with sex. The optimal management technique is guided by abscess size. Open incision and drainage combined with antibiotics continues to be the mainstay of management. However, minimally invasive techniques are gaining favor. To the authors' knowledge, this is the first systematic appraisal and management algorithm for periurethral abscess.
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Affiliation(s)
- Arsalan Tariq
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Adam G. Stewart
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Devang J. Desai
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Toowoomba Base Hospital, Toowoomba, QLD, Australia
| | - Sumudu Britton
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Nigel Dunglison
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Rachel Esler
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Matthew J. Roberts
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
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13
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Chang YH, Pan SY, Lin CY, Huang CP, Chung CJ, Chen YH, Chen WC. Factors Deciding Conservative or Intervention Treatment for Prostate Abscess: A Retrospective Case-Control Study. J Pers Med 2023; 13:jpm13030484. [PMID: 36983666 PMCID: PMC10058703 DOI: 10.3390/jpm13030484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Prostate abscess (PA) can lead to severe urosepsis and septic shock if not treated promptly. However, early diagnosis can be hindered by the declining incidence of PA, especially in developing countries and high-risk patients. Despite the prevalence of PA, there is currently a lack of well-established contemporary guidelines or treatment algorithms. This study aimed to review the etiology, pathophysiology, diagnosis, and treatment options for PA, as well as analyze the characteristics, background profiles of patients, and clinical course. Ultimately, the goal was to develop a personalized treatment strategy for patients with PA. This retrospective study examined 44 patients diagnosed with PA at a tertiary medical center between 2010 and 2020. The patients were divided into two groups based on their treatment: conservative treatment or intervention (transurethral resection of the prostate [TURP] or transurethral prostate drainage [TPD]). The study evaluated various factors, including patients' background profiles, comorbidities, laboratory data, and PA size and volume. Complications of the interventions were also analyzed. No significant differences were found in basic data between the conservative treatment group (19 patients) and intervention group (25 patients; 20 for TURP, 5 for TPD). However, it was observed that single abscesses, size <2.2 cm, and prostate volume <48 cm3, may be suitable for conservative treatment. Patients with diabetes mellitus and human immunodeficiency virus should be monitored for thrombotic events. In addition, there was a significant difference in white blood count between the two groups (12.1 ± 7.0 vs. 17.6 ± 9.7 × 109/L, p < 0.05). A subgroup analysis of the intervention group showed no significant difference in the risk of complications between TPD and TURP. Patients with poorly controlled diabetes mellitus and immunodeficiency are at a high risk of PA but are not indicated for surgical treatment. The PA profile, including number, size, volume, and percentage to prostate volume, should be considered when deciding on surgical intervention for patients with PA. Patients with higher leukocytosis may require surgical treatment. Overall, these findings can help guide the development of a personalized treatment strategy for patients with PA.
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Affiliation(s)
- Yi-Huei Chang
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung 406333, Taiwan
| | - Szu-Ying Pan
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
| | - Chia-Yu Lin
- School of Medicine, College of Medicine, China Medical University, Taichung 404333, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 404333, Taiwan
| | - Chi-Jung Chung
- Department of Public Health, College of Public Health, China Medical University, Taichung 406333, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung 404327,Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 413305, Taiwan
| | - Wen-Chi Chen
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung 404327,Taiwan
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14
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Muacevic A, Adler JR, Horinishi Y, Sano C, Ohta R. Meningitis With Staphylococcus aureus Bacteremia in an Older Patient With Nonspecific Symptoms: A Case Report. Cureus 2023; 15:e34153. [PMID: 36843800 PMCID: PMC9949557 DOI: 10.7759/cureus.34153] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/25/2023] Open
Abstract
Staphylococcus aureus bacteremia has been associated with various symptoms that can spread to diverse organs, including the meninges, which can be challenging to diagnose given the nonspecific symptoms. Early examination, including assessment of the cerebrospinal fluid, is necessary when a patient is diagnosed with S. aureus bacteremia accompanied by unconsciousness. A 73-year-old male presented to our hospital complaining of general malaise without fever. The patient developed impaired consciousness immediately after hospitalization. Following the investigations, the patient was diagnosed with S. aureus bacteremia and meningitis. If a patient presents with symptoms of unknown cause and acute progressive disease, meningitis and bacteremia should always be considered. Blood cultures should be performed promptly, affording an early diagnosis, bacteremia treatment, and the establishment of meningitis.
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15
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Cheng KW, Alsyouf M, Wang S, Hu B. Prostatic Abscess – A Rare Causative Organism. Urology 2022; 168:e12-e14. [DOI: 10.1016/j.urology.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022]
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16
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Hwang JH, Hwang JH, Lee SY, Lee J. Prostatic Abscess Caused by Klebsiella pneumoniae: A 6-Year Single-Center Study. J Clin Med 2022; 11:jcm11092521. [PMID: 35566647 PMCID: PMC9099488 DOI: 10.3390/jcm11092521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023] Open
Abstract
Hypervirulent Klebsiella pneumoniae (hvKp) is an important strain that can cause multiple organ infections. Although hvKp infection cases are increasing, there is limited information on the prostatic abscesses caused by K. pneumoniae. Furthermore, the clinical significance of hvKp associated with K1 or K2 capsular types or virulence genes in prostatic abscesses remains unclear. Therefore, we aimed to elucidate the clinical and microbiological characteristics of prostatic abscesses caused by K. pneumoniae in relation to various virulence genes. A retrospective study was performed at a 1200-bed tertiary hospital between January 2014 and December 2019. Patients diagnosed with prostatic abscesses with K. pneumoniae isolated from blood, urine, pus, or tissue cultures were enrolled in this study. Our results demonstrate that 30.3% (10/33) of the prostatic abscesses were caused by K. pneumoniae. All strains isolated from patients with prostatic abscesses due to K. pneumoniae were the K1 capsular type, and eight patients (80.0%) carried rmpA and iutA genes that identified hvKp. These findings suggest that hvKp is an important pathogen in prostatic abscesses. Therefore, when treating patients with K. pneumoniae prostatic abscesses, attention should be paid to the characteristics of hvKp, such as bacteremia, multiorgan abscess formation, and metastatic spread.
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Affiliation(s)
- Joo-Hee Hwang
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea; (J.-H.H.); (J.-H.H.)
- Research Institute of Clinical Medicine of Jeonbuk National University—Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea;
| | - Jeong-Hwan Hwang
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea; (J.-H.H.); (J.-H.H.)
- Research Institute of Clinical Medicine of Jeonbuk National University—Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea;
| | - Seung Yeob Lee
- Research Institute of Clinical Medicine of Jeonbuk National University—Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea;
- Department of Laboratory Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea
| | - Jaehyeon Lee
- Research Institute of Clinical Medicine of Jeonbuk National University—Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea;
- Department of Laboratory Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea
- Correspondence: ; Tel.: +82-63-250-2693
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17
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Ohta R, Hattori S, Inoue K, Sano C. Difficulty in Diagnosing and Treating a Prostate Abscess With Bacterial and Fungal Coinfection in an Immunocompromised Patient. Cureus 2022; 14:e21774. [PMID: 35251844 PMCID: PMC8890593 DOI: 10.7759/cureus.21774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/22/2022] Open
Abstract
Prostate abscesses often occur in immunocompromised individuals. Contrast-enhanced imaging tests can aid diagnosis; however, they can be difficult to perform in older patients with renal insufficiency. Various organisms can cause prostate abscesses, and poor antibiotic penetration into the prostate can hinder treatment. Here, we report a case of prostate abscess manifesting as fever of unknown origin. The patient, a 78-year-old man with a history of heart failure, renal failure, and liver cirrhosis, presented with dyspnea and fever. He was initially diagnosed with aspiration pneumonia. However, the fever persisted, and urinary tract infection was diagnosed and treated with antibiotics and antifungal drugs. Further investigation with contrast-enhanced computed tomography revealed a prostate abscess. This case demonstrates the importance of aggressive investigation of fever of unknown origin in older patients with renal insufficiency. Furthermore, the problem of tissue penetration of antimicrobial agents should be thoroughly considered when treating prostate abscesses.
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18
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Konagaya K, Yamamoto H, Suda T, Tsuda Y, Isogai J, Murayama H, Arakawa Y, Ogino H. Ruptured Emphysematous Prostatic Abscess Caused by K1-ST23 Hypervirulent Klebsiella pneumoniae Presenting as Brain Abscesses: A Case Report and Literature Review. Front Med (Lausanne) 2022; 8:768042. [PMID: 35047523 PMCID: PMC8761798 DOI: 10.3389/fmed.2021.768042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022] Open
Abstract
Emphysematous prostatic abscess (EPA) is an extremely rare but potentially fatal urinary tract infection (UTI). Here, we describe a case (a 69-year-old male with prediabetes) of ruptured EPA caused by a hypervirulent Klebsiella pneumoniae (hvKp) K1-ST23 strain, presenting as motor aphasia. Our patient presented with ruptured EPA concurrent with various severe systemic pyogenic complications (e.g., urethro-prostatic fistula, ascending UTIs, epididymal and scrotal abscesses, and liver, lung, and brain abscesses). Whole-body computed tomography (CT) and next-generation sequencing (NGS) were useful for the detection of ruptured EPA and its systemic complications, and for identification of K1-ST23 hvKp strains, respectively. Subsequently, the infections were successfully treated with aggressive antimicrobial therapy and multiple surgical procedures. This case highlights the significance of awareness of this rare entity, the clinical importance of CT for the early diagnosis of EPA and the detection of its systemic complications in view of hvKp being an important causative organism of severe community-acquired UTI, and the usefulness of NGS to identify hvKp strains.
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Affiliation(s)
- Kensuke Konagaya
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Tomoyuki Suda
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Yusuke Tsuda
- Department of Bacteriology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Jun Isogai
- Department of Radiology, Asahi General Hospital, Asahi, Japan
| | - Hiroyuki Murayama
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Yoshichika Arakawa
- Department of Bacteriology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
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Olarte Barragán EH, Sánchez Caballero L, Sarrió Sanz P, Nakdali-Kassab B, Gómez Garberí M, Gómez Pérez L, Ortiz Gorraiz MÁ. Transurethral Drainage of Prostatic Abscess Using 120 W Holmium Laser Technology. J Lasers Med Sci 2021; 12:e80. [PMID: 35155165 PMCID: PMC8837840 DOI: 10.34172/jlms.2021.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/19/2021] [Indexed: 08/25/2023]
Abstract
Introduction: Prostatic abscess is an infrequent but serious pathology that could be treated by ultrasound-guided puncture, transurethral resection, or open surgery. Case Report: We present a case of a 72-year-old male with a 3x5 cm prostatic abscess in the right lobe showed in abdominal computed tomography (CT). In the blood test, he presented coagulopathy. Urgent transurethral drainage by holmium laser was decided to be performed. It started with incision and opening of the right prostatic lobe with an energy of 1.2 J and a frequency of 20 Hz with a total power of 24 W. A 550-micron fiber was used for this technique. Coagulation of the area was performed with a power of 20 W. The postoperative course was uneventful. Conclusion: The holmium laser appears to be an effective alternative in the treatment of this pathology in patients with coagulation disorders by providing adequate hemostatic control.
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Affiliation(s)
| | | | - Pau Sarrió Sanz
- Department of Urology, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Baraa Nakdali-Kassab
- Department of Urology, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Miguel Gómez Garberí
- Department of Urology, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Luis Gómez Pérez
- Department of Urology, Hospital Universitario San Juan de Alicante, Alicante, Spain
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20
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McCormick DW, Kaplan J, Whigham C, Coburn M, Greenberg SB. The Changing Epidemiology and Microbiology of Patients With Prostate Abscess: Increase in Staphylococcal Infection. Open Forum Infect Dis 2021; 8:ofab503. [PMID: 34805434 PMCID: PMC8600174 DOI: 10.1093/ofid/ofab503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/29/2021] [Indexed: 01/04/2023] Open
Abstract
Background Prostatic abscesses are rare and have been most commonly associated with gram-negative bacteria; however, Staphylococcus aureus has emerged as a leading cause, particularly in persons who are immunocompromised. Methods We conducted a retrospective chart review of all patients discharged from Ben Taub Hospital with a diagnosis of prostatic abscess during January 2011-January 2019. Demographic, clinical, microbiologic, and radiographic data were abstracted from the patients' charts and analyzed for comorbidities, causative organisms, clinical course, and outcomes. Results We identified 32 patients with a prostatic abscess during the study period. S. aureus was the most common causative organism (18/32, 56%). Most patients (24/32, 75%) were admitted to a general medicine service, and the median length of stay was 9 days. Twenty-one patients (66%) were treated with a combination of surgical drainage and antibiotic therapy; 11 (34%) were treated with antibiotics alone. All patients treated with antibiotics alone had full clinical recovery. Two patients (6.3%) died, both of whom had septic shock secondary to disseminated S. aureus infection. Conclusions Prostatic abscesses are rare and can be difficult to diagnose, leading to significant morbidity and mortality. S. aureus is a frequent causative organism especially in persons with diabetes mellitus or other immunocompromising conditions. Hematogenous spread of S. aureus infection to the prostate appears common. Prostatic abscesses can serve as the nidus of disseminated S. aureus infection.
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Affiliation(s)
- David W McCormick
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.,Ben Taub Hospital, Houston, Texas, USA
| | - Julika Kaplan
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.,Ben Taub Hospital, Houston, Texas, USA
| | - Cliff Whigham
- Ben Taub Hospital, Houston, Texas, USA.,Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Michael Coburn
- Department of Urology, Baylor College of Medicine, Houston, Texas, USA
| | - Stephen B Greenberg
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.,Ben Taub Hospital, Houston, Texas, USA
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21
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Degener T, Quon S, Holtom P, Hsieh E. From prostate to the pons: The first reported case of multi-organ septic emboli and brain empyema from an untreated prostate abscess. Clin Case Rep 2021; 9:e05018. [PMID: 34786192 PMCID: PMC8578817 DOI: 10.1002/ccr3.5018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 09/12/2021] [Indexed: 12/01/2022] Open
Abstract
Prostate abscesses in developed countries are becoming increasingly less common. Left untreated these abscesses can lead to numerous complications, including some which are very rare.
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Affiliation(s)
- Tyler Degener
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Samantha Quon
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Paul Holtom
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Eric Hsieh
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCAUSA
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22
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Lan S, Guo Z, He Y, Liu W, Guo H. Brucella prostatic abscess: a retrospective study of eight cases and a literature review. J Int Med Res 2021; 49:3000605211027442. [PMID: 34586877 PMCID: PMC8485306 DOI: 10.1177/03000605211027442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To present the clinical characteristics, diagnostics, and treatments for Brucella prostatic abscess (BPA). METHODS We retrospectively analyzed eight BPA patients according to their vocations, age, clinical manifestations, laboratory test results, magnetic resonance imaging (MRI) findings, and treatments. RESULTS The median age was 59 years. The most common clinical symptom was fever, followed by dysuria, erectile dysfunction, frequent urination, and urodynia. C-reactive protein (CRP) concentrations were significantly elevated in all patients, and in all by one patient, the erythrocyte sedimentation rate (ESR) was high. Prostate enlargement occurred in 87.5% of the patients. Lesions were located in the prostate peripheral (87.5%) and central zones (100%), with homogenous signals on T1-weighted imaging (T1WI) and a hyperintense signal on short tau inversion recovery (STIR). Patients had a small nodule or multiple nodules, with slight hyperintense to hyperintense signals on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI). Three patients had pelvic effusion, and seminal vesicle (37.5%), epididymis (12.5%), and bladder (12.5%) infections occurred. All patients received rifampicin and doxycycline with levofloxacin; all lesions had resolved at follow-up ultrasonography. CONCLUSION Even in epidemic areas, the incidence of BPA is relatively rare. Our findings may increase the understanding of BPA and reduce misdiagnosis and mistreatment.
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Affiliation(s)
- Siqin Lan
- Xinjiang Medical University Affiliated First Hospital, Medical Imaging Center, Urumqi, P.R. China
| | - Zhaoxing Guo
- Beijing Capital Medical University, Beijing, P.R. China
| | - Yuanlin He
- Xinjiang Medical University Affiliated First Hospital, Medical Imaging Center, Urumqi, P.R. China
| | - Wenya Liu
- Xinjiang Medical University Affiliated First Hospital, Medical Imaging Center, Urumqi, P.R. China
| | - Hui Guo
- Xinjiang Medical University Affiliated First Hospital, Medical Imaging Center, Urumqi, P.R. China
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23
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Seizilles de Mazancourt E, Vallée M, Sotto A, Le Goux C, Dihn A, Therby A, Boissier R, Savoie PH, Long JA, Bruyere F. [Infectious emergencies in urology]. Prog Urol 2021; 31:978-986. [PMID: 34420878 DOI: 10.1016/j.purol.2021.07.006] [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: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report the nature, diagnosis and therapeutic strategy of infectious emergencies in urology. MATERIAL AND METHODS Bibliographic research from Pubmed, Embase, and Google scholar in July 2021. A synthesis of the guidelines of national infectious diseases societies. RESULTS Urosepsis and complicated urinary tract infection have a standardized definition. Diagnosis and therapeutic strategy are presented for upper tract urinary infection, male urinary infection, healthcare associated urinary infection, symptomatic canduria and urinary infections of the elderly. Appropriate antibiotherapy should be tailored to the degree of severity, bacterial ecosystem, patient characteristics et localization of the infection. CONCLUSION Urinary infections can be critical and require immediate care. Knowledge of the guidelines and of appropriate diagnosis and therapeutics strategy improve care which should be rapidly applied, and collegial.
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Affiliation(s)
- E Seizilles de Mazancourt
- Service d'urologie et de la transplantation, Hôpital Édouard-Herriot, hospices civils de Lyon, 69008 Lyon, France
| | - M Vallée
- Service d'urologie, CHRU Poitiers, 86000 Poitiers, France
| | - A Sotto
- Service de maladies infectieuses, CHU Nîmes, 30000 Nîmes, France
| | - C Le Goux
- Centre Alfred-Kastler, Hôpital privé Nord parisien, 95200 Sarcelles, France
| | - A Dihn
- Service de maladies infectieuses, CHU Garches, 92380 France
| | - A Therby
- Service de maladies infectieuses, CH Versailles, 78150 France
| | - R Boissier
- Hopital de la conception, Assistance publique Hôpitaux de Marseille, 13005, France
| | - P H Savoie
- Hôpital d'Instruction des Armées Saint-Anne, BP 600, 83190 Toulon cedex 09
| | - J A Long
- Service d'urologie, Centre hospitalier universitaire de Grenoble, 38000 France; TIMC-IMAG, CNRS 5525, France
| | - F Bruyere
- Service d'urologie, CHRU Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France.
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24
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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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25
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Imaging of abdominal and pelvic infections in the cancer patient. Abdom Radiol (NY) 2021; 46:2920-2941. [PMID: 33386914 PMCID: PMC7778421 DOI: 10.1007/s00261-020-02896-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 11/01/2022]
Abstract
Infections are the most commonly encountered complications in patients with cancer. The classical signs and symptoms of infections are often not present in this patient population, which makes the diagnosis more challenging. Host factors play a major role in the development and prognosis of infections in cancer patients; these can be related to the underlying type of malignancy (solid organ versus hematological), tumor burden, anatomic obstruction, altered integrity of barriers (skin or mucosa), treatment-related factors (from chemotherapy, radiation treatment, surgery, interventional procedures, and/or medical device placement) and the degree of immunosuppression. This article reviews common, as well as less common, imaging manifestations of infections and their potential mimics in the abdomen and pelvis in cancer patients and discusses their differentiating features, with the role of imaging in various organs in the abdomen and pelvis taking into consideration relevant clinical background information and the main risk factors.
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26
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Nepal P, Ojili V, Kumar S, Kumar D, Nagar A. Imaging spectrum of common and rare infections affecting the lower genitourinary tract. Abdom Radiol (NY) 2021; 46:2665-2682. [PMID: 33388810 DOI: 10.1007/s00261-020-02889-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
In this review, we will discuss the imaging findings of common as well as uncommon lower genitourinary tract infections. For both clinicians and radiologists, it is imperative to understand etiopathogenesis, epidemiological information, clinical presentation, imaging findings and management options of such conditions. Knowledge of salient imaging features of these infections is of utmost importance because prompt recognition enables appropriate management.
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27
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Ha AS, Helman TA, Haas CR, Decastro GJ, Hyams ES. A population-based analysis of risk factors and outcomes of prostatic abscess. Prostate Cancer Prostatic Dis 2021; 24:1143-1150. [PMID: 33972703 DOI: 10.1038/s41391-021-00374-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/24/2021] [Accepted: 04/20/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prostate abscess is a severe complication of acute bacterial prostatitis. To date, a population-based analysis of risk factors and outcomes of prostatic abscess has not been performed. METHODS Using the National Inpatient Sample from 2010 to 2015, we identified rates of prostatic abscess among non-elective hospitalizations for acute prostatitis. Significant Elixhauser comorbidities and risk factors were analyzed using survey-weighted logistic regression. Additional survey-weighted regression models were constructed to analyze sepsis, in-hospital mortality, length of hospital stay (LOS), and total hospital charges. RESULTS A weighted total of 126,103 hospitalizations for acute prostatitis was identified, with 6,775 (5.4%) hospitalizations with prostatic abscess. Numerous risk factors for prostatic abscess were identified, with a history of prostate biopsy (adjusted OR: 5.7; p < 0.001), complicated diabetes mellitus (adjusted OR: 3.23, p < 0.001), and urethral stricture (adjusted OR: 3.15; p < 0.001) having the greatest magnitude of developing abscess. Moreover, those diagnosed with prostatic abscess had increased odds of sepsis (adjusted OR: 1.71, p < 0.001), in-hospital mortality (adjusted OR: 2.73, p < 0.001), LOS (adjusted Incidence Rate Ratio: 1.86, p < 0.001), and total hospital charges (adjusted Ratio: 2.06, p < 0.001). CONCLUSIONS Numerous risk factors were associated with the development of prostatic abscess, with those diagnosed experiencing greater odds of sepsis, in-hospital mortality, longer LOS, and greater hospital charges. Ultimately, better understanding of risk factors associated with this condition will enable clinicians to identify patients at high risk, thereby expediting and tailoring management.
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Affiliation(s)
- Albert S Ha
- Columbia University Irving Medical Center, Department of Urology, New York, NY, USA.
| | - Talia A Helman
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Christopher R Haas
- Columbia University Irving Medical Center, Department of Urology, New York, NY, USA
| | | | - Elias S Hyams
- Columbia University Irving Medical Center, Department of Urology, New York, NY, USA
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Vanmali A, Haines M. Prostate abscess in a paediatric patient: A rare diagnosis. SA J Radiol 2021; 25:2053. [PMID: 33936800 PMCID: PMC8063760 DOI: 10.4102/sajr.v25i1.2053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/03/2021] [Indexed: 11/06/2022] Open
Abstract
Prostate abscess (PA) is an uncommon clinical manifestation that typically presents in the fifth to sixth decade of age and sporadically affects neonates. These characteristics, coupled with the atypical presentation, represent a clinical dilemma and a challenging diagnosis. A detailed history depicting the clinical course and the presence of risk factors is imperative to alert the clinician of the possibility of a PA. In this case report, we present a surgically confirmed PA, a diagnosis that is rarely encountered within the paediatric age group.
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Affiliation(s)
- Atish Vanmali
- Department of Radiology, Jackpersad and Partners Inc., Durban, South Africa
| | - Mario Haines
- Department of Radiology, Jackpersad and Partners Inc., Durban, South Africa
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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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Starnes LS, Hanson HR, Swarm M, Johnson A, Ritter K, Frazier SB. Adolescent with Pelvic and Rectal Pain. J Emerg Med 2021; 60:e97-e98. [PMID: 33422371 DOI: 10.1016/j.jemermed.2020.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/22/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Lauren Slesur Starnes
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Holly R Hanson
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Matthew Swarm
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew Johnson
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathryn Ritter
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Steven Barron Frazier
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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Wooster ME, Huang G, Sanders JW, Peacock JE. Prostatic abscess: clinical features, management, and outcomes of a "Stealth" infection: retrospective case series and review of the literature. Diagn Microbiol Infect Dis 2020; 99:115285. [PMID: 33360491 DOI: 10.1016/j.diagmicrobio.2020.115285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/17/2020] [Accepted: 11/28/2020] [Indexed: 11/26/2022]
Abstract
Prostatic abscess (PA) is uncommon and may be difficult to distinguish from acute prostatitis which often leads to delayed or missed diagnoses. Although gram-negative bacilli are the traditional etiology of PA, Staphylococcus aureus is an emerging cause. The goals of this study were to characterize the current clinical features, microbiology, management, and outcomes of PA at a US academic center. A retrospective review of adult patients hospitalized with an ICD-9/10 diagnosis of PA between January 2013 and July 2018 was conducted. Inclusion criteria included age ≥18 years, a compatible genitourinary (GU) infection syndrome, and imaging consistent with PA. Relevant data were extracted and analyzed by univariate analysis as appropriate. Twenty-two patients with PA were identified with median age 57 years. Five patients (23%) were immunosuppressed and 11 (50%) had diabetes. No patient had prior PA but 3 had past prostatitis. Only 1 patient had recent GU instrumentation and none had indwelling urinary catheters. The most common presenting symptoms were fever (59%), dysuria (45%), and urinary retention (32%). Only 7 out of 18 (39%) patients had prostate tenderness on exam and none had fluctuance. As demonstrated by computed tomography, PAs were multifocal in 8 (36%) patients and 16 (73%) had PAs >2 cm in diameter. The median abscess size was 3.2 cm. S. aureus was isolated in 60% of positive urine cultures and 78% of positive blood cultures; 46% were methicillin-resistant. Nine patients (41%) received antibiotics alone whereas 13 (59%) required antibiotics plus drainage. The median duration of antimicrobial therapy was 34.5 days. Four week mortality was 9%. When comparing S. aureus PA to other causes, S. aureus patients tended to have higher fevers, more often had diabetes, and received longer durations of antibiotic therapy (median 35 days vs 31 days, P = 0.04) but age, abscess size, and mortality did not differ. PA is relatively uncommon and often clinically unsuspected. Imaging may be critical to accurate diagnosis. Optimal management usually requires antibiotics and sometimes drainage depending on abscess size. We found a significant proportion of cases due to S. aureus which might be relevant when deciding empiric antimicrobial therapy.
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Affiliation(s)
| | - Glen Huang
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - John W Sanders
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC, USA; Wake Forest School of Medicine, Winston-Salem, NC, USA; Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - James E Peacock
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC, USA; Wake Forest School of Medicine, Winston-Salem, NC, USA; Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Chevalier K, Marie G, Cabon M, Matthias B, Ficko C, Andriamanantena D. Abcès prostatiques à Staphylococcus aureus sécréteur de leucocidine de Panton et Valentine compliqués de localisations secondaires graves : à propos de deux cas. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prostate tuberculosis complicated by huge prostatic abscess: A rare case report from Nepal. Int J Surg Case Rep 2020; 77:152-156. [PMID: 33161288 PMCID: PMC7649586 DOI: 10.1016/j.ijscr.2020.10.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 11/28/2022] Open
Abstract
Prostatic tuberculosis is one of the rarest clinical entities. Huge prostatic abscess might be one of the complications of granulomatous prostatitis. Most cases follow the disseminated tuberculosis. Transurethral loop drainage can be a promising method of treatment. Category 1 anti-tubercular therapy should be initiated.
Introduction Prostatic tuberculosis is one of the rarest findings in clinical practice and associated prostatic abscess is even scarce, described in literatures. We present a rare case of prostatic tuberculosis complicated by huge prostatic abscess. Presentation of a case A 68-year-old male with no any comorbidity presented with history of increased frequency of micturition along with poor flow, urgency and nocturia for 17 days. He was under medical treatment for benign enlargement of prostate for 2 years. Per rectal examination revealed a boggy cystic swelling anteriorly with enlarged prostate with mild tenderness. Ultrasonography abdomen and pelvis showed massive enlargement of prostate with central avascular necrotic area with moving internal echoes. Contrast enhanced computed tomography (CECT) showed 230 g of prostate with central liquefaction of approximately 101 mm3. Transurethral loop drainage along with resection of prostate was done. Histopathology revealed granulomatous prostatitis highly suggestive of prostatic tuberculosis. Prostatic abscess culture was negative. Patient is currently under category 1 anti-tubercular therapy. Discussion Prostatic tuberculosis is a rare clinical finding which is commonly seen in patients with disseminated tuberculosis with immunocompromised status. Prostatic abscess in setting of granulomatous tuberculosis of prostate is even rarer. Transrectal ultrasonography is the investigation of choice for diagnosis of abscess if available. Treatment includes drainage of abscess preferably transurethral, and antitubercular therapy. Conclusion Trans-urethral loop drainage is a safe treatment modality for patients presenting with prostatic abscess followed by anti-tubercular therapy if histopathology findings are suggestive of granulomatous lesions.
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Eichenberger EM, Dagher M, Ruffin F, Park L, Hersh L, Sivapalasingam S, Fowler VG, Prasad BC. Complement levels in patients with bloodstream infection due to Staphylococcus aureus or Gram-negative bacteria. Eur J Clin Microbiol Infect Dis 2020; 39:2121-2131. [PMID: 32621149 PMCID: PMC7334117 DOI: 10.1007/s10096-020-03955-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023]
Abstract
The complement system is a vital component of the innate immune system, though its role in bacteremia is poorly understood. We present complement levels in Staphylococcus aureus bacteremia (SAB) and Gram-negative bacteremia (GNB) and describe observed associations of complement levels with clinical outcomes. Complement and cytokine levels were measured in serum samples from 20 hospitalized patients with SAB, 20 hospitalized patients with GNB, 10 non-infected hospitalized patients, and 10 community controls. C5a levels were significantly higher in patients with SAB as compared to patients with GNB. Low C4 and C3 levels were associated with septic shock and 30-day mortality in patients with GNB, and elevated C3 was associated with a desirable outcome defined as absence of (1) septic shock, (2) acute renal failure, and (3) death within 30 days of bacteremia. Low levels of C9 were associated with septic shock in patients with GNB but not SAB. Elevated IL-10 was associated with increased 30-day mortality in patients with SAB. Complement profiles differ in patients with SAB and those with GNB. Measurement of IL-10 in patients with SAB and of C4, C3, and C9 in patients with GNB may help to identify those at higher risk for poor outcomes.
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Affiliation(s)
- Emily M Eichenberger
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA.
| | - Michael Dagher
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA
| | - Felicia Ruffin
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA
| | - Lawrence Park
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Lisa Hersh
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY, USA
| | | | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA
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Alnadhari I, Sampige VRP, Abdeljaleel O, El Ansari W, Ali O, Salah M, Shamsodini A. Presentation, diagnosis, management, and outcomes of prostatic abscess: comparison of three treatment modalities. Ther Adv Urol 2020; 12:1756287220930627. [PMID: 32550860 PMCID: PMC7278333 DOI: 10.1177/1756287220930627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 05/10/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose The lack of available guidelines for the management of prostatic abscess (PA) results in inconsistencies in its management. The most commonly used management modalities were conservative treatment with parenteral antibiotics alone, transrectal ultrasound-guided (TRUS) needle aspiration, or transurethral deroofing (TUD).The current study is a retrospective study and examines prostatic abscess cases treated by either one or more of the different modalities. We assess and compare presentation, diagnosis, management, and outcomes of prostatic abscess and we compare the outcomes of the three management modalities. Methods We retrieved the records of all patients (n = 23) admitted to the Urology department at Al Wakra hospital with the computed tomography (CT) diagnosis of prostatic abscess from January 2013 to March 2018. Data collected included demographic, clinical, laboratory, and imaging findings, as well as management modality, duration of hospital stay, duration of follow up, outcome, and recurrence. Results A total of nine (39.1%) patients had conservative treatment only; eight (34.8%) had TUD, and six (26.1%) had TRUS needle aspiration. The mean age was 52.7 years. Lower urinary tract symptoms and fever were the most common presentations (95.7% and 82.6%, respectively). CT scan of the abdomen and pelvis with contrast was undertaken for all patients and it showed that multiple abscesses were observed in 14 (60.9%) cases.The overall mean hospital stay was 8.45 days (range 2-21 days). We observed no recurrences for patients treated conservatively or those who undertook TUD, but three patient (50%) recurrences were noted in TRUS aspiration patients. There was no mortality across the sample. Conclusion Early diagnosis of prostatic abscess and prompt management may have decreased the morbidity and mortality. Conservative management can succeed in subcentimeter abscesses but TUD is the definite therapy for large and multiloculated abscess. TRUS aspiration does have a role in treatment, but it has higher recurrence and longer hospital stay.
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Affiliation(s)
- Ibrahim Alnadhari
- Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Osama Abdeljaleel
- Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Omar Ali
- Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Morshed Salah
- Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Shamsodini
- Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
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Staphylococcus aureus Prostatic Abscess in the Setting of Prolonged S. aureus Bacteremia. Case Rep Infect Dis 2020; 2020:7213838. [PMID: 32518699 PMCID: PMC7256736 DOI: 10.1155/2020/7213838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/28/2020] [Accepted: 05/06/2020] [Indexed: 11/17/2022] Open
Abstract
Staphylococcus aureus rarely causes prostatic abscess. We report five cases of S. aureus prostatic abscess in the setting of bacteremia at our institution that occurred between 12/2018 and 05/2019. Three of the cases were caused by MRSA, and four of the patients underwent drainage of the prostatic abscess. All five patients received a minimum of six weeks of antibiotic therapy. One of the five patients died during the course of their infection. S. aureus prostatic abscess with bacteremia is an uncommon but serious disease. Treatment should consist of a combination of prolonged antibiotic therapy and surgical drainage when feasible.
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Extensive Prostatic Abscess in an Elderly Patient Requiring Multidisciplinary Drainage. Case Rep Urol 2020; 2020:4398561. [PMID: 32566352 PMCID: PMC7298311 DOI: 10.1155/2020/4398561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/20/2020] [Accepted: 05/22/2020] [Indexed: 12/03/2022] Open
Abstract
Background. Prostatic abscess is rare and mainly affects immunocompromised individuals, classically presenting with both systemic and lower urinary tract symptoms. Our case is unique as the patient presented with an exceptionally long duration of symptoms prior to seeing a health-care provider, had no systemic symptoms, and was managed via a multidisciplinary approach. Case Presentation. We present a case of a 70-year-old man with type-two diabetes who endured two months of lower urinary tract symptoms and constipation without systemic symptoms prior to seeking medical attention. He had a positive urinalysis and culture and was initially thought to have a urinary tract infection; however, computed tomography scan revealed a large, complex, and multiloculated prostatic abscess. Multidisciplinary drainage of the abscess was performed by interventional radiology and urology. A postoperative Foley catheter was left in place, and the patient recovered without complications. Discussion. Prostatic abscess is uncommon and presents almost exclusively in patients with immunocompromising conditions such as diabetes. Prior to the advent of antibiotics, the major causes were gonorrheal and Staphylococcus aureus infections, but with the advent of antibiotics, microbial culprits have shifted to gram-negative organisms. Patients typically present with lower urinary tract symptoms, perineal or lower back pain, and systemic symptoms. Management often consists of intravenous antibiotics and surgical drainage either by transrectal ultrasound-guided needle aspiration, or transurethral deroofing of the prostate. Our case highlights the following: (a) the importance of a high index of suspicion for a prostatic abscess in an immunocompromised patient with persistent leukocytosis and perineal pain after treatment with antibiotics and (b) the potential for an early multidisciplinary approach to draining extensive, loculated prostatic abscesses.
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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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Ebomah KE, Okoh AI. An African perspective on the prevalence, fate and effects of carbapenem resistance genes in hospital effluents and wastewater treatment plant (WWTP) final effluents: A critical review. Heliyon 2020; 6:e03899. [PMID: 32420480 PMCID: PMC7215200 DOI: 10.1016/j.heliyon.2020.e03899] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/30/2020] [Accepted: 04/28/2020] [Indexed: 01/04/2023] Open
Abstract
This article provides an overview of the antibiotic era and discovery of earliest antibiotics until the present day state of affairs, coupled with the emergence of carbapenem-resistant bacteria. The ways of response to challenges of antibiotic resistance (AR) such as the development of novel strategies in the search of new antibiotics, designing more effective preventive measures as well as the ecology of AR have been discussed. The applications of plant extract and chemical compounds like nanomaterials which are based on recent developments in the field of antimicrobials, antimicrobial resistance (AMR), and chemotherapy were briefly discussed. The agencies responsible for environmental protection have a role to play in dealing with the climate crisis which poses an existential threat to the planet, and contributes to ecological support towards pathogenic microorganisms. The environment serves as a reservoir and also a vehicle for transmission of antimicrobial resistance genes hence, as dominant inhabitants we have to gain a competitive advantage in the battle against AMR.
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Affiliation(s)
- Kingsley Ehi Ebomah
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice 5700, South Africa
- Applied and Environmental Microbiology Research Group (AEMREG), Department of Biochemistry and Microbiology, University of Fort Hare, Alice 5700, South Africa
| | - Anthony Ifeanyi Okoh
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice 5700, South Africa
- Applied and Environmental Microbiology Research Group (AEMREG), Department of Biochemistry and Microbiology, University of Fort Hare, Alice 5700, South Africa
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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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Apostolov R, Nicolaides S, Vasudevan A. Complex Fistulizing Crohn's Disease. Gastroenterology 2020; 158:827-828. [PMID: 31738912 DOI: 10.1053/j.gastro.2019.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/21/2019] [Indexed: 12/02/2022]
Affiliation(s)
- Ross Apostolov
- Department of Gastroenterology, Eastern Health, Victoria, Australia.
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Abstract
RATIONALE The emphysematous prostatic abscess is a rare but potentially life-threatening clinical condition. The early diagnosis is difficult due to nonspecific symptoms. PATIENT CONCERNS A 72-year-old man with poorly controlled diabetes mellitus was admitted to hospital because of dysuria and acute urine retention. He had a refractory fever after admission. DIAGNOSES The diagnosis of emphysematous prostatic abscess was confirmed by culture of catheterized urine and pelvic CT. INTERVENTIONS We tried to give antimicrobial treatment and control of blood glucose at first, but the infection could not be controlled by antibiotic therapy and control of blood glucose. TRUS-guided aspiration was performed, but obviously not adequate for abscess drainage and the abscess progressed. TUR was then performed and the infection was gradually controlled. OUTCOMES Pelvic CT scan 1 month after discharge showed complete resolution of the EPA. LESSONS Given the poor conservative treatment effect of emphysematous prostatic abscesses, CT or TRUS should be performed in the patients with suspected diagnosis. Early and appropriate drainage with proper antibiotic therapy is important to achieve a favorable outcome.
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Walker B, Heidel E, Shorman M. Clinical Characteristics and Outcome of Staphylococcus aureus Prostate Abscess, Ten-Year Experience at a Tertiary Care Center. Open Forum Infect Dis 2019; 6:5552345. [PMID: 31430373 PMCID: PMC6767969 DOI: 10.1093/ofid/ofz372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prostatic abscess (PA) is an uncommon infection that is generally secondary to Escherichia coli and other members of the Enterobacteriaceae family. In recent years, although rare, more reports of Staphylococcus aureus (S. aureus) PA have been reported, especially with increasing reports of bacteremia associated with injection drug use (IDU). METHODS This was a retrospective review of adult patients admitted to a tertiary care hospital between 2008 and 2018 and who had a diagnosis of S. aureus PA. RESULTS Twenty-one patients were included. Average age was 46 years. Fourteen (67%) presented with genitourinary concerns. Main risk factors included concurrent skin or soft tissue infections in 52%, history of genitourinary disease or instrumentation in 48%, IDU in 38%, and diabetes mellitus in 38%. Methicillin-resistant staphylococcus aureus (MRSA) was identified in 57% and concomitant bacteremia in 81% of patients. Surgical or a radiologically guided drainage was performed in 81% of patients. Antibiotic treatment duration ranged from 3 to 8 weeks. Six patients were lost to follow-up. Clinical resolution was observed in the remaining 15 (81%) patients who had follow-up. CONCLUSIONS S. aureus prostate abscess (PA) continues to be a rare complication of S.aureus infections. MRSA is the culprit in most published reports. In high risk patients with persistent bacteremia physicians need to consider the prostate as a site of infection.
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Affiliation(s)
- Bryan Walker
- University of Tennessee, Graduate School of Medicine
| | - Eric Heidel
- University of Tennessee, Graduate School of Medicine
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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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Diabetes mellitus und Immunantwort bei pyogenen Infektionen. DIABETOLOGE 2018. [DOI: 10.1007/s11428-018-0320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shigemura K, Fujisawa M. Editorial Comment to Diagnosis and treatment of patients with prostatic abscess in the post-antibiotic era. Int J Urol 2017; 25:110-111. [PMID: 29067727 DOI: 10.1111/iju.13478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Katsumi Shigemura
- Department of Urology, Kobe University Graduate School of Health Science, Kobe, Japan.,Infection Control Team, Kobe University Hospital, Kobe University Graduate School of Health Science, Kobe, Japan.,Division of Infectious Disease, Department of Health Science, Kobe University Graduate School of Health Science, Kobe, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Health Science, Kobe, Japan
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