Acute Prostatitis Research Articles

Prostate abscess with acute urinary retention as the initial presentation of granulomatosis with polyangitis

A 50-year-old male presented with acute urinary retention. He also had a history of cough, haemoptysis, exertional dyspnoea, loss of appetite, generalised weakness and left-ear discharge of 1-month duration. Prior episode of acute urinary retention had occurred 2 months ago; diagnostic evaluation revealed prostate abscess, and he had received treatment elsewhere for the same. He also had a history of hypertension. Physical examination revealed fever, pallor, bilateral parotid enlargement and left-ear serous discharge. Clinical examination, imaging of chest revealed consolidation with cavitation on the left side, bilateral pleural effusion. Laboratory testing revealed normocytic normochromic anaemia (haemoglobin 6.6 g/dL); neutrophilic leucocytosis (total leucocyte count 13,100 cells/mm3; polymorphs 87%); raised erythrocyte sedimentation rate (110 mm at the end of the first hour); elevated serum creatinine (2.69 mg/dL) and an active urine sediment. Flexible fibreoptic bronchoscopy showed alveolar haemorrhages. Bronchoalveolar lavage fluid Xpert MTB/RIF testing, cytopathology were negative. Computed tomography-guided biopsy from the lesion was suggestive of granulomatous vasculitis. Cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA) tested positive. The patient was diagnosed to have granulomatosis with polyangitis (GPA). As arterial hypoxaemia was evident, tracheal intubation and mechanical ventilatory support were initiated. Renal replacement therapy, intravenous (iv) methyl prednisolone and cyclophosphamide pulse therapy and five sessions of plasmapheresis were administered. As remission could not be achieved, iv rituximab was started. On the 36th day of admission, the patient developed septic shock and died. The present case documents the uncommon association of GPA with prostate abscess, acute urinary retention.

Сирингоцеле Купера (бульбоуретральная киста)

This article presents a clinical case of a 30-year-old patient with a closed cystic lesion in the bulbourethral gland, whose clinical presentation was masked as acute prostatitis. Cowper’s syringocele is a cystic dilation (deformity) of the main duct of the bulbourethral (Cowper’s) gland. This disease is not uncommon, but is rarely identified; it is often asymptomatic, and its clinical manifestations are highly variable, depending mainly on its type (open, closed) and are similar to lower urinary tract symptoms (perineal pain, post-micturition dribble, recurrent urinary tract infection, dysuria, etc.). A syringocele should be included in the examination algorithms for boys, adolescents, and men with signs of inflammatory diseases of the urogenital system or symptoms of infravesical obstruction. Ultrasonography is informative for closed cysts (a fluid-filled cavity may be identified); a pelvic MRI scan, supplemented by ureteroscopy, allows to visualize the cyst cavity and to determine its association with the urethra. Ureteroscopy is a preferable option for surgical treatment in most cases. Key words: bulbourethral gland cyst, lower urinary tract symptoms, Cowper’s syringocele, ureteroscopy

Contemporary management of prostatic abscess: Our experience.

Introduction:Prostatic abscess is a serious urological problem that needs immediate attention due to its high morbidity and mortality in absence of appropriate treatment. The objective of our study is to evaluate the efficacy and safety of various modalities of management of prostatic abscess: medical management (MM), transrectal ultrasound-guided aspiration (TRUS-GA), and transurethral deroofing (TU-DRMethods:This retrospective study was done in a tertiary care center after taking approval from the institutional review board. Conservative management was done by oral or parenteral medications. Transrectal ultrasound GAs were performed under local anesthesia with an 18-gauge two-part needle. Collapse of cavity was seen in “real time” on TRUS. TU-DR of the prostate was done by 26 French continuous irrigation monopolar resectoscopes. The aspirated pus was sent for microbiological investigation.Results:TRUS-guided aspiration was performed in 20 patients, TU-DR in five patients, and conservative management in 15 patients. The mean volume of abscess aspirated by TRUS guidance was 13 cc (range 8–50 cc) with single-time aspiration in 85% of cases. Re-aspiration was done in 3 patients. The mean volume of abscess was 33.2 cc (range: 25–40 cc) in TU-DR group and 1.2 cc (range 0.5–2.0 cc) in the MM group. The predominant organism isolated was Escherichia coli (48%). Clinical improvement was seen in 97.5% of cases.Conclusion:We suggest TRUS-GA for symptomatic patients with abscess size more than 2 cc and TU-DR if TRUS-GA fails or is contraindicated.

Role of Multiparametric Magnetic Resonance Imaging in the Evaluation of Prostatic Pathologies on 3 Tesla Machine

Background and objectives Prostate diseases with an overall incidence of 9% are the leading cause affecting millions of males worldwide, with prostate cancer being the primary cause of death in males owing to benign prostatic hypertrophy being the primary cause of morbidity in the older age group. In light of this, we aimed to evaluate the utility of Magnetic Resonance Imaging in evaluating and characterization prostatic pathologies and grading prostatic cancer using PIRADS v2. Methods This was a study carried out on 50 patients with the age group ranging from 50 to 90 years with clinical suspicion or ultrasonographically demonstrable prostatic pathology and correlation of multiparametric MRI findings on various sequences with clinical features and histopathological findings and classification into groups of benign and malignant prostatic lesions and according to the PIRADS v2 scoring. Results Out of our study group, 4 cases were diagnosed with prostatitis and prostatic abscess, and 46 cases were categorized into PI-RADS, out of which most cases were classified into PI-RADS category V, followed by PI-RADS II and III. These were then evaluated with MR spectroscopy, of which 30 cases showed choline peak, and 16 cases showed citrate peak. The sensitivity and specificity for multiparametric MRI sequences combination detect the carcinoma of the prostate was calculated, and the Positive Predictive Value (PPV) & Negative Predictive Value (NPV) was found as 76% and 92%, respectively. Conclusion Based on our findings, we found out that the multiparametric MRI approach gives a wealth of practical information that has dramatically enhanced the detection and characterization of prostatic lesions. We also found out that morphological and functional sequencing improves the sensitivity and specificity of the lesions' identification and characterization.

Thinking Beyond Adenocarcinoma of Prostate: A Case Series of T2W Hyperintense Prostatic Lesions

The T2-weighted sequences form an integral part of multiparametric Magnetic Resonance Imaging (MRI) protocol performed for evaluation of the prostate. Most commonly encountered prostatic pathologies are adenocarcinoma and benign prostatic hyperplasia, which are mostly T2W hypointense and heterogeneously hypointense, respectively. Apart from prostatic cysts, only a small proportion of prostatic lesions demonstrate predominantly high signal intensity on T2-weighted sequences. Herein, the authors present three such cases with T2W hyperintense prostatic lesions. The first case (60-year-old male) was a prostatic abscess, which apart from T2W hyperintensity, showed central restricted diffusion and peripheral enhancement. The second case (40-year-old male) was a cystic lesion in left side of prostate, which was an ectopic ureterocele opening into the prostatic urethra with associated left renal agenesis. The third case (35-year-old male) was of a metastatic prostatic malignancy, which was a rare prostatic sarcoma. Radiologists should be cognizant of such conditions so as to enable them to make accurate diagnosis and guide appropriate patient management.

Ureteral stone presenting as acute prostatitis: A case report of a COVID-19 patient with distal ureteral stone

Background and Objective: Distal ureterolithiasis is one of the most common urinary tract problems and can be accompanied by such symptoms as abdominal pain, nausea, vomiting, dysuria, frequent urination, and hematuria. Case Presentation: The ureteral stone might be misdiagnosed in the presence of atypical symptoms. We reported a 31-year-old man with clinical signs of prostatitis, normal laboratory tests, and normal ultrasonography who had received treatment for acute prostatitis for several weeks, however, had no improvement. Conclusion: Further assessments by intravenous pyelography revealed distal right ureteral stone. Complete recovery was achieved immediately after transurethral lithotripsy.

The state of the microflora of prostate secretions in healthy individuals and in acute bacterial prostatitis

Relevance. Acute bacterial prostatitis is one of the urgent problems in urology. According to the data presented in the literature, the number of men who have been diagnosed with this disease ranges from 10 to 40 %. At the same time, the main etiological factor in the development of this pathology is most often assigned to the bacterial microflora. However, most of the works are devoted to the study of the microflora in chronic prostatitis, and the state of the microflora in acute bacterial prostatitis remains insufficient. The aim of the study is to evaluate the state of prostate secretion microflora in a comparative aspect in healthy individuals and in patients with acute bacterial prostatitis. Materials and Methods. The study included a comparative analysis of microbiological cultures in prostate secretion of 30 people. All examined were divided into two groups: the first included 15 people without established urological pathology, the second - 15 people with an established diagnosis of acute bacterial prostatitis. Results and Discussion. As a result of the study, it was found that when sowing prostate secretion in persons without established pathology, the absence of microorganism growth was not observed in 60 % of observations, while in 40 % of cases, microorganisms growth was obtained. In the group of examined without established urological pathology, the growth of microorganisms of the following was noted: Escherichia coli - in 58 % of observations; Staphylococcus epidermidis - in 10 % of observations; Staphylococcus warnerii - in 6 % cases and Enterobacter spp. - in 26 %. At the same time, the number of detected microorganisms did not exceed 104 CFU/ml. At the same time, the presence of microbial associations was not recorded. In patients with acute bacterial prostatitis, the sterile prostate secret was 13,3 %, and in 86,7 % of people, microflora growth was obtained. Most often, in the group examined with acute bacterial prostatitis, Escherichia coli was obtained - in 45 % of the observations; Klebsiella spp. - in 23 % cases and Proteus spp. - in 19 %. Less often Staphylococcus epidermidis - in 8 % of observations; Enterobacter spp. - 3,2 %. Serratia spp. - 1,1 % and Staphylococcus warnerii - in 0,7 % cases were the least obtained. At the same time, 86 % of observations in this group revealed microbial associations. Conclusion . Comparison of the state of microflora of prostate secretions in healthy individuals and patients with acute bacterial prostatitis revealed that in patients with acute bacterial prostatitis, the absence of inoculated microflora in prostate secretions was 3 times less than in healthy individuals (13.3 % and 40 %, respectively.), and Escherichia coli was the most common microorganism in the group of patients with acute bacterial prostatitis.

Prostatic Malakoplakia Presenting as PI-RADS Score 5 Lesion Which was Down-Scored after Treatment: A Case Report and Review Literatures

Background: Malakoplakia is a rare, granulomatous disorder that is typically triggered by infections in immunocompromised patients and most commonly affects the bladder. Herein, we report the seventy-fourth case of prostatic malakoplakia in the world literatures and the first case reported in Thailand. The paper will also be the first to compare the multiparametric (mp) magnetic resonance imaging (MRI) of malakoplakia before and after treatment, for differentiating the combined concurrence of malakoplakia and prostatic adenocarcinoma. Case Report: A case of prostatic malakoplakia in a 70-year-old Thai man with a history of recurrent urinary tract infections who presented with acute urinary retention and prostatitis. An mpMRI study showed a Prostate Imaging- Reporting and Data System (PI-RADS) 5 lesion. His serum prostate specific antigen level (PSA) had risen to be 47.53 ng/mL. All findings strongly indicated prostate cancer. The patient underwent MRI-TRUS (Transrectal ultrasound) fusion-guided prostate biopsy and pathology slides revealed, microscopically, macrophages known as von Hansemann cells with scattered targetoid intracytoplasmic inclusions known as Michaelis-Gutmann bodies. He underwent transurethral resection of the prostate combined with antibiotic therapy. There was no longer any evidence of the PI-RADS 5 lesion by mpMRI six months after the treatment. Conclusion: We reported that prostatic malakoplakia can present as prostatitis and a PI-RADS score 5 lesions. This awareness can prevent misdiagnosis and overtreatment of such a rare but benign condition. Combined surgical excision and antibiotic courses were effective in the treatment, and the importance of long-term follow-up of the patient is emphasized. Keywords: Malakoplakia; Michaelis-Gutmann bodies; Prostate; Multiparametric magnetic resonance imaging

269. A Review of Gram Negative Endogenous Endophthalmitis at University Hospital in Newark

BackgroundEndophthalmitis (EO) is an ocular emergency characterized by intraocular inflammation, usually in response to infection. While most cases are exogenous, gram negative (GN) EO account for 10-24% of all cases, and endogenous EO (EEO) account for 2-8% of all cases. Risk factors for EEO include diabetes mellitus (DM), IV drug use, and indwelling catheters. Major sources of infection are urinary tract infections (UTI), liver abscesses, pneumonia, and bacteremia. Common pathogens include K. pneumoniae, P. aeruginosa, and H. influenzae. Outcomes are poor, with only 20% of patients achieving improved visual acuity, and 30-40% requiring enucleation. MethodsRetrospective analysis was performed on patients diagnosed with EO (n=89) at University Hospital in Newark from January 2016 to December 2020 using ICD-10 codes H44.0-H44.009, H44.1, and H44.19. Patients included were 18 years of age or older with culture proven GN endogenous EO (GNEEO) (n=7). Outcomes included anatomical success, functional success, and mortality at 28 days and 3 months. Results7 of 89 patients met criteria for GNEEO (median age 67, 4 males, 71.4% Hispanic/Latino). Comorbidities included hepatobiliary disease (57.1%) and DM (42.9%). All 7 patients presented with ocular symptoms and 3 had non-ocular symptoms. Primary sources of infection included UTI, prostate abscess, and pneumonia/empyema. Eye cultures identified Pseudomonas in 4 patients and Klebsiella in 3 patients. Mean antibiotic length was 17.7 days with 6 patients receiving intravitreal antibiotics. Enucleation was performed in 3 patients. 2 patients had functional success and 4 had anatomical success, with 0 mortality at 28 days and 3 months. Table 1. Ocular symptoms on presentation of cases of gram negative endogenous endophthalmitis Table 2. Positives cultures obtained from cases of gram negative endogenous endophthalmitis ConclusionAlthough rare, GNEEO causes significant morbidity, with only 2 recovering visual acuity and 3 requiring enucleation. Risk factors, sources of infection, and microbes were all consistent with those in previous reports. Hepatobiliary disease and DM were the most prominent risk factors while sources of infection included UTI and empyema. Eye cultures were positive for K. pneumoniae and P. aeruginosa, two common pathogens previously identified. This case series highlights the importance of prompt recognition and initial treatment of GNEEO with empiric coverage that includes vancomycin and ceftazidime. Disclosures All Authors: No reported disclosures

Prostatic Abscess: A Review and Update

Prostatic Abscess: A Review and Update

The Changing Epidemiology and Microbiology of Patients With Prostate Abscess: Increase in Staphylococcal Infection.

BackgroundProstatic 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.MethodsWe 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.ResultsWe 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.ConclusionsProstatic 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.

Risk Factors for Relapse in Acute Bacterial Prostatitis: the Impact of Antibiotic Regimens.

ABSTRACTThe aim of the study was to analyze the risk factors for relapse in patients with acute bacterial prostatitis (ABP), focusing on the impact of different antibiotic regimens. We conducted an observational study of all patients diagnosed with ABP (irritative and/or obstructive urinary symptoms, temperature of >37.8°C, and the presence of bacteriuria in urine culture, in the absence of data suggesting pyelonephritis) from January 2017 to December 2018. The main outcome was relapse. We performed a multivariate analysis to identify the risk factors associated with relapse. A propensity score with inverse weighting was applied to attenuate antibiotic selection bias. We included 410 patients. The mean age was 68 years; 28.8% had diabetes mellitus, and 61.1% benign prostatic hyperplasia. The most common isolated bacteria were Escherichia coli (62.4%) and Klebsiella spp. (10%). The overall resistance rate was 39.5% to quinolones. The mortality rate was 1.2%, and the relapse rate was 6.3%. The only independent risk factor for relapse was inadequate antibiotic therapy (odds ratio [OR] 12.3; 95% confidence interval [95% CI], 3.5 to 43.1). When the antibiotic was modified according to the susceptibility pattern, the rates of relapse were 1.8% in those treated with ciprofloxacin, 3.6% with intravenous beta-lactam, 9.3% with co-trimoxazole, and 9.8% with oral (p.o.) beta-lactam (P = 0.03). Treatment with oral beta-lactam (OR, 5.3; 95% CI, 1.2 to 23.3) and co-trimoxazole (OR, 4.9; 95% CI, 1.1 to 23.2) were associated with a risk of relapse. In this large real-life observational study, a significantly higher relapse rate was observed when antibiotic treatment was inadequate. When the antibiotic was tailored, quinolones and intravenous beta-lactams had a lower relapse rate than co-trimoxazole and oral beta-lactams.IMPORTANCE In the manuscript, we report a large series of acute bacterial prostatitis cases and describe data about the etiology, antibiotic resistance rate, and outcome, specially focused on the risk factors for relapse. We found high rates of resistance to the most frequently used antibiotics and a high relapse rate in patients whose treatment was not adjusted according to their microbiological susceptibility. We did not observe differences, though, in mortality or relapse according to appropriate or inappropriate empirical treatment. What is new in this article is the different relapse rates observed depending upon the definitive adequate antibiotic used. Quinolones and intravenous (i.v.) beta-lactam have lower rates of relapse (1.8% and 3.6%, respectively) compared to co-trimoxazole and oral (p.o.) beta-lactam (3.3% and 9.8%, respectively). Clinicians should carefully choose an adequate antibiotic for definitive ABP treatment depending on the results of microbiological isolation, using quinolones as the first option. Whenever quinolones cannot be administered, i.v. beta-lactams seem to be the second-best option.

Diagnostic Accuracy of Magnetic Resonance Spectroscopy in Diagnosing Carcinoma Prostate

Background: Magnetic resonance spectroscopy (1H-MRS) produces a non-invasive analysis of the metabolism of the tissue, determining the relative concentrations of their metabolites and the interactions produced between them, which may be used in tumor diagnosis and showed good diagnostic accuracy for prostate cancer detection. Objective: To determine the diagnostic accuracy of Magnetic Resonance Spectroscopy (MRS) in diagnosing prostate cancer. Methodology: This was a cross sectional study, conducted at department of Radiology, Bahawal Vitoria Hospital, Bahawalpur, from July 2019 to June 2020. A total of 206 male patients with clinical suspicion of carcinoma prostate, 50-80 years of age will be included. Patients with already diagnosed carcinoma prostate, prostatic abscess, acute or chronic prostatitis were excluded. Each patient has undergone MRS examination. Each MRS was interpreted by one consultant radiologist and was looked for choline + creatine/citrate ratio for carcinoma prostate. Findings of MRS and histopathology were correlated. Data were analyzed by using SPSS 20. Results: In 120 MRS-positive patients, 108 were True Positive and 12 were False Positive. Among, 86 MRS negative patients, 16 were False Negative whereas 70 were True Negative. Overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of magnetic resonance spectroscopy (MRS) in diagnosing carcinoma prostate was 87.10%, 85.37%, 90.0% 81.40%, and 86.41% respectively. Conclusion: This study concluded that Magnetic Resonance Spectroscopy is the non-invasive modality of choice with high diagnostic accuracy in detecting prostate cancer.

A Case Report of Acute Prostatitis Secondary to Use of P-valve Condom Catheter During Cave Diving.

IntroductionAcute bacterial prostatitis is characterized by acute inflammation of the prostate gland accompanied by the presence of pain and other urinary tract or systemic symptoms. Prostatitis is a relatively common disease of the urinary tract in men, However, this case reports a man diagnosed with acute bacterial prostatitis with an unusual presentation, as well as an unusual pathogen and a unique mechanism of colonization.Case ReportA 52-year-old male with no past medical history presented to our facility for right-sided buttock pain associated with dysuria, diarrhea, and perianal burning. The patient was diagnosed with sepsis secondary to acute bacterial prostatitis, and the pathogen identified in his urine was Aeromonas hydrophila/A. caviae. His disease process was later recognized as a complication of the use of a P-valve condom catheter while freshwater cave diving.ConclusionThis is the first documented case of prostatitis as a result of the use of a P-valve condom catheter while diving. Furthermore, the pathogen identified is of particular interest as there are very few documented cases of urosepsis secondary to Aeromonas hydrophila or A. caviae.

V06-09 TRANSURETHRAL HOLMIUM LASER DEROOFING OF A PROSTATIC ABSCESS

You have accessJournal of UrologyBPH & Infection & Imaging (V06)1 Sep 2021V06-09 TRANSURETHRAL HOLMIUM LASER DEROOFING OF A PROSTATIC ABSCESS Alberto Coscione, Juliet Campbell, and Peter Acher Alberto CoscioneAlberto Coscione More articles by this author , Juliet CampbellJuliet Campbell More articles by this author , and Peter AcherPeter Acher More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002021.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are multiple techniques for draining prostatic abscesses. The traditional transurethral approach consists in using a loop or knife with monopolar or bipolar diathermy to deroof the abscess.We present a video recording of our centre's technique for effective deroofing of a prostatic abscess using a Holmium Laser fibre and HoLEP kit. The patient presented with urosepsis not responding to antimicrobial treatment and a very tender and abnormal digital rectal examination. Magnetic resonance imaging confirmed a sizeable prostatic abscess and the decision was made to proceed to transurethral drainage using a Holmium laser fiber. METHODS: The procedure was performed using a 24 Fr Olympus resectoscope with a HoLEP bridge and a 550 micron Lumenis laser fibre connected to a 120Watt laser.The patient underwent transurethral deroofing of the abscess followed by urethral catheterisation with an 18Fr 2-way catheter over a guidewire to ensure the catheter did not end in the abscess cavity. Pus was sent for microbiological culture and sensitivity and targeted antimicrobial treatment was commenced. RESULTS: The patient made a good post operative recovery and was discharged on day 4 following his procedure with appropriate antibiotics. He did not experience severe urethral bleeding or other immediate surgical complications. CONCLUSIONS: We found this technique to be a safe and effective way to deroof a prostatic abscess. The benefits include high accuracy of the laser fiber allowing precise and effective incision and haemostasis. The improved vision expedited the procedure which is key in a septic patient receiving a general anaesthetic.A further benefit over traditional monopolar diathermy was the ability to use 0.9% Saline solution for irrigation as opposed to hypotonic irrigants such as glycine which we wanted to avoid given the patient's age and septic state. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e451-e451 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alberto Coscione More articles by this author Juliet Campbell More articles by this author Peter Acher More articles by this author Expand All Advertisement Loading ...

MP35-09 TRANSPERINEAL PROSTATE BIOPSY: THE FIRST ANALYSIS OF THE TRUE PROSTATE MICROBIOME

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia (MP35)1 Sep 2021MP35-09 TRANSPERINEAL PROSTATE BIOPSY: THE FIRST ANALYSIS OF THE TRUE PROSTATE MICROBIOME Clay Martin, Pandya Shashank, Annette Lee, and Michael Schwartz Clay MartinClay Martin More articles by this author , Pandya ShashankPandya Shashank More articles by this author , Annette LeeAnnette Lee More articles by this author , and Michael SchwartzMichael Schwartz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002044.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The human microbiome has become a rapidly evolving field of research with health implications in a variety of organ systems. Despite this growing body of literature, little is understood about the microbiome of the prostate. A major difficulty in prostate microbiome research is the difficulty in uncontaminated sample collection. Prior studies have utilized transrectal biopsy cores or surgical pathology specimens, both of which introduce significant contamination. The shift from transrectal to transperineal prostate biopsy technique provides a novel way of obtaining uncontaminated prostate specimens. This study aims to use transperineal prostate biopsy specimens to provide an initial description of the microbiome of the prostate. METHODS: Adult, biopsy-naive men (age 18 and older) who were undergoing elective transperineal prostate biopsy for medically indicated purposes were collected prospectively for inclusion in the study. Those with prior prostate biopsies or surgery, a history of chronic or acute prostatitis, history of chronic pelvic pain, antibiotics within 30 days of biopsy, catheterization within 60 days of biopsy, history of chronic indwelling or clean intermittent catheterizations were excluded such to represent the native bacteria of the unmanipulated gland. In addition to 12-14 diagnostic biopsies, enrolled patients underwent 2 additional biopsies. These core biopsies, along with skin and urine samples were sent directly for microbiome analysis via Illumina 16S Metagenomic sequencing. RESULTS: Prostate tissue samples, voided urine and perineal skin swabs from 10 patients were sent for analysis. 1 prostate biopsy specimen was excluded for suspected contamination. Evidence of a distinct microbiome within the prostate was discovered. Prominent species included Pseudomonas veronii, Comamonas testosteroni and Achromobacter xylosoxidans groups. Phylogenic diversity and weighted UniFrac analysis suggest a significant difference between biopsy specimens and perineal skin swabs but not a significant difference between the biopsy specimens and voided urine samples. CONCLUSIONS: These findings suggest that there exists a distinct microbiome specific to the human prostate gland, which may be closely related to that of bladder urine. Sterile sampling via transperineal ultrasound-guided prostate biopsy represents a viable method of sample collection for microbiome analysis. Further research is needed to further characterize the microbiome of the prostate and to elucidate the potential implications on human health and disease states. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e630-e630 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clay Martin More articles by this author Pandya Shashank More articles by this author Annette Lee More articles by this author Michael Schwartz More articles by this author Expand All Advertisement Loading ...

MP35-01 A POPULATION-BASED ANALYSIS OF RISK FACTORS AND OUTCOMES OF PROSTATE ABSCESS

INTRODUCTION AND OBJECTIVE: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 b...

MP29-15 COVID-19 ASSOCIATED CYSTITIS (CAC): INCREASED URINARY SYMPTOMS AND BIOMARKERS OF INFLAMMATION IN URINE IN PATIENTS WITH ACUTE COVID-19

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II (MP29)1 Sep 2021MP29-15 COVID-19 ASSOCIATED CYSTITIS (CAC): INCREASED URINARY SYMPTOMS AND BIOMARKERS OF INFLAMMATION IN URINE IN PATIENTS WITH ACUTE COVID-19 Michael B. Chancellor, Melissa Wills, Ryan Timar, Sarah N. Bartolone, Nevedita Dhar, Sorabh Dhar, Dragana Komnenov, and Laura E. Lamb Michael B. ChancellorMichael B. Chancellor More articles by this author , Melissa WillsMelissa Wills More articles by this author , Ryan TimarRyan Timar More articles by this author , Sarah N. BartoloneSarah N. Bartolone More articles by this author , Nevedita DharNevedita Dhar More articles by this author , Sorabh DharSorabh Dhar More articles by this author , Dragana KomnenovDragana Komnenov More articles by this author , and Laura E. LambLaura E. Lamb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002026.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Emerging evidence suggests that the bladder is one of many organs are targeted by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which contributes significantly to Coronavirus Disease 2019 (COVID-19) morbidity and leads to organ-specific complications. We were the first U.S. group to identify severe and bothersome de novo genitourinary symptoms in patients with confirmed SARS-CoV-2 infection, termed COVID-19 Associate Cystitis (CAC). We then sought to determine if this was associated with pro-inflammatory cytokines in the urine of patients. METHODS: With IRB approval, hospital discharged COVID-19 patients with normal renal function (N=53) and asymptomatic controls (N=12) completed an AUA Urology Care Foundation Overactive Bladder (OAB) Assessment Tool to determine their current urinary symptoms (score of 0 to 25, increasing severity) and provided a urine sample. Urine samples were tested for SARS-CoV-2 using PCR, CRP by ELISA, and pro-inflammatory cytokines using Luminex assays following manufacturer’s instructions. RESULTS: The median total OAB symptom score in both men and women with COVID-19 was 18 (range 4-21). The median total QOL score for both men and women with COVID-19 was 19 (range 8-24). Median age was 64.5 (range 47-82). Symptoms of CAC include increased urinary frequency, urgency, nocturia, and pain or pressure upon voiding. These symptoms were not due to urinary tract infection, acute renal injury, prostatitis, or urinary retention. These symptoms have caused worsening QOL in CAC patients, and nocturia the most bothersome symptom. The majority of COVID-19 patients did not have virus in their urine. The levels of GRO/CXCL-1, IL-6, IP-10, and CRP were significantly increased in urine samples from COVID-19 patients compared to controls. CONCLUSIONS: COVID-19 patients reported severe de novo genitourinary symptoms, most notably an increase in urgency, frequency, and nocturia. SARS-CoV-2 infection results in increased expression of proinflammatory biomarkers in the urine. The variance between individuals may reflect the severity and duration of their disease, and/or the presence of comorbidities. This data supports that COVID-19 patients, especially those with CAC, have increased inflammatory cytokines in the urine. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e496-e496 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael B. Chancellor More articles by this author Melissa Wills More articles by this author Ryan Timar More articles by this author Sarah N. Bartolone More articles by this author Nevedita Dhar More articles by this author Sorabh Dhar More articles by this author Dragana Komnenov More articles by this author Laura E. Lamb More articles by this author Expand All Advertisement PDF downloadLoading ...

Brucella prostatic abscess: a retrospective study of eight cases and a literature review.

ObjectiveTo present the clinical characteristics, diagnostics, and treatments for Brucella prostatic abscess (BPA).MethodsWe retrospectively analyzed eight BPA patients according to their vocations, age, clinical manifestations, laboratory test results, magnetic resonance imaging (MRI) findings, and treatments.ResultsThe 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.ConclusionEven in epidemic areas, the incidence of BPA is relatively rare. Our findings may increase the understanding of BPA and reduce misdiagnosis and mistreatment.

Infectious complications secondary to prostate biopsy

Introduction: Prostate biopsy (PB) is a routine procedure performed by urologists in cases of suspected prostate cancer, any abnormality in the prostate-specific antigen (PSA) assay, and/or perceived by the digital rectal exam. Although this is a safe and rapid procedure, it is not without potentially serious complications, including infectious complications ranging from asymptomatic bacteriuria to acute prostatitis and even septic shock. Materials and methods: This work reports the experience of the urology department of the Hassan II University Hospital of Fez in the study of post-biopsy prostatitis through the analysis of a retrospective series of 538 cases during the period January 2014 - December 2018. Results: We report 11 cases of acute post-biopsy prostatitis diagnosed in the urology department of the Hassan II University Hospital in Fez. The bacteria most frequently involved in post-biopsy infections are gram-negative bacteria (Escherichia coli, Klebsiella pneumonia, Acinetobacter baumannii) although gram-positive cocci (Enterococcus faecalis and Staphylococcus saprophyticus) can also be responsible. Anaerobic bacteria are rarely found. The treatment of these post-biopsy infections is based on prolonged antibiotic therapy (3 to 6 weeks) using third-generation cephalosporins (Ceftriaxone). In our series, no death, septic shock, or prostatic abscess was found. The evolution was towards a good improvement under antibiotic treatment with discharge at home after 48 hours of apyrexia. Conclusion: The study of infectious complications secondary to prostate biopsy makes it possible to determine the most appropriate empirical (therapeutic and prophylactic) regimens to minimize the risks. Because of the prevalence of infection by multi-resistant bacteria, particularly to quinolones, the biopsy must be performed following the rules of antibiotic prophylaxis.