Acute Prostatitis Research Articles

Predicting the need for additional intervention in prostate abscess treatment: Insights from a multicenter study and proposal of a Prostate Abscess Complexity Score

Purpose: To evaluate prostate abscess outcomes and identify predictors for additional intervention. Additionally, assess a complexity score for clinical decision-making. Materials and methods: This is a retrospective, multicenter study including 62 consecutively admitted prostate abscess patients. Primary treatment involved antibiotics or a combination with transrectal ultrasound-guided aspiration (TRUS-GA) or transurethral resection of the prostate with abscess deroofing. Outcomes were assessed by comparing resolution with primary treatment to additional intervention. Additional intervention involved escalation to TRUS-GA, repeat TRUS-GA, or transurethral resection of the prostate with abscess deroofing. The sample was further categorized by Prostate Abscess Complexity Score (PACS) into complex and noncomplex. Risk factors, clinical features, abscess characteristics, and reintervention predictors were analyzed using logistic regression and receiver operating characteristic analysis. Results: Sixty-two patients were included, 47 (75.8%) responded well to primary treatment, while 15 (24.2%) needed additional intervention. Risk factors for additional intervention included multifocal abscess (P = 0.005), septa (P = 0.023), bilateral involvement (P = 0.008), abscess diameter ≥3 cm (P = 0.040), and volume ≥20 cc (P ≤ 0.001). The PACS, considering abscess focality, septa, laterality, polarity, abscess diameter, and volume, showed 73% sensitivity and 74% specificity in predicting additional intervention (P = 0.001) with a threshold of ≥6 points to classify as complex. Among complex cases, 80% required additional intervention, compared to 34% in noncomplex cases (P = 0.002). Conclusion: This study highlights personalized treatment for prostate abscess. Identified risk factors (multifocal abscess, septa, bilateral involvement, large abscess diameter, and increased volume) provide insights into predicting the need for additional interventions. The proposed PACS offers a valuable tool for clinical decision-making when ≥6 points are encountered.

Case report: A follow-up report of omental packing and drug therapy for canine prostate adenocarcinoma

Canine prostate is susceptible to diseases such as cysts, abscesses, and tumors. A 15-year-old male castrated Chinese rural dog underwent staged treatment. Preliminary diagnosis is based on examination results, including clinical symptoms (tenesmus, dysuria, frequent urination, and hematuria); hematology (elevated neutrophil count); X-rays (swelling of the prostate); ultrasound examination (less uniform echo in the prostate region, no echo effect in parenchyma); biopsy smear of prostate tissue (large number of neutrophils and rod-shaped bacteria). Therefore, the dog was preliminarily diagnosed with a prostate abscess. Antibiotic therapy was used for treatment. Three days later, the symptoms of hematuria and frequent urination did not improve, and the state was poor. The owner was advised to undergo surgical treatment-omental packing. Meanwhile, bacterial culture identification, drug sensitivity test and histopathological examination were performed. Pathological diagnosis was prostate adenocarcinoma. Subsequently, antibiotic therapy with enrofloxacin and antineoplastic maintenance therapy with mitoxantrone were administered. Six months later, the dogs were followed up, and the results showed no disease in the prostate tissue and no metastatic lesions. This is the report describing the use of omental packing for the treatment of prostate adenocarcinoma in dogs. In order to provide an important theoretical basis for the treatment of prostate cancer - omental packing into veterinary routine.

EPIDEMIOLOGY OF MALIGNANT PROSTATE NEOPLASMS IN THE SUMY REGION

Introduction. One of the most critical medical and social challenges facing the male population globally is the prevalence of malignant tumors of the prostate gland. Cancer-related mortality ranks the second position in Ukraine and worldwide, following cardiovascular diseases. Therefore, early diagnosis remains the most promising and effective strategy for combating malignant tumors. Objective: to investigate the prevalence and frequency of diagnosis of malignant prostate neoplasms in the Sumy region. Materials and Methods. The study utilized statistical data from the medical records of patients with prostate disease treated at the Urology Departments of Sumy Clinical Hospital of St. Panteleimon and Sumy City Clinical Hospital from 2018 to 2022. Results. The statistical analysis revealed that the prevalence of prostate diseases among patients aged 40-54 years was 21.5%, among those aged 55-74 years it was 34.3%, and for patients over 75 years it was 44.2%. An examination of the data regarding when patients sought medical help from the onset of the disease highlighted that most men with prostate cancer were asymptomatic, contributing to the spread of the disease and complicating early-stage diagnosis. Cardiovascular diseases and urinary system disorders (e.g., urolithiasis, benign prostatic hyperplasia, chronic prostatitis, and acute prostatitis) were common comorbidities in these patients. Conclusion. The statistical analysis identified a rising trend in the incidence of malignant prostate tumors in men over 50. Diseases of cardiovascular and urinary system were the most prevalent comorbidities in patients with prostate tumors. The majority of the patients were hospitalized late in the course of the disease.

Simultaneous prostatic and right seminal vesicle abscesses: a case report

BackgroundSynchronous abscesses of the prostate and seminal vesicles represent a rare but clinically significant form of purulent retention. They pose diagnostic and therapeutic challenges and are associated with considerable morbidity and a high risk of sepsis.Case presentationWe present the case of a 60-year-old Caucasian man with a history of insulin-dependent diabetes mellitus, who had a voluminous prostatic abscess associated with a right seminal vesicle abscess due to compression of the right ejaculatory duct, and who presented to our department with sepsis. He had clinical and radiological confirmation with computed tomography scan and magnetic resonance imaging. The patient underwent percutaneous drainage of the prostatic abscess resulting in the subsidence of the seminal vesicle abscess. The treatment also consisted on prolonged antibiotic therapy. The clinical evolution was favorable.ConclusionWe conclude that prostatic abscesses can lead to synchronous seminal vesicle abscesses due to ejaculatory duct compression. Percutaneous drainage of the prostatic abscess by transrectal ultrasound-guided drainage, combined with prolonged antibiotic therapy, can effectively treat both abscesses.

Hematogenous Brain Abscess Resulting from Prostatic Abscess Caused by Klebsiella pneumoniae

Brain abscess, a life-threatening infection, can result from hematogenous spread. Although uncommon, Klebsiella pneumoniae can lead to brain abscess and systemic dissemination. In this case report, Klebsiella pneumoniae brain abscess, linked with prostate abscess, in a 57-year-old diabetic male with liver cirrhosis and hepatitis B, resulted in fatal sepsis despite antibiotic therapy. This case underscores Klebsiella's grave risk in immunocompromised patients, highlighting brain abscess and high mortality. Early diagnosis, treatment, and evaluation for multiple organ involvement are crucial.

Etiological diagnosis of prostatitis: current methods and ethical evaluation

The incidence of acute and chronic bacterial prostatitis in the juvenile and adult population is steadily increasing. This phenomenon is related to changing sexual habits. The clinical diagnosis of acute prostatitis is quite simple, both because of the characteristic symptomatology (fever with chills, sacral rachialgia, perineal pain) and the semeiological data of the rectal exploration. Prostate ultrasound may finally help to settle a doubt.

Predictive values and relationships of serum PSA levels, delta neutrophil index, neutrophil-lymphocyte ratio and other hematological parameters in patients with acute prostatitis.

This study aimed to evaluate the predictive values and relationships of serum prostate-specific antigen (PSA) levels, delta neutrophil index (DNI), neutrophil-lymphocyte ratio (NLR), and other hematological parameters in patients diagnosed with acute prostatitis. Serum PSA levels and hemogram parameters of patients diagnosed with acute prostatitis were retrospectively analyzed. Healthy patients of the same age group were assigned to the control group. WBC, neutrophil, lymphocyte, thrombocyte (PLT), mean platelet volume (MPV), plateletcrit (PCT), NLR, and DNI were determined. Serum total PSA and C-reactive protein (CRP) levels were also assessed. Total PSA levels (3.48 [1.11-6.66]) in the acute prostatitis (AP) group were significantly higher than those of healthy men (0.82 [0.47-1.39]) (p < 0.001). Total CRP levels (3.88 [1.50-22.03]) in the AP group were significantly higher than those in healthy men (1.15 [0.89-2.00]) (p < 0.001). The sensitivity and specificity of PSA at a cutoff value of 1.52 were 68.4% and 79.7%, respectively. The NLR value in the AP group was 2.62 (1.87-4.42), compared to 1.63 (1.18-2.20) in the healthy group (p < 0.001). Differences in WBC, neutrophil, and lymphocyte counts were also statistically significant (p < 0.001). There were no significant differences in PLT, PCT, or DNI values. Significant positive correlations were observed between PSA, CRP, and DNI values (all p < 0.001). This study demonstrated the usefulness of NLR, PSA, CRP, and WBC as predictors of acute prostatitis. NLR is a simple, inexpensive inflammation parameter that correlates well with CRP levels.

Occurrence of liver abscess in patients with acute prostatitis.

Liver abscesses concomitant with acute prostatitis are rare and potentially fatal. We analyzed the occurrence of this condition and clinical characteristics of the affected patients. The medical records of 474 patients diagnosed with acute prostatitis between June 2006 and July 2022 were retrospectively reviewed. Patients in whom pathogens were not detected in serum or urine cultures were excluded. A total of 271 patients were included in the analysis. Patient characteristics and laboratory test results were compared between patients with acute prostatitis with and without liver abscesses. Fifteen patients (5.5%) were identified with simultaneous liver abscesses and acute prostatitis. The liver abscess group was younger than the non-liver abscess group in terms of mean age. In the univariate analysis, a high proportion of patients had diabetes mellitus, whereas a low proportion had hypertension. None of the underlying diseases, including benign prostatic hyperplasia, malignancy, or alcoholism, demonstrated a significant association with liver abscess in multivariate analysis; however, an association was observed in liver function test results. All patients with liver abscesses tested positive for Klebsiella pneumoniae. When K. pneumoniae is identified in patients with acute prostatitis and abnormal liver function tests, considering the possibility of metastatic infection in other organs, including the liver, and performing an active evaluation is essential.

Outcome of three different techniques of prostatic abscess drainage: a retrospective single-center experience

BackgroundDespite the fact that prostate abscess (PA) is a serious condition, no standardized guidelines are available on the best methods for its drainage. The goal of the current study is to compare the outcomes of the three modalities of prostate abscess (PA) drainage: transrectal ultrasound (TRUS) guided aspiration (TRA), transperineal aspiration (TPA), and transurethral de-roofing (TUD).MethodsThe records of 66 patients diagnosed with PAs were collected between 2015 and 2022 and divided into 3 groups according to the technique of abscess drainage that was used. Group A included 26 patients treated by TRA; Group B included 28 patients treated by TUD; and Group C included 12 patients treated by TPA. The three groups were compared based on demographic data, drainage success, recurrence, complications, and hospital stay.ResultsThe mean abscess size (cm) was 4.8 ± 1, 5.7 ± 1, and 5.4 ± 1.3 cm in groups A, B, and C, respectively. Central abscesses were detected in 35 patients (53%), peripheral in 21 patients (31.8%), and both central and peripheral in 10 patients (15.2%). The most common clinical presentation was lower urinary tract symptoms (LUTS) in 45 patients (68.18%), followed by fever in 40 patients (60.6%). The mean abscess size (cm) was 4.8 ± 1, 5.7 ± 1, and 5.4 ± 1.3 cm in groups A, B, and C, respectively. Recurrence of the abscess occurred in three (11.5%), one (3.6%), and one (8.3%) patients in groups A, B, and C, respectively (p = 0.496). The mean hospital stay was 4.8 ± 1.7, 5 ± 1.8, and 4.5 ± 1.3 days in groups A, B, and C, respectively (p = 0.763). When compared to the other two groups, the TUD group had a higher rate of complications (32.1%).ConclusionA TRUS-guided transrectal and transperineal aspiration of PA were comparable to TUD technique regarding the recurrence rate and hospitalization period; however, the safety profile was in favor of the aspiration groups.

Fluoroquinolone resistance and clinical characteristics of acute bacterial prostatitis in Japan: A multicenter study by the Japanese Research Group for Urinary Tract Infection

ObjectiveThis multicenter study aimed to analyze the risk factors for fluoroquinolone (FQ) resistance and to clarify the clinical characteristics of acute bacterial prostatitis (ABP) in Japan. MethodsA total of 124 patients clinically diagnosed with ABP at 13 medical institutions participating in the Japanese Research Group for Urinary Tract Infection between January and December 2017 were retrospectively reviewed. ResultsOf the 124 patients included in this study, 37 were outpatients, and 87 were inpatients. The main underlying medical conditions before the onset of ABP were severe dysuria, urinary retention, transurethral manipulation, indwelling urinary catheter, and transrectal prostate biopsy (TRBx). The main symptoms were fever (≥ 37.5°C), prostate tenderness, dysuria, micturition pain, urinary retention, and macrohematuria. Bacteremia was observed in 14 patients. Prostatic abscess was observed in three patients. Escherichia coli was the predominant organism, accounting for 48% (51/106). FQ-resistant E. coli was detected in 33% (17/51), and extended-spectrum beta-lactamases-producing E. coli in 12% (6/51). TRBx (odds ratio [OR] = 48.60, 95% confidence interval [CI]: 5.49–430.00, p < 0.001) and inpatient status (OR = 29.00, 95% CI: 1.95–430.00, p = 0.014) were risk factors for the detection of FQ-resistant bacteria. ConclusionsThe detection rate of FQ-resistant bacteria was significantly higher with TRBx ABP and inpatient status. These findings have important implications for the management of ABP and antimicrobial treatment, especially for TRBx ABP, which should be considered a separate category.

Gender Differences in the Clinical Profile of Sodium-Glucose Cotransporter-2 Inhibitor-Related Urinary Tract Infections.

Background Sodium-glucose cotransporter-2 inhibitors (SGLT2Is) are a novel class of oral antidiabetic agents with proven cardiovascular and mortality benefits. By promoting glucosuria, SGLT2Is increase the risk of genital and urinary tract infections (UTIs), which remain uncomplicated in most cases. Comparative studies detailing the gender differences in the clinical profile of SGLT2I-related UTIs (SUTIs) are lacking. Hence, this study was designed to investigate the gender-related differences in the clinical profile of SUTIs. Methodology This prospective study enrolled 100 consecutive diabetes mellitus patients with UTI symptoms who were on SGLT2Is. In addition to collecting clinical details, patients were subjected to the following investigations: complete blood counts, urea, creatine, liver function, lipid components, urine analysis, urine culture, and ultrasonography. Results Females (n = 80) outnumbered males (n = 20). Although females were younger than males (53.68 ± 10.26 vs. 63.30 ± 10.75 years, p = 0.003), body mass index (29.84 ± 7.22 vs. 24.62 ± 3.10 kg/m2, p = 0.008) and waist circumference (103.01 ± 14.49 vs. 93.75 ± 4.50 cm, p = 0.109) were higher in females. About 22.5% of females had undergone hysterectomy. The mean duration of diabetes mellitus was longer in males (10.64 ± 6.74 vs. 7.78 ± 4.75 years), whereas the median duration of SGLT2I use (4 (interquartile range (IQR) = 1-12) vs. 3 (IQR = 2-4) months) and mean HbA1c levels were not different between the two groups. A greater proportion of males were complicated by retinopathy (55% vs. 15%) and proteinuria (65% vs. 17.5%), while neuropathy (85% vs. 71.25%) rates were similar. Overall, 35% of males had complicated UTIs (renal abscess, pyelonephritis, prostatic abscess) compared to only 3.75% of females (p = 0.001). Conclusions The majority of SUTIs are uncomplicated in females whereas in males one-third are complicated infections. Although females with SUTI had a higher prevalence of obesity and dyslipidemia, males had a longer duration of diabetes mellitus and higher retinopathy prevalence. Extreme caution should be exercised in patients at risk for SUTI before prescribing SGLT2I.

Medical imaging in melioidosis - 20-year experience in a non-endemic Australian city.

Melioidosis may occasionally be encountered in non-endemic areas and medical imaging is frequently used to identify and characterise sites of disease. The purpose of this study is to describe the spectrum of imaging findings encountered in melioidosis patients treated in the tertiary public hospitals of Perth, Western Australia, between 2002 and 2022. A database search and electronic medical record review was used to identify cases. Cases were included if they had Burkholderia pseudomallei isolated on culture and if they had at least one diagnostic imaging study performed at a Perth public tertiary hospital. The relevant imaging studies were reviewed, and imaging findings were recorded. Thirty-six cases were identified. The most common disease manifestation was bacteraemia (72%, 26 cases), followed by pulmonary infection (58%, 21 cases), skin and soft tissue infection (22%, eight cases), prostate abscess (14%, five cases) and septic arthritis (6%, two cases). A previously unreported case of isolated melioid pleural effusion was identified, as was a case of reactivated chronic latent pulmonary melioidosis with an apparent delay of over 20 years between the onset of symptoms and the time of infection. In cases with pulmonary melioidosis, the major lung abnormalities on CT chest could be categorised into one of two distinct patterns: nodular-predominant (78%) or consolidation-predominant (22%). Further research is required to assess the utility of the pattern-based categorisation of lung abnormalities on CT chest seen in the pulmonary melioidosis cases of this series.

Comparative Evaluation of Prostatic Smear and Semen Analysis in The Diagnosis of Chronic Prostatitis

Abstract Background Chronic prostatitis is one of the most common medical problems among andrology and urology patients. Besides being the primary problem in many cases, it seems to play an important contributing role “major or minor” in a significant proportion of patients whether at the level of fertility, sexology or venerology. Consequently, effective management of the prostatic pathology has a great impact on the overall successful management of such andrologic problem. Aim of the Work to provide an objective comparison between traditional prostatic discharge analysis and traditional semen analysis as regards detection of pus cells in cases of prostatitis as well as to assess the possible advantage(s) of applying some modifications to enhance the diagnostic value of the previous techniques. These would include preliminary centrifugation of expressed prostatic discharge and preliminary peroxidase staining of semen sample before microscopic examination. Patients and Methods This pilot study included 40 patients suffering from prostatitis except acute prostatitis. The patients were recruited from the outpatient clinic of Venerology and Andrology department of Ain Shams University Hospitals in the period from February 2021 to November 2021. Results The current study included 40 patients suffering from any kind of prostatitis except acute prostatitis. Their age ranged between 30 and 50 years old with a mean age of 39.60 ± 4.52 years. Duration of disease ranged from 4-18 months with a mean of 7 ± 3.1 months. Most of patients were married (38, 95%). Main symptoms presented among studied patients were groin pain (37.5%), groin pain and painful micturition (20%) and groin pain, painful micturition and sexual problems (42.5%) Conclusion prostatic smear examination revealed higher sensitivity in detection of infection compared to semen analysis especially if combined with centrifugation. In addition, peroxidase positive cell testing revealed a significant role in detection of infection if the diagnosis is made solely on semen analysis results.

Rhabdomyosarcoma of prostate presenting as prostatic abscess in young adult – Rare presentation of a rare disease

Abstract Rhabdomyosarcoma (RMS) of the prostate in adults is a rare but highly malignant tumor and often metastatic at diagnosis. RMS of the prostate in adults has been reported in isolated case reports in the literature. Timely diagnosis and multimodal treatment give the best survival chance to the patient. The varied presentation of RMS of the prostate in adults mimicking multiple other pathologies of the prostate and lack of pathognomic radiological findings makes its diagnosis difficult and delays in treatment. Transrectal biopsy of the prostate with immunohistochemistry panel at histopathological examination confirms the diagnosis. A 27-year-old man diagnosed as prostatic abscess and treated with antibiotics was referred to our center. Adequate suspicion of malignancy with proper evaluation and biopsy leads to correct diagnosis of RMS of the prostate. Multimodality treatment was initiated as the disease was not metastatic at diagnosis.

A Transperineal Biopsy of the Prostate Does Not Require Routine Antibiotic Cover.

Introduction A transperineal ultrasound-guided prostate biopsy (TPB) under local anaesthetics (LA) after a prostate MRI scan is the gold standard for performing a prostate biopsy in patients with suspected prostate cancer. It has superseded transrectal ultrasound-guidedprostate biopsy (TRUSB). Historically, TRUSB by definition was performed in a contaminated environment and was routinely covered with antibiotics to reduce the risks of infection. Despite this, the rate of post-biopsy urosepsis has been documented to be as high as 5% in some series. In the transition from TRUSB to the establishment of a TPB under LA service in our unit, we continued to use a single dose of oral antibiotics for all patients attending for biopsy. The aim of this study is to establish whether the use of single-dose antibiotics has any effect on morbidity rates post-TPB. Methods A retrospective analysis of complications was carried out on 326 consecutive patients, who underwent TPB over a six-month period. One cohort of patients were biopsied with no antibiotic cover (n=149, 45.7%) as compared to another cohort who were given a single dose of oral antibiotics (n=177, 54.3%). Those patients in the group receiving antibiotics received either a single dose of co-amoxiclav or a single dose of ciprofloxacin. Patients with indwelling urethral catheters or with a urinary tract infection (UTI) were excluded from the analyses. All patients were followed- up after a multidisciplinary team meeting discussion (MDT) with either a telephone or a face-to-face consultation. Results A total of 324 (99.4%) patients did not report post-procedural complications. Two patients from the antibiotic group presented with infectious complications (1.1%); one patient was admitted with a prostate abscess and required drainage under general anaesthesia, and another was admitted with urosepsis requiring intravenous antibiotics. In the group who did not receive antibiotics, there were no complications reported, which was not significantly different compared to the antibiotic group (p=0.50). Conclusion Our results demonstrate that the routine use of single-dose antibiotics with TPB does not affect morbidity rates. On the basis of this investigation, we have now stopped using routine antibiotic cover for patients undergoing an LA TPB.

Multidrug-resistant Escherichia coli causing canine pyometra and urinary tract infections are genetically related but distinct from those causing prostatic abscesses

Despite extensive characterisation of uropathogenic Escherichia coli (UPEC) causing urinary tract infections (UTIs), the genetic background of non-urinary extraintestinal pathogenic E. coli (ExPEC) in companion animals remains inadequately understood. In this study, we characterised virulence traits of 104 E. coli isolated from canine pyometra (n = 61) and prostatic abscesses (PAs) (n = 38), and bloodstream infections (BSIs) in dogs (n = 2), and cats (n = 3). A stronger association with UPEC of pyometra strains in comparison to PA strains was revealed. Notably, 44 isolates exhibited resistance to third-generation cephalosporins and/or fluoroquinolones, 15 were extended-spectrum ß-lactamase-producers. Twelve multidrug-resistant (MDR) strains, isolated from pyometra (n = 4), PAs (n = 5), and BSIs (n = 3), along with 7 previously characterised UPEC strains from dogs and cats, were sequenced. Genomic characteristics revealed that MDR E. coli associated with UTIs, pyometra, and BSIs belonged to international high-risk E. coli clones, including sequence type (ST) 38, ST131, ST617, ST648, and ST1193. However, PA strains belonged to distinct lineages, including ST12, ST44, ST457, ST744, and ST13037. The coreSNPs, cgMLST, and pan-genome illustrated intra-clonal variations within the same ST from different sources. The high-risk ST131 and ST1193 (phylogroup B2) contained high numbers of ExPEC virulence genes on pathogenicity islands, predominating in pyometra and UTI. Hybrid MDR/virulence IncF multi-replicon plasmids, containing aerobactin genes, were commonly found in non-B2 phylogroups from all sources. These findings offer genomic insights into non-urinary ExPEC, highlighting its potential for invasive infections in pets beyond UTIs, particularly with regards to high-risk global clones.

Should we review our prophylaxis approach for increased antibiotic resistance in transrectal prostate biopsy?

This study aims to show the bacteriologic picture of acute prostatitis and bacteremia caused by infective agent after transrectal ultrasound-guided prostate biopsy (TRUSBx) and to determine the resistance rates of the infections in patients undergoing transrectal biopsy and to guide prophylaxis approach before biopsy. The retrospective data of 935 patients who underwent TRUSBx between January 2010 to January 2019 were reviewed. Pre-biopsy urine cultures and antimicrobial susceptibility were obtained. Subsequently, patients admitted to the hospital with any complaint after biopsy were examined for severe infection complications. Of the 430 (61.7%) patients who underwent urine culture before the procedure, 45 (10.5%) had growth; 30 (66.7%) of the growing microorganisms were Escherichia coli. Twenty (44.4%) of all Gram-negative agents in pre-biopsy urine culture were susceptible to quinolone. Post TRUSBx bacteremia was present in 18.2%, urinary system infection in 83.6%, and hospitalization in 61.8% of 55 patients who were admitted to the hospital. In the isolated gram-negative microorganisms, fluoroquinolones resistance in urinary system infections was seen in 40% and bacteremia was seen in 70% of the cases. ESBL-producing Gram-negative bacteria were determined in 40% of infections in blood and 38.5% of urinary system infections in the post biopsy period in the current study. These high antibiotic resistance rates suggest that we better review our pre-procedure prophylaxis approaches.

Dynamics of metalloproteinases in acute bacterial prostatitis during combination therapy

The purpose of the study – to study the effect of combination therapy, including magnetolaser exposure and the use of photodynamic therapy on the state of matrix metthaloproteinases in acute bacterial prostatitis. Materials and methods. An analysis of the treatment of 30 patients from whom approval was received for conducting a study with an established diagnosis of acute prostatitis of bacterial nature. For this purpose, men aged 18–40 years were selected, the average age was 32 ± 2 years. To conduct the study, the men were divided into three groups of 15 people each. Group 1 included patients who received a combination of antibiotic therapy and magnetic laser therapy as the main treatment. In group 2, patients who received antibiotic therapy and magnetic laser therapy were supplemented with photoditazine at a dose of 0.8 mg/kg per 100 ml. To compare laboratory parameters, a third group (group 3) of 15 relatively healthy men of the same age was formed. To assess the effectiveness of treatment, a dynamic study of metalloproteinase-1 inhibitor (TIMP-1), as well as metalloproteinases (MMPs) -1, -2, -3, -7, -8, -9, into the blood serum. Results. It has been established that the use of photodynamic therapy and laser irradiation of blood in the complex treatment of acute bacterial prostatitis leads to an early recovery of serum MMPs, and as a result, an early relief of signs of inflammation, while the use of this method contributes to a greater number of recoveries, is well tolerated, has a few side effects, which can serve as recommendations for a wider range of the use of this technique in the treatment of acute bacterial prostatitis.

Disseminated Melioidosis Presenting as Sepsis, Neurological Melioidosis, Liver and Prostate Abscess in United Arab Emirates.

Melioidosis is an infection caused by Burkholderia pseudomallei, a Gram-negative bacterium. It is a disease endemic to Southeast Asia and northern Australia although its global incidence has been rising. It most commonly infects people with certain identified risk factors such as diabetes, alcoholism, thalassemia, and underlying chronic disease involving lungs, kidney and liver. This bacterium is capable of producing a wide array of clinical manifestations ranging from asymptomatic disease to localised infections such as in the lung, bone or skin to disseminated infection. This is a case, from United Arab Emirates, of a 40-year-old male recently diagnosed with diabetes who presented with multiple abscesses and was eventually diagnosed with disseminated melioidosis. He was treated successfully with antibiotics and drainage of abscesses. In non-endemic regions, melioidosis can be easily missed in common diagnostic approaches. This gap of awareness could delay the diagnosis and allow further deterioration of the patient due to complications. Thus, case reports like this can enlighten internists about changing incidences and complexity of clinical presentations, thus preparing them to better handle such patients in the future. Owing to its considerably rare incidence in non-endemic regions including the United Arab Emirates, melioidosis can easily be overlooked or misdiagnosed.Moreover, due to similarity with multiple other diseases and infections as well as significant absence from standard medical curricula, melioidosis is rarely on the differential list of an internist.This report aims to enhance awareness and alertness to aid earlier detection and avoid severe complications.

Pearls and Pitfalls in Applying PI-RADS 2.1

AbstractThe use of Prostate Imaging Reporting and Data System (PI-RADS) with multiparametric magnetic resonance imaging (MRI) has significantly improved the detection of clinically significant prostate cancer (csPCa), but there are certain challenges that the reader may face. This review provides an overview of the pitfalls associated with the PI-RADS system for multiparametric prostate MRI (mpMRI), with suggestions/pearls to help overcome these pitfalls.PI-RADS assessment is hindered by several causes of false positives (FPs) and false negatives (FNs). In addition, there is wide variability in the positive predictive value (PPV) of the PI-RADS system across different centers, highlighting the need for improvement. While the negative predictive value (NPV) for csPCa is generally high, variations exist.This review discusses the pitfalls contributing to FNs, including MRI artifacts, such as susceptibility and motion artifacts. Techniques to optimize image acquisition, such as switching the phase encoding direction and reducing bowel peristalsis, are suggested to mitigate these artifacts. Improper b-value selection for diffusion-weighted imaging (DWI) is another pitfall, emphasizing the importance of using high b-values (≥1,400 s/mm2) to optimize neoplasm detection. Similarly, optimizing window settings to visualize csPCa, correctly positioning the endorectal coil, awareness of rare variants like mucinous adenocarcinoma and cribriform adenocarcinoma, and distinguishing central zone tumors from normal central zone are discussed.This article highlights the common pitfalls causing FPs, such as benign pathologies like prostatitis, granulomatous prostatitis, prostatic abscess, stromal BPH nodules, extruded BPH nodules, and prostatic calcifications. It also discusses the pitfalls related to normal anatomical structures, including the central zone, anterior fibromuscular stroma, thickened surgical capsule, neurovascular bundle, and periprostatic venous plexus. Techniques for carefully evaluating these entities' morphology and distribution of signal abnormalities are described to avoid overdiagnosing these as PCa. The article also addresses the pitfalls related to postintervention changes, including postbiopsy hemorrhage and artifacts caused by the UroLift procedure, while providing recommendations for managing these challenges.Finally, the pitfalls that may be encountered during staging, including evaluation for extraprostatic extension, and pelvic nodal and osseous metastases, are highlighted.