Acute Bacterial Prostatitis in a 12-Year-Old Boy Without Any Underlying Disease

Acute bacterial prostatitis (ABP) is a common disease in adults but uncommon in children. Here, we report the case of a pediatric patient without any underlying disease who was diagnosed with ABP while trying to determine the cause of fever refractory to antimicrobial therapy. A previously healthy 12-year-old boy presented with a 13-day history of fever and malaise despite initial antimicrobial treatment. Further tests revealed pyuria and enlarged prostate with possible abscesses, which led to the diagnosis of ABP based on a contrast-enhanced computed tomography (CT) scan. Although initial urine cultures were negative, Corynebacterium pyruviciproducens was detected in subsequent cultures. Antimicrobial therapy for 10 weeks led to improvement without relapse. This case demonstrates that ABP can cause fever in children. Moreover, it shows that contrast-enhanced CT imaging can help identify the cause of fever and that administration of antimicrobials before adequate investigations can confound the diagnosis and complicate the treatment.

Viruses, bacteria and parasites: infection of the male genital tract and fertility

BACKGROUND

Infertility affects one couple out of six worldwide. Male infertilty can result from congenital or acquired factors, of which pathogens that reach the genital tract through sexual contact or blood dissemination. The impact of major viral, bacterial and parasitic infections on the male genital tract and fertility has been summarized.

RESULTS AND CONCLUSIONS

A systematic review of articles published in the Google Scholar and PubMed databases was conducted. It turns out that viruses, as well as bacteria and parasites are major inducers of male genital tract infections and ensuing infertility through damage to the organs and subsequent loss of function and/or through direct damage to the sperm cells. Moreover, not only male infertility results from such infections but these can also be transmitted to women and even to the offspring, thus highlighting the need to efficiently detect, treat and prevent them.

Acute and Chronic Infectious Prostatitis in Older Adults

Acute and chronic bacterial prostatitis are clinically significant entities that can be difficult to diagnose and appropriately treat. Herein, we review when to suspect these clinical conditions, how to diagnose them, and how to effectively treat them based on the extant literature. Our aim was to equip the practicing clinician with the ability to proficiently diagnose and manage acute and chronic bacterial prostatitis, particularly in older patients.

Innate Immune Program in Formation of Tumor-Initiating Cells from Cells-of-Origin of Breast, Prostate, and Ovarian Cancers

Tumor-initiating cells (TICs), also known as cancer stem cells (CSCs), are cancer cells that can initiate a tumor, possess self-renewal capacity, and can contribute to tumor heterogeneity. TICs/CSCs are developed from their cells-of-origin. In breast, prostate, and ovarian cancers, progenitor cells for mammary alveolar cells, prostate luminal (secretory) cells, and fallopian tube secretory cells are the preferred cellular origins for their corresponding cancer types. These luminal progenitors (LPs) express common innate immune program (e.g., Toll-like receptor (TLR) signaling)-related genes. Microbes such as bacteria are now found in breast, prostate, and fallopian tube tissues and their corresponding cancer types, raising the possibility that their LPs may sense the presence of microbes and trigger their innate immune/TLR pathways, leading to an inflammatory microenvironment. Crosstalk between immune cells (e.g., macrophages) and affected epithelial cells (e.g., LPs) may eventually contribute to formation of TICs/CSCs from their corresponding LPs, in part via STAT3 and/or NFκB pathways. As such, TICs/CSCs can inherit expression of innate-immunity/TLR-pathway-related genes from their cells-of-origin; the innate immune program may also represent their unique vulnerability, which can be explored therapeutically (e.g., by enhancing immunotherapy via augmenting TLR signaling).

Pharmacological Interventions for Bacterial Prostatitis

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.

Surgical and functional outcomes of radical retropubic prostatectomy after biopsy-related acute prostatitis

Introduction

The present study sought to evaluate the intraoperative, postoperative, oncologic, and functional results of radical prostatectomy (RP) after previous prostatitis.

Material and methods

We retrospectively reviewed available data of 320 patients undergoing open radical prostatectomy between 2010 and 2016. From this group, 23 (7.2%) had previous transrectal prostate biopsy-related acute prostatitis history. The perioperative and postoperative data were statistically compared between Group 1 (with previous prostatitis) and Group 2 (without previous prostatitis). The variables that were evaluated included demographic characteristics, perioperative complications, functional and oncological outcomes.

Results

In Group 1, the operative time, hospitalization and bladder catheterization time was statistically increased by 40 min, 1.9 days, and 2.5 days, respectively (p <0.001, p <0.001, p = 0.02). The positive margin rate was not significantly different between the two groups (p = 0 .64). The rate of complications with Clavien >2 increased in Group 1 (G1 26% vs. G2 12%) (p = 0.02). Neurovascular bundle preservation ratio was statistically higher in Group 2 (G1 46.5% vs. G2 76.9%) (p = 0.02). The functional results were similar for both groups 12 months after surgery.

Conclusions

Previously, transrectal prostate biopsy-related acute prostatitis history was associated with a higher operative time, hospitalization and bladder catheterization time, and perioperative complications during RP. According to our study, although the neurovascular bundle preservation is technically more difficult, potency and urinary continence rate was not affected by previous prostatitis history. However, further studies are still required to confirm these results.

[Characteristics of acute bacterial prostatitis in elderly patients attended in the Emergency Department]

OBJECTIVE

To compare the characteristics of acute bacterial prostatitis between patients ≥75 years old with those <75 years old attended in the Emergency Department.

MATERIAL AND METHODS

A descriptive and observational study was conducted with a prospective follow-up including all consecutive patients with acute bacterial prostatitis that were admitted during one year to the Emergency Department of a tertiary-care hospital. Data were collected for demographic variables, comorbidities, clinical and microbiological findings, treatment, outcome, and re-consultation at 30 days follow-up. Patients were compared depending on age.

RESULTS

A total of 241 episodes of acute bacterial prostatitis were included. The mean age was 62.9±16 years, and 64 patients (26.5%) were ≥75 years old. In the microbiology findings, 104 out of 215 (48.4%) of urine cultures and 25 out of 136 (18.4%) blood cultures were positive. Escherichia coli was the most frequent isolation, with resistance rates in elderly patients above 30% for ciprofloxacin, amoxicillin-clavulanic, and cotrimoxazole, and 15.4% of extended spectrum beta-lactamase producing strains. In the univariate analysis, previous manipulation of the urinary tract, history of cancer, previous antibiotic treatment, resistant E. coli strains, renal impairment, and admission to the hospital were more frequent among patients ≥75 years. Nonetheless, in the multivariate analysis only inadequate empirical antibiotic treatment was found to be significantly more frequent in elderly patients (P=.004).

CONCLUSIONS

Drug-resistance patterns to commonly used antibiotics should be considered when choosing empirical treatment for acute bacterial prostatitis in the Emergency Department setting, especially for patients ≥75 years.

Septic shock secondary to acute bacterial prostatitis in an HIV-positive male: a novel presentation

Acute bacterial prostatitis, an acute infection of the prostate gland, results in lower abdominal pain, flank pain, urinary symptoms and the potential for systemic symptoms like fever and shock. With a high mortality rate if left untreated, acute bacterial prostatitis becomes a true urological emergency, which if allowed to progress, may result in bacteremia, severe sepsis/septic shock and death. Diagnosis is mainly clinical with a detailed history and physical and laboratory evaluation to include a urinalysis. However, imaging may be necessary to exclude other pathology. We present the case of a 44-year-old male with a history of well-controlled HIV that used a prostate vibrator for 1-week prior to his presentation to the ED. He was subsequently diagnosed with septic shock secondary to acute bacterial prostatitis and required ICU management.

Comparison of the delta neutrophil index with procalcitonin, erythrocyte sedimentation rate, and C-reactive protein as predictors of sepsis in patients with acute prostatitis

Background

We investigated the usefulness of inflammatory markers including the delta neutrophil index (DNI), erythrocyte sedimentation rate, C-reactive protein, and procalcitonin as early predictors of sepsis in patients with acute prostatitis (AP). In addition, we evaluated the efficacy of intermittent catheterization for the initial management of acute urinary retention (AUR) in patients with AP.

Materials and methods

All patients who presented to the emergency department and were admitted to the urology department from January 2011 to December 2013 were retrospectively reviewed. The clinical features, prostate-specific antigen levels, inflammatory marker levels, and urine and blood culture results were obtained from medical records. Patients who underwent urethrocystoscopy or prostate biopsy within 7 days were excluded.

Results

Of 132 patients (mean age, 64.8 years) in this cohort, 17 (12.9%) had sepsis and 22 (16.7%) had positive blood cultures. Escherichia coli was the most common isolate in blood and urine cultures. In multivariate analysis, the DNI and prostate-specific antigen were identified as predictors of sepsis. The DNI was a significant prognostic factor for bacteremia. In patients with AP, procalcitonin was not a significant predictor of sepsis. Of 19 patients with AUR, 10 needed Foley catheterization because of refractory AUR. C-reactive protein was a significant predictor of failure of the initial management of AUR.

Conclusions

The DNI is useful as a predictive factor for sepsis and bacteremia in patients with AP. Without mandatory cystostomy, intermittent catheterization could be one of the useful management options of AUR in patients with AP.

Comprehensive overview of prostatitis

Prostatitis is a common urinary tract syndrome that many doctors find problematic to treat effectively. It is the third most commonly found urinary tract disease in men after prostate cancer and Benign Prostate Hyperplasia (BPH). Prostatitis may account for 25% of all office visits made to the urological clinics complaining about the genital and urinary systems all over the world. In the present study, we classified prostatitis and comprehensively elaborated the etiology, pathogenesis, diagnosis, and treatment of acute bacterial prostatitis (category I), chronic bacterial prostatitis (category II), chronic pelvic pain syndrome (CPPS) (category III), and asymptomatic prostatitis (category IV). In addition, we also tried to get some insights about other types of prostatitis-like fungal, viral and gonococcal prostatitis. The aim of this review is to present the detail current perspective of prostatitis in a single review. To the best of our knowledge currently, there is not a single comprehensive review, which can completely elaborate this important topic in an effective way. Furthermore, this review will provide a solid platform to conduct future studies on different aspects such as risk factors, mechanism of pathogenesis, proper diagnosis, and rational treatment plans for fungal, viral, and gonococcal prostatitis.

Concurrent Diffuse Pyelonephritis and Prostatitis: Discordant Findings on Sequential FDG PET/CT and 67Ga SPECT/CT Imaging

A 45-year-old man underwent FDG PET/CT for initial imaging evaluation of recurrent Escherichia coli urinary tract infections, which demonstrated no significant FDG uptake in either kidney and subtle FDG uptake in the right prostate lobe. Subsequent Ga SPECT/CT demonstrated abnormal intense gallium uptake throughout the right kidney and entire prostate gland, clearly discordant with PET/CT findings and consistent with unexpected concurrent pyelonephritis and prostatitis. Although FDG has effectively replaced Ga in everyday clinical practice, the current case serves as a reminder that there is still a role for Ga in the evaluation of genitourinary infections.

Acute prostatitis probably due to Listeria monocytogenes in an HIV-infected patient

We report a unique case of acute bacterial prostatitis probably caused by Listeria monocytogenes in an HIV-infected patient. For the best of our knowledge, this is the first case reported of a patient with this association. Our case illustrates the protean clinical presentations that L. monocytogenes infections may adopt, particularly in immunocompromised patients.