Prostatic Calcifications Research Articles

Predictive Factors for Tissue Inflammation in Patients with Benign Prostatic Hyperplasia: A Clinical Prediction Study

Introduction: Benign prostatic hyperplasia (BPH) is a common condition in older men, marked by the noncancerous enlargement of the prostate gland. Inflammation of the prostate plays a significant role in the progression of BPH and the symptoms it causes. The objective of this study was to create a predictive model for prostatic inflammation in men with BPH based on important clinical factors. Methods: A retrospective cohort study was conducted with 137 patients diagnosed with BPH. Data collected included various factors such as age, prostate volume (PV), preoperative international prostate symptom score, preoperative maximum urine flow rate (Qmax), preoperative post-void residue, weight of the excised tissue, body mass index, fasting blood glucose (FBG), cholesterol levels, prostate-specific antigen, blood calcium, blood phosphorus, blood uric acid, triglycerides, hypertension status, and presence of prostate calcifications. Multivariate logistic regression and LASSO regression analyses were performed to identify significant predictors and develop a nomogram. The model’s performance was evaluated using receiver operating characteristic curves, calibration plots, and decision curve analysis (DCA). Results: Among the patients, 9.49% showed no signs of prostatic inflammation, while 22.63% had mild, 47.45% had moderate, and 20.44% had severe inflammation. Factors such as PV, FBG, and prostate calcification were identified as important predictors of prostatic inflammation. The predictive model developed exhibited strong discrimination and calibration, as evidenced by a high area under the curve value, indicating reliable predictive accuracy. DCA further validated the clinical usefulness of the nomogram. Conclusion: The developed nomogram, incorporating PV, FBG, and prostate calcification, effectively predicts prostatic inflammation in men with BPH. This tool can aid in early intervention and targeted treatment, potentially improving patient outcomes. Further validation in diverse populations is recommended to enhance its generalizability and clinical applicability.

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.

Analysis of risk factors for benign prostate enlargement with prostate calcification

Analysis of risk factors for benign prostate enlargement with prostate calcification

Clinical, laboratory and ultrasonographic correlates of prostate calcifications in patients with chronic prostatitis/chronic pelvic pain syndrome.

The research aim was to determine the role of clinical, laboratory, immunological and sonographic parameters in the development of an assessment tool for the symptomatic manifestations of prostate calcifications in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). All men underwent a transabdominal ultrasonographic examination using a grayscale B-mode and color Doppler mapping, the evaluation of the National Institutes of Health-Chronic Prostatitis Symptom Index and the Patient Health Questionnaire-9, spermogram. Vascular endothelial growth factor (VEGF), serotonin and gamma-aminobutyrate (GABA), interleukins 1β and 10 were determined in blood serum and ejaculate. This study included 102 men aged 18-45 years. Group 1 (n = 34) consisted of patients with CP/CPPS. Group 2 included patients (n = 34) with asymptomatic prostatitis. Group 3 consisted of healthy volunteers (n = 34). More severe symptoms of prostatitis and depression, as well as frequent exacerbations in patients with CP/CPPS, were associated with ultrasound evidence of prostate calcifications, and especially the twinkling artifact (Spearman's r = 0.481; р <0.001; Spearman's r = 0.437; р <0.001, respectively).The presence of prostate calcifications in both CP/CPPS and asymptomatic prostatitis was accompanied by a significantly higher concentration of pro-inflammatory cytokine IL-1β and a lower concentration of anti-inflammatory cytokine IL-10 in the ejaculate (p < 0.05 in both cases, Kolmogorov-Smirnov test). The clinical manifestations observed in patients with CP/CPPS and asymptomatic prostatitis were not correlated with the leukocyte count in the ejaculate or the levels of VEGF, GABA, and serotonin in both blood and ejaculate. Twinkling artifact potentially could serve as a valuable tool for evaluating the condition of patients with CP/CPPS and prostate calcifications.

Current status and future outlook of ultrasound treatment for prostate cancer.

Radical prostatectomy and radiation therapy are the standard treatment options for localized prostate cancer (PC). However, radical prostatectomy may cause the deterioration of urinary and sexual function, and radiation-induced hemorrhagic cystitis and severe rectal bleeding are risk factors for fatal conditions in patients after radiation therapy. With the recent development of magnetic resonance imaging (MRI) for the localization of clinically significant PC (csPC) and treatment modalities, "focal therapy", which cures csPC while preserving anatomical structures related to urinary and sexual functions, has become a minimally invasive treatment for localized PC. Based on the clinical results of transrectal high-intensity focused ultrasound (HIFU) for localized PC in the whole gland and focal therapy, HIFU is considered an attractive treatment option for focal therapy. Recently, the short-term clinical results of transurethral high-intensity directional ultrasound (HIDU) have been reported. With the resolution of some issues, HIDU may be commonly used for PC treatment similar to HIFU. Because HIFU and HIDU have limitations regarding the treatment of patients with large prostate calcifications and large prostate volumes, the proper use of these modalities will enable the treatment of any target area in the prostate. To establish a standard treatment strategy for localized PC, pair-matched and historically controlled studies are required to verify the oncological and functional outcomes of ultrasound treatment for patients with localized PC.

The feasibility and satisfaction study of 5G-based robotic teleultrasound diagnostic system in health check-ups.

Regular check-up with ultrasound in underserved rural and/or remote areas is hampered due to the limited availability of sonologists and ultrasound devices. This study aimed to assess the feasibility and satisfaction of health check-ups with a 5G-based robotic teleultrasound diagnostic system. In this prospective study, sonologists from two hospitals manipulated the telerobotic ultrasound system to perform teleultrasound check-ups of the liver, gallbladder, pancreas, spleen, kidneys, bladder, prostate (male), uterus and ovaries (female) for the subjects. The feasibility and satisfaction of health check-ups with a 5G-based robotic teleultrasound diagnostic system were evaluated in terms of examination results, examination duration, and satisfaction questionnaire survey. A total of 546 subjects were included with the most frequently diagnosed being abdominal disorders (n = 343) and male reproductive illnesses (n = 97), of which fatty liver (n = 204) and prostatic calcification (n = 54) were the most. The median teleultrasound examination duration (interquartile range) for men and women was 9 (9-11) min and 9 (7-11) min (p = 0.236), respectively. All the subjects were satisfied with this new type of telerobotic ultrasound check-ups and 96% reported no fear of the robotic arm during the examination. The 5G-based teleultrasound robotic diagnostic system in health check-ups is feasible and satisfactory, indicating that this teleultrasound robot system may have significant application value in underserved rural and/or remote areas to mitigate disparity in achieving health equity.

ULTRASOUND IN THE ETIOLOGICAL ASSESSMENT OF MALE INFERTILITY: ABOUT 300 CASES AT THE FERTILIA MEDICAL CLINIC IN BAMAKO

Objectives: To describe ultrasound lesions that may explain male-type infertility. Subjects And Methods: This was a cross-sectional, descriptive study involving 300 men collected between March 2019 and March 2022 at the Fertilia medical clinic in Bamako. The study population consisted of consenting male subjects presenting for infertility. All our patients had already undergone a spermogram, they then underwent endorectal and/or suprapubic ultrasound. Results: 300 patients were recruited in our study. The mean age was 37 years, with extremes ranging from 25 to 62 years. 136 patients (45.33%) were aged between 35 and 40. 216 patients (72%) had primary infertility. 267 patients (89%) had a sperm abnormality. 288 patients (96%) had ultrasound abnormalities. The most common pathologies were varicocele (91.66%), prostatic calcifications (3.47%), testicular calcifications (1.38%), seminal vesiculitis (1. 04%), ejaculatory duct calcifications (0.69%), unilateral cryptorchidism (0.69%), differential agenesis (0.69%), anorchidism (0.69%), epididymitis (0.69%). Conclusion:The pressing challenge in the face of male infertility is to establish an etiology in order to satisfy the couples desire to procreate. The spermogram is essential to determine the origin of the infertility, whether male or female. Ultrasound is the technique of choice for diagnosing infertility of testicular or prostato-seminal origin, and must be meticulous and well performed.

Predictive value of prostate calcification for future cancer occurrence: a retrospective long-term follow-up cohort study.

Although prostate calcification is often identified on pelvic CT images, calcification itself is usually not considered clinically significant. A recent histological study proposed an association between prostate calcification and prostate cancer occurrence. Our aim was to determine the predictive value of prostate calcifications for future prostate cancer occurrence. We retrospectively analysed male patients (≥50 years old) without prior prostate cancer history, who underwent unenhanced pelvic CT between April 2010 and March 2011, and followed-up until December 2021. Cox proportional hazards models were used to assess prostate cancer risk with prostate calcification (defined as a high-density area larger than 3 mm with CT attenuation values ≥ 130 HU), controlling for age, body mass index (BMI), hypertension and diabetes mellitus. A total of 636 male patients (mean age, 68 years ± 9 [standard deviation]) were evaluated. At the end of follow-up, prostate cancer had been more frequently diagnosed in patients with prostate calcification than those without prostate calcification (6.5% vs 2.6%). Multivariate analysis revealed that prostate calcification on CT was a significant predictor of future prostate cancer occurrence (hazard ratio [HR], 2.7; 95% CI: 1.20, 5.91; p = 0.016). No statistical differences were observed in any other factors. Prostate calcification may be a significant predictor of future prostate cancer occurrence, and may be used for risk stratification and to guide screening protocols. Presence of prostate calcification on unenhanced CT scan was associated with increased incidence of prostate cancer occurrence on long term follow-up.

Rapid On-Site Microscopy and Mapping of Diagnostic Biopsies for See-And-Treat Guidance of Localized Prostate Cancer Therapy.

Prostate cancer continues to be the most diagnosed non-skin malignancy in men. While up to one in eight men will be diagnosed in their lifetimes, most diagnoses are not fatal. Better lesion location accuracy combined with emerging localized treatment methods are increasingly being utilized as a treatment option to preserve healthy function in eligible patients. In locating lesions which are generally <2cc within a prostate (average size 45cc), small variance in MRI-determined boundaries, tumoral heterogeneity, patient characteristics including location of lesion and prostatic calcifications, and patient motion during the procedure can inhibit accurate sampling for diagnosis. The locations of biopsies are recorded and are then fully processed by histology and diagnosed via pathology, often days to weeks later. Utilization of real-time feedback could improve accuracy, potentially prevent repeat procedures, and allow patients to undergo treatment of clinically localized disease at earlier stages. Unfortunately, there is currently no reliable real-time feedback process for confirming diagnosis of biopsy samples. We examined the feasibility of implementing structured illumination microscopy (SIM) as a method for on-site diagnostic biopsy imaging to potentially combine the diagnostic and treatment appointments for prostate cancer patients, or to confirm tumoral margins for localized ablation procedures. We imaged biopsies from 39 patients undergoing image-guided diagnostic biopsy using a customized SIM system and a dual-color fluorescent hematoxylin & eosin (H&E) analog. The biopsy images had an average size of 342 megapixels (minimum 78.1, maximum 842) and an average imaging duration of 145 s (minimum 56, maximum 322). Comparison of urologist's suspicion of malignancy based on MRI, to pathologist diagnosis of biopsy images obtained in real time, reveals that real-time biopsy imaging could significantly improve confirmation of malignancy or tumoral margins over medical imaging alone.

Application of Real-Time Ultrasound Elastography Combined with Prostate Calcification in Differential Diagnosis of Prostate Cancer.

This study aimed to explore the clinical and differential diagnostic value of real-time ultrasound elastography combined with transabdominal prostate calcification in prostate cancer (PCa). This study retrospectively analysed the clinical pathological data of 97 patients with PCa and 105 patients with benign prostatic hyperplasia (BPH) diagnosed by postoperative pathology in our hospital from May 2020 to May 2021; Comparatively analysed the clinical data of the two groups, including the elastic strain ratio, elastic image compression index, types of prostate calcification and calcification diameter; And used logistic regression analysis to screen out the independent risk factors for identifying PCa and BPH. No significant difference in age, body weight, body mass index, location of calcification and calcification diameter was observed between the two groups (p > 0.05), and overt differences in elastic strain ratio, elastic image compression index, types of calcification, and testosterone were found between the PCa group and BPH group (p < 0.05). Logistic regression analysis showed that the elastic strain ratio, elastic image compression index and types of calcification were independent risk factors for identifying PCa (p < 0.05). The area under curve value of combined diagnosis under receiver operating characteristic curve was as high as 0.756 (95% CI: 0.691-0.813), with a sensitivity of 67.60% and a specificity of 76.30%. A certain correlation is observed amongst elastic strain ratio, elastic image compression index, types of prostate calcification and the occurrence and development of PCa. The application of real-time ultrasound elastography combined with the detection of transabdominal prostate calcification in clinical diagnosis can improve the detection rate of PCa, which has an important clinical application value.

Predictive factors affecting morcellation efficiency in holmium laser enucleation of the prostate.

To determine the factors affecting morcellation efficiency in holmium laser enucleation of the prostate (HoLEP) surgery. Patients who underwent HoLEP surgery by a single surgeon between 2018 and 2022 were included in the study. Our primary outcome of interest in this study was morcellation efficiency. The effect of preoperative and perioperative variables on morcellation efficiency was evaluated with linear regression analysis. A total of 410 patients were included in the study. The mean morcellation efficiency was 6.95±1.70 g/min. Univariable and multivariable linear regression analysis was performed to identify factors affecting morcellation efficiency. Presence of the "beach ball" effect (small, round prostatic tissue fragments that are fibrotic and difficult to morcellate), the learning curve, resectoscope sheath type, prostate-specific antigen (PSA) density, morcellated tissue weight, and the presence of prostate calcification were found to be independent predictive factors (β=-1.107, 95% CI: -1.59 to -0.55, p<0.001; β=-0.514, 95% CI: -0.85 to -0.17, p=0.003; β=-0.394, 95% CI: -0.65 to -0.13, p=0.003; β=-0.302, 95% CI: -0.59 to -0.09, p=0.043; β=0.062, 95% CI: 0.05 to 0.06, p<0.001; β=-0.329, 95% CI: -0.55 to -0.10, p=0.004; respectively). This study reports that presence of the beach ball effect, the learning curve, small resectoscope sheath, PSA density, and presence of prostate calcification negatively affect morcellation efficiency. On the contrary, morcellated tissue weight has a linear relationship with morcellation efficiency.

Prostatic bed calcification with [99mTc]Tc-MDP uptake: Easy to miss on planar images.

A 65 years old man with high-risk prostate adenocarcinoma underwent bone scintigraphy with 99mTc-methylene diphosphate ([99mTc]Tc-MDP). The scan revealed a focus of radiotracer uptake in the left pubic region, which was suspicious for metastatic involvement. Additional imaging with single photon emission computed tomography (SPECT/CT) confined the uptake to be extra-osseous and contributed to the calcified zone in the prostate bed. Prostatic bed calcification with [99mTc]Tc-MDP uptake mimics metastasis and can be easily missed on planar images.

Frequency of Ultrasound in Assessment of Prostate Gland in Different Age Groups

The prostate gland is the main male accessory gland as it secretes fluid that nourishes and protects sperm. With age, the prostate can enlarge. As it surrounds part of the urethra, the enlarged prostate can squeeze the tube. This and some other pathologies of the prostate can cause different problems like urinary retention, impaired kidney feature, recurrent urinary tract infections, gross hematuria, and bladder calculi. This was a descriptive study with a sample size of 200 patients, performed at Gillani Ultrasound Center Lahore and The University Ultrasound Clinic Green Town Lahore from July till November 2021. Individuals of all ages above 23 years of age were diagnosed with all pathologies of the prostate. The patients with UTI, cystitis or bladder stone were not considered in this research. Transabdominal sonography was performed with the convex transducer of 3.5 - 5 MHz frequency. In this descriptive study, the total sample size of the study was 200 from which BPH was found in 142 Patients 71%, BPH with prostatic cyst was in 6 patients 3%, Prostatic calcification was in 14 patients 7%, BPH with prostatic calcification was in 11 patients 5.5%, Prostatic cancer was in 1 patient 0.5% and the prostatic cyst was in 26 patients that are 13% of the sample size. Ultrasound has been proven to diagnose early prostatic enlargement and other prostate-related pathologies, our study concluded that BPH is the most common pathology ranging between 50 to 60 years, and prostatic cyst and calcification were common in ages 23 to 35.

The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: An overview on male genital tract ultrasound reference ranges.

So far, male genital tract color-Doppler ultrasound (MGT-CDUS) was not standardized. Recently, the European Academy of Andrology (EAA) published the results of a multicenter study assessing the CDUS characteristics of healthy-fertile men (HFM) to obtain normative parameters. To report the EAA US study (i) standard operating procedures (SOPs) for assessing MGT-CDUS, (ii) main MGT-CDUS normative parameters, and (iii) compare the EAA and previously published "normal" CDUS values. A cohort of 248 HFM (35.3±5.9 years) was studied, evaluating MGT-CDUS before and after ejaculation following SOPs. SOPs for MGT-CDUS assessment are summarized here. All subjects underwent scrotal CDUS and 188 men underwent transrectal ultrasound before and after ejaculation. The main CDUS reference ranges and characteristics of the HFM-MGT are reported here. The mean testicular volume was ∼17mL. The lower limit for right and left testis was 12 and 11mL, defining testicular hypotrophy. The upper limit for epididymal head, body, tail, and vas deferens was 11.5, 5, 6, and 4.5mm, respectively. Testicular and epididymal arterial reference ranges are reported. The EAA varicocoele classification is reported. CDUS-varicocoele was detected in ∼37% of men. Prostate mean volume was ∼25mL, while lower and upper limits were 15 and 35mL, defining hypotrophy and enlargement, respectively. Prostate arterial reference ranges are reported. Prostate calcifications and inhomogeneity were frequent; midline prostatic cysts were rare and small. Ejaculatory duct abnormalities were absent. The upper limit for periprostatic venous plexus was 4.5mm. Lower and upper limits of seminal vesicles (SV) anterior-posterior diameter were 6 and 16mm, defining hypotrophy or dilation, respectively. Seminal vesicle volume and ejection fraction reference ranges are reported. SV-US abnormalities were rare. Deferential ampullas upper limit was 6mm. A discussion on the EAA and previously published "normal" CDUS values is reported here. The EAA findings will help in reproductive and general male health management.

Associated Factors for Prostate Enlargement in Chinese Adult Men Aged

Purpose Prostate enlargement (PE) is an increase in prostate volume in morphology. PE was also observed in some patients aged <40 with chronic prostatitis. This study aimed to explore the associated factors for PE in Chinese adult men aged <40. Methods The medical records of 1851 consecutive Chinese adult men aged <40 in a single center were retrospectively analyzed. The checkup indicator characteristics between the PE and non-PE groups were compared by univariate analysis, and the associated factors were analyzed by multivariate analysis. Results The overall prevalence of PE (defined as prostate volume ≥ 20 ml) in adult men aged < 40 was 10.4%. Age and the proportions of subjects with prostate calcification or hypertension were different between the PE and non-PE groups (P < 0.05). Multivariate logistic analysis showed that prostate calcification (odds ratio [OR], 1.831; 95% confidence interval [CI], 1.281–2.619; P=0.001), hypertension (OR, 1.528; 95% CI, 1.125–2.076; P=0.007), and age (OR, 1.117; 95% CI, 1.078–1.159; P < 0.001) were associated factors for PE in adult men aged <40. Conclusions The prevalence of PE in Chinese adult check-up men aged <40 was not rare. In addition to age, prostate calcification and hypertension were associated factors for PE in Chinese adult men aged <40.

Evaluation of dosimetric effects of metallic artifact reduction and tissue assignment on Monte Carlo dose calculations for 125 I prostate implants.

Monte Carlo (MC) simulation studies, aimed at evaluating the magnitude of tissue heterogeneity in 125 I prostate permanent seed implant brachytherapy (BT), customarily use clinical post-implant CT images to generate a virtual representation of a realistic patient model (virtual patient model). Metallic artifact reduction (MAR) techniques and tissue assignment schemes (TAS) are implemented on the post-implant CT images to mollify metallic artifacts due to BT seeds and to assign tissue types to the voxels corresponding to the bright seed spots and streaking artifacts, respectively. The objective of this study is to assess the combined influence of MAR and TAS on MC absorbed dose calculations in post-implant CT-based phantoms. The virtual patient models used for 125 I prostate implant MC absorbed dose calculations in this study are derived from the CT images of an external radiotherapy prostate patient without BT seeds and prostatic calcifications, thus averting the need to implement MAR and TAS. The geometry of the IsoSeed I25.S17plus source is validated by comparing the MC calculated results of the TG-43 parameters for the line source approximation with the TG-43U1S2 consensus data. Four MC absorbed dose calculations are performed in two virtual patient models using the egs_brachy MC code: (1) TG-43-based Dw,w-TG 43 , (2) Dw,w-MBDC that accounts for interseed scattering and attenuation (ISA), (3) Dm,m that examines ISA and tissue heterogeneity by scoring absorbed dose in tissue, and (4) Dw,m that unlike Dm,m scores absorbed dose in water. The MC absorbed doses (1) and (2) are simulated in a TG-43 patient phantom derived by assigning the densities of every voxel to 1.00gcm-3 (water), whereas MC absorbed doses (3) and (4) are scored in the TG-186 patient phantom generated by mapping the mass density of each voxel to tissue according to a CT calibration curve. The MC absorbed doses calculated in this study are compared with VariSeed v8.0 calculated absorbed doses. To evaluate the dosimetric effect of MAR and TAS, the MC absorbed doses of this work (independent of MAR and TAS) are compared to the MC absorbed doses of different 125 I source models from previous studies that were calculated with different MC codes using post-implant CT-based phantoms generated by implementing MAR and TAS on post-implant CT images. The very good agreement of TG-43 parameters of this study and the published consensus data within 3% validates the geometry of the IsoSeed I25.S17plus source. For the clinical studies, the TG-43-based calculations show a D90 overestimation of more than 4% compared to the more realistic MC methods due to ISA and tissue composition. The results of this work generally show few discrepancies with the post-implant CT-based dosimetry studies with respect to the D90 absorbed dose metric parameter. These discrepancies are mainly Type B uncertainties due to the different 125 I source models and MC codes. The implementation of MAR and TAS on post-implant CT images have no dosimetric effect on the 125 I prostate MC absorbed dose calculation in post-implant CT-based phantoms.

The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: Prostate-vesicular transrectal ultrasound reference ranges and associations with clinical, seminal and biochemical characteristics.

BackgroundTransrectal ultrasound (TRUS) parameters are not standardized, especially in men of reproductive age. Hence, the European Academy of Andrology (EAA) promoted a multicenter study to assess the TRUS characteristics of healthy‐fertile men (HFM) to establish normative parameters.ObjectivesTo report and discuss the prostate and seminal vesicles (SV) reference ranges and characteristics in HFM and their associations with clinical, seminal, biochemical parameters.Methods188 men (35.6 ± 6.0 years) from a cohort of 248 HFM were studied, evaluating, on the same day, clinical, biochemical, seminal, TRUS parameters following Standard Operating Procedures.ResultsTRUS reference ranges and characteristics of the prostate and SV of HFM are reported herein. The mean PV was ∼25 ml. PV lower and upper limits were 15 and 35 ml, defining prostate hypotrophy and enlargement, respectively. PV was positively associated with age, waistline, current smoking (but not with T levels), seminal volume (and negatively with seminal pH), prostate inhomogeneity, macrocalcifications, calcification size and prostate arterial parameters, SV volume before and after ejaculation, deferential and epididymal size. Prostate calcifications and inhomogeneity were frequent, while midline prostatic cysts were rare and small. Ejaculatory duct abnormalities were absent. Periprostatic venous plexus size was positively associated with prostate calcifications, SV volume and arterial peak systolic velocity. Lower and upper limits of SV anterior‐posterior diameter after ejaculation were 6 and 16 mm, defining SV hypotrophy or dilation, respectively. SV total volume before ejaculation and delta SV total volume (DSTV) positively correlated with ejaculate volume, and DSTV correlated positively with sperm progressive motility. SV total volume after ejaculation was associated negatively with SV ejection fraction and positively with distal ampullas size. SV US abnormalities were rare. No association between TRUS and time to pregnancy, number of children or history of miscarriage was observed.ConclusionsThe present findings will help in better understanding male infertility pathophysiology and the meaning of specific TRUS findings.

Hematospermia and Its Sexual Ramifications: A Systematic Review

ABSTRACT Introduction Hematospermia (HS) is the presence of blood in ejaculatory fluid. It is a rare, usually benign condition associated with various etiologies and treatments. Though a source of great anxiety for patients, no comprehensive review exists on the sexual ramifications of HS. Objective To determine HS effects on sexual wellbeing, with emphasis on original research. Methods A systematic review of HS was performed via PubMed (Figure 1). The following search terminology was used: “(hemospermia OR hematospermia) AND (sexual OR libido OR anxiety OR infertility OR cryopreservation OR erectile dysfunction).” Articles were assessed for sexual health-related implications, such as emotional disturbances, changes in sexual activity, hindered sexual response cycles, pain associated with intercourse, altered fertility, and sexual infections. Results Thirty-eight articles met our inclusion criteria while 111 were excluded. The effect of HS on sexual health proved multifaceted. Anxiety is known to compromise sexual health. Two articles reported that anxiety following transrectal ultrasound (TRUS)-guided prostate biopsy had a positive correlation with duration of HS. Additionally, in both studies, 50% of patients reported decreased sexual activity due to HS. A similar study showed that patients with substantial prostatic calculi had greater HS after biopsy as well as significantly increased anxiety compared to those with no prostatic calcifications. Patients with underlying comorbidities experienced sexual complications from HS. One study described a man who developed HS due to hypertensive emergency. In response to his HS, sexual partners ostracized him and family members believed he was divinely cursed. Another article described 3 patients with congenital bleeding disorders (e.g., hemophilia A, prothrombin deficiency, von Willebrand disease) who required episodes of sexual abstinence due to HS. HS was associated with blood during parts of the sexual response cycle. Two studies showed urethrorrhagia occurred after sexual excitation in those with HS and urethral hemangiomas. Likewise, four articles revealed HS and post-coital hematuria, sometimes with severe bleeding after ejaculation, in patients with urethral hemangiomas, previous coital trauma, or seminal vesicle cysts (SVC.) Of note, another study demonstrated patients with SVC experienced HS and post-ejaculatory pain. In certain populations, HS indicated increased risk of sexual pathologies. One study illustrated patients with HS and chronic prostatitis had 4-fold increased risk of erectile dysfunction (ED) compared to those without HS. Sixteen articles showed that HS was associated with infertility (IF) in various circumstances, including anatomic genitourinary pathologies (e.g., SVC, prostatic cysts, Mullerian duct cysts, ejaculatory duct stones, vas deferens injuries, varicoceles), herpes simplex virus (HSV) infection with low seminal volume, hydroxyurea treatment of essential thrombocythemia, leukospermia, Zinner syndrome, and isolated follicle-stimulating hormone deficiency. Furthermore, two studies revealed HS was related to temporarily altered semen quality after shockwave lithotripsy. In 7 articles, patients with HS had infections that could be sexually transmitted, including HSV, Chlamydia, enterococcus, Ureaplasma, Schistosoma, and Zika virus. Conclusions Sexual effects of HS included increased anxiety, exacerbated comorbidities, bleeding during sexual response cycle, ED, IF, and increased risk of sexual infections. Further research is needed to better understand causality in addition to associations of HS on sexual wellbeing. Disclosure No

Correction of chronic prostatitis by extracorporeal shock wave therapy

Introduction. This article presents the results of treatment of patients with chronic prostatitis (CP) type II, IIIA and IIIB by extracorporeal shock wave therapy (ESWT).The study objective was to evaluate the effectiveness of ESWT in the treatment of CP.Materials and methods. The research included 43 patients with CP. The patient’s age was 38.8 (27–65). The mean CP duration was 13.5 (3–24) months. 43 patients were assigned into 3 groups based on transrectal ultrasound (TRUS) examination. Group 1 had fibrotic changes in the prostate (n = 21). Group 2 had prostate calcifications (n = 5). Group 3 had fibrotic changes and calcifications in the prostate (n = 17). Treatment included ESWT (Dornier Aries) twice per week during 6 weeks. Each ESWT-session was comprised 2000–3500 pulses (0.05–0.062 mJ/mm2) and 8–6 Hz of frequency. All men were evaluated on 0 and 60 days of the study using NIH-CPSI (National Institutes Health Chronic Prostatitis Symptom Index), IPSS (International Prostate Symptom Score), TRUS of the prostate, the culture of seminal or prostate fluid, spermogram or prostate fluid analysis, serum prostatic specific antigen for men over 50 years of age.Results. The patients over 50 years-old had total prostatic specific antigen less than 4 ng/ml. Bacterial growth was found in the culture of seminal/prostate fluid of the 26 patients. They were additionally prescribed antibiotics according to antibiogram. All patients got the treatment well. Control study pointed at lower scores of NIH-CPSI – grade decreased from 13.39 (1–34) to 5.54 (0–24) (p &lt;0.05), IPSS decreased from 11.39 (0–34) to 4.39 (0–29) (p &lt;0.05). Prostate volume decreased from 25.18 (12.2–58.8) cm3 to 22.78 (12–56.6) cm3 according to TRUS (p &gt;0.05). In the group 1 in 3 cases local fibrosis were completely resolved, in 18 cases fibrotic changes decreased from 5.3 (0–13) mm to 3.24 (0–8.1) mm (p &lt;0.05). In the second group the number and the size of calcifications decreased from 6.92 (2–21) mm to 4 (0–20) mm (p &gt;0.05). In the group 3 calcifications were completely resolved (p &lt;0.05), the volume of fibrosis decreased from 6.8 (3.2–15) mm to 4.5 (1–17) mm (p &lt;0.05). Bacterial growth wasn’t found in 9 patients’ seminal/ prostate fluid, 16 patients had a decrease of the causative agent concentration on 60 day, WBC count normalized in all subjects with CP/chronic pelvic pain syndrome IIIA.Conclusion. ESWT is an effective and non-invasive method of treatment of CP type II, IIIA and IIIB. The proposed treatment to relieve pain syndrome, inflammation, to promote lysis of fibrosis zone and calcinates, improves the draining function of prostate, contributing to accelerated elimination of microflora.

Применение ректальных свечей с окисленным декстраном при калькулезном простатите

This article presents its own experience of using suppositories with oxidised dextran in the treatment of a patient with recurrent bacterial prostatitis complicated by prostate calcifications, these are the positive effects on the use of suppositories with oxidised dextran: a decrease in the size of calcified areas, a stable elimination of opportunistic microflora and the achievement of long-term remission of the disease.