Transrectal Aspiration Research Articles

Intrapelvic Intestinal Leiomyoma in a Dog - Diagnostic and Therapeutic Challenges

Background: Rectal tumors are uncommon in dogs and cats. The clinical signs result from intra- and extraluminal compression. Diagnosis and treatment of rectal tumors are challenging due to their intraplevic location. Owing to considerable bone superposition, computed tomography is the best exam to evaluate the tumor and plan surgery; however, poor availability and high costs may hinder its use. The objective of this case report is to describe the successful use of a combination of diagnostic techniques, namely transrectal ultrasound, transrectal fine-needle aspiration, and colonoscopy, for diagnosis and surgery planning in a case of intrapelvic intestinal leiomyoma in a dog.Case: A 13-year-old female mongrel dog with tenesmus, low stool production, and hematochezia for two months was presented for examination. During this two-month period, a symptomatic treatment was administered, but there was no clinical improvement. In the clinical evaluation revealed a painless mass on the left dorsolateral region, at a depth of around 4 cm, with considerable luminal reduction. Abdominal ultrasound revealed a mass close to the descending colon; however, bone superposition precluded identification of its origin or delimitation of its boundaries. The patient was subjected to transrectal ultrasound imaging, colonoscopy, and cytological examination of fine-needle aspiration biopsy material collected under general anesthesia. The mass was located at the final portion of the descending colon; it was extraluminal, and measured around 7 x 7 cm. The integrity of the intestinal wall was preserved. Next, radiographic examination of the thorax using three projections (ventrodorsal, left lateral, and right lateral) was performed to check for metastases, and no alteration was detected. Cytology suggested presence of leiomyoma. The patient underwent exploratory laparotomy with pubic osteotomy for intrapelvic access. The extraluminal mass was found adhered to the dorsal colorectal surface, whose serosa was compromised. The mass, which occupied around 80 to 90% of the pelvic canal, was completely removed and submitted to histopathological examination, which confirmed presence of proliferative neoplastic mesenchymal cells (intestinal leiomyoma). The patient's clinical picture evolved without intercurrences, and the patient was discharged 40 days after the pubic bone consolidation procedure.Discussion: The occurrence of leiomyomas in the colorectal segment of the intestine is rare in dogs. Neoplasms that develop in such a region of the intestine are usually more frequently found in elderly animals, such as the patient of this report. Leiomyomas are benign (non-invasive) neoplasms with slow growth. Consequently, clinical signs emerge when the mass exhibits a large size, which causes intra- or extraluminal compression, tenesmus, diminished production or absence of defecation, and hematochezia, as observed in the present case. Even though the clinical signs are similar in these cases, they are unspecific; consequently, for reaching a diagnosis, biopsy and histological investigation are required. In spite of the usefulness of these procedures for diagnosis, computed tomography is the exam of choice to investigate neoplasms in intrapelvic intestinal segments because it allows three-dimensional reconstruction of the affected structures and facilitates surgical planning. Unfortunately, computed tomography was not available for this case. Consequently, colonoscopy, transrectal ultrasound, and transrectal fine-needle aspiration biopsy were performed. When combined, these procedures allowed determination of the location, size and type of neoplasm, which were crucial pieces of information for the correct diagnosis and surgical planning, thus contributing for the successful management of the patient.

Accuracy of Perineal Percutaneous Fine Needle Aspiration Cytology (FNAC) of Prostate under Ultra- Sound in Comparism with Transrectal Aspiration in Diagnosis of Prostatic Cancer

Background: Prostatic carcinoma is the commonest internal malignancy of adult males. Patients usually presenting withvoiding symptoms. Clinical suspicion of prostatic carcinoma depends on finding of one or more of the followings; hard prostaticnodule(s) on digital rectal examination (DRE), hypoechoic lesion on transrectal ultrasonography (TRUS), and/or highserum level of prostatic specific antigen (PSA). Final diagnosis depends on FNAC and/or histopathology. Objective: This is acase control prospective study designed to evaluate the usefulness of FNAC of prostate through perineal skin under ultrasoundinstead of transrectal aspiration in diagnosis of suspicious prostatic conditions.Patients and Methods: One hundred and ten males with voiding symptoms and clinical suspicion of prostatic carcinoma wereparticipated in the study. Their ages were between 45 and 92 years. The aspiration was carried out as outpatient procedure.Results: Cytopathological results were; 64 (58.18%) positive, 4 (3.64%) suspicious, and 40 (36.36%) negative for prostaticcancer. Two specimens (1.82%) were inadequate for proper cytopathology. Results of histopathological examination of resectedspecimens from the same patients was very close to that of cytopathology with only two false positive and one falsenegative results. There was no any mentioned complication following aspiration, and sensitivity, specificity, and accuracywere 98%, 95%, and 91.81% respectively, and all results were statistically significant with p-values <0.05.Conclusion: Percutaneous perineal FNAC of prostate under ultrasound is a safe, reliable, cost effective, and as accurate astransrectal FNAC in diagnosis of prostatic cancer.Keywords: Perineal prostatic FNAC, Prostatic Cytopathology, PSA, TRUS.

Outcome analysis of transrectal ultrasonography guided aspiration versus transurethral resection of prostatic abscess: 10 years’ experience from a tertiary care hospital

ObjectiveTo compare the effectiveness and safety of two minimally invasive methods (transrectal aspiration vs transurethral resection (TUR)/deroofing) of treating prostatic abscess. Patients and methodsA retrospective study was conducted, from 2007 to 2016, of patients with prostatic abscesses not responding to antibiotics and/or with large (>2cm) or multiple abscesses. Patients were divided into two groups depending on treatment received: Group A, transrectal aspiration; and Group B, TUR/deroofing of abscess. ResultsThe most common clinical presentation was dysuria (81.8%), followed by urinary frequency (68.2%), and fever (36.4%). Acute urinary retention occurred in seven patients. The most common infective organism in both groups was Escherichia coli (43.9%). The mean (SD, range) prostate volume was 36 (6.4, 17–68)mL and 37 (7.3, 21–72)mL in Groups A and B, respectively. The mean (SD, range) volume of the abscess was 51.24 (12.6, 21–215)mL and 48.34 (15.4, 15–240)mL in Groups A and B, respectively. Overall, 37 (84.1%) patients responded to treatment (68.4% in Group A and 96.0% in Group B, P<0.23) after the first treatment session. Six patients in Group A and one patient in Group B had recurrence of abscess (P<0.03). Of the six patients in Group A with recurrence, four patients had complete resolution after repeat aspiration (average 1–3times). The mean (SD) follow-up duration was 17.25 (6.3)months. ConclusionTUR of prostatic abscess is more effective (96%) than transrectal aspiration with a lesser hospital stay. However, transrectal aspiration was successful in 89% of cases, is less invasive and can be performed under local anaesthesia and or sedation.

Bacterial emphysematous prostatic abscess – A case report

s / Urological Science 26 (2015) 301e310 310 Materials and Methods: An 82 years old female patient presented to the Emergency Department with feeling unwell, pyrexia, gross hematuria, nausea and abdominal pain. She gave a history of type 2 Diabetes mellitus with regular follow-up in our hospital. A large right renal mass was detected near 4 years ago. However, she and family refused operation since then due to old age. On examination she looked weakness. A mass was palpable in the right upper quadrant and lumbar region. Liver and spleen were not palpable. There were no signs of peritonitis. Her pulse rate was 121/minute, BP 189/104 and temp 39.3 degree. She had blood tests in the Emergency Department which revealed the following: Hb 15.6 g/dL, WBC 11,400 and platelets 202,000. Electrolytes were as follows: Na 136 mmol/ litre, K 3.3 mmol/litre, BUN: 12, creatinine: 0.8, blood sugar: 213. Chest X ray showed 1) Mild coarse and crowding lung markings, some infiltration in bilateral lungs; but no focal active lung lesion. 2) Borderline cardiomegaly and mild tortuosity of aorta with some calcified atheroma plaques of aortic arch wall.. The patient had ultrasound scanwhich showed mass in the right kidney. Computerised tomography (CT) scan image of abdomen showed anterior upper pole tumor 9.5 x 12 x9.0 cm in size with heterogeneous enhancement and area of necrosis. Extension to perirenal fat and renal sinus fat but not Gerota fascia. Positron emission tomography (PET) revealed: 1. F-18 FDG avid lesion in the left thyroid, malignancy should be considered. 2. Right paraaortic lymph node metastases should be considered. She underwent right-side radical nephrectomy after full staging procedures and appropriate investigations. NDP32: BACTERIAL EMPHYSEMATOUS PROSTATIC ABSCESS e A CASE REPORT Chih-Cheng Lu, Wen-Chou Fan. Division of Urology, Department of Surgery, Chi Mei Medical Center, Liouying, Tainan, Taiwan Purpose: We present a case of emphysematous prostatic infection complicated with multiple organs abscess by Klebsiella pneumoniae. Materials and Methods: A 47 year-old male patient suffered from uncontrolled diabetes. Four days before admission, he had fever and general weakness. He visited our emergent department after empirical treatment at local clinic. After admission, intensive care was given due to diabetic ketoacidosis and septic shock. Although multiple drains for liver and lung, spiking fever persisted. Sequential CT showed air and abscess in the prostate region. Urgent transurethral prostate incision was done to drain the abscess. Afterwards, the general condition became stable. He was discharged with oral antibiotics and antidiabetic drugs. After one year followup, the patient kept uneventful condition with tight diabetic control. Conclusion: Emphysematous prostatic abscess is an unusual acute disease with high morbidity and mortality. The predisposing factors include diabetes mellitus, hepatic cirrhosis, and intravesical obstruction. CT provides a good tool for immediate diagnosis. Treatment of prostatic abscess includes parenteral antibiotics and abscess drainage. Transperineal needle aspiration, transrectal needle aspiration, open perineal incision, and transurethral resection or unroofing are available routes for drainage.

Prostate Abscess in A Peritoneal Dialysis Patient

s / Urological Science 26 (2015) S50eS81 S56 NDP024: PROSTATE ABSCESS IN A PERITONEAL DIALYSIS PATIENT Ping-Ju Tsai , Cheng-Chen Su , Chung-Sung Shen , Shih-Ya Hung , YiChun Liu . Division of Urology, Yuan's General Hospital, Kaohsiung, Taiwan; Division of Nephrology, Yuan's General Hospital, Kaohsiung, Taiwan Prostate abscess is an uncommon condition of infective urinary tract disease. Predisposing factors for prostate abscess included acute bacterial prostatitis, urethral catheterization, diabetic mellitus, chronic kidney disease, cirrhosis and immunocompromised patients. The prostate abscesses were attributed to gonococcus, Escherichia coli, Staphylococcus aureus, and Klebsiella pneumoniae. We can make the diagnosis with transrectal ultrasound and abdominal CT scan. Treatments of prostate abscess were attributed to parental broad-spectrum antibiotics administration and abscess drainage. The methods of drainage included transrectal aspiration and transurethral (TUR) incision of prostate. We presented that a 60-year-old male has hypertension, diabetes mellitus, coronary artery disease, cerebrovascular accident with left hemiparesis, bilateral blow-knee amputation, and end stage renal disease with peritoneal dialysis. He called for help at emergency room due to fever, poor appetite, and vomiting. Abdominal CT scan revealed loculated fluid and air collection in the prostate and seminal vesicles. We performed TUR drainage and urethral Foley indwelling with 24 hours irrigation. Prostate abscess pus culture showed Escherichia coli. After 2 days, we removed the drainage Foley and he was discharged. Unfortunately, he recalled for help at emergency room due to cloudy peritoneal dialysis fluid and sepsis. Peritoneal fluid culture revealed Escherichia coli. We suspected prostate abscess related continuous ambulatory peritoneal dialysis (CAPD). After removal of peritoneal dialysis tube and antibiotics therapy, his conditions improved. At last, he was under stable conditions and received regular hemodialysis at outpatient department of nephrology.

A case report of an uncommon large size of prostatic cyst

Introduction: Prostatic cyst is an uncommon disease, especially large one, which need to be differentiated from prostatic neoplastic masses, prostatic non-neoplastic masses and periprostatic neoplastic masses. Case Report: A 63-year-old male who had dysuria for three years and could not urinate for three days. Initially, he was diagnosed as prostatic hyperplasia by color Doppler ultrasound. After further examinations with prostate-specific antigen (PSA), computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, cystoscopy and transrectal ultrasound-guided aspiration, he was diagnosed as prostatic cyst. The size of prostatic cyst was 9.2x4.9cm. Two weeks after diagnosis patient received an open surgery through perianal incision to remove all content in the cyst and clean this large prostatic cyst. Patient is still seen for follow-up visits every two months to further assess the treatment. Conclusion: Ultrasound, CT scan and MRI scan together help to get final diagnosis of prostatic cyst. The surgery of prostate cyst excision we performed improved outcome although we still need to follow our patient for longer time.

Transurethral Drainage of Prostatic Abscess: Points of Technique

BackgroundThe incidence of prostatic abscess (PA) has markedly declined with the widespread use of antibiotics and the decreasing incidence of urethral gonococcal infections.ObjectivesTo evaluate different treatment methods for prostatic abscess and to describe technical points that will improve the outcome of transurethral (TUR) drainage of prostatic abscess.Patients and MethodsWe performed a retrospective study of a series of 11 patients diagnosed with prostatic abscess, who were admitted and treated in Farwaniya Hospital, Kuwait, between February 2008 and November 2010. Drainage was indicated when antibiotic therapy did not cause clinical improvement and after prostatic abscess was confirmed by TRUS (Transrectal ultrasonography) and/or CT computed Tomographyscan. TUR drainage was indicated in 7 cases, ultrasound-guided transrectal drainage was performed in 2 cases, and ultrasound-guided perineal drainage was performed in 2 cases.ResultsAll patients that underwent TUR-drainage had successful outcomes, without the need of secondary treatment or further surgery.ConclusionsTUR drainage of a prostatic abscess increases the likelihood of a successful outcome and lowers the incidence of treatment failure or repeated surgery. Less invasive treatment, with perineal or transrectal aspiration, may be preferred as a primary treatment in relatively young patients with localized abscess cavities.

Transrectal ultrasound - Techniques and outcomes in the management of intestinal endometriosis.

The widespread use of endoscopic ultrasound has facilitated the evaluation of subepithelial and surrounding lesions of the gastrointestinal tract. Deep pelvic endometriosis, with or without infiltration of the intestinal wall, is a frequent disease that can be observed in women in their fertile age. Patients of this disease may present nonspecific signs and symptoms or be completely asymptomatic. Laparoscopic surgical resection of endometriotic lesions is the treatment of choice in symptomatic patients. An accurate preoperative evaluation is indispensable for therapeutic decisions mainly in the suspicion of intestinal wall and/or urinary tract infiltration, and also in cases where we need to establish histological diagnosis or to rule out malignant disease. Diagnostic tools, including transrectal ultrasound, magnetic resonance image, transvaginal ultrasound, barium enema, and colonoscopy, play significant roles in determining the presence, depth, histology, and other relevant data about the extension of the disease. Diagnostic algorithm depends on the clinical presentation, the expertise of the medical team, and the technology available at each institution. This article reviews and discusses relevant clinical points in endometriosis, including techniques and outcomes of the study of the disease through transrectal ultrasound and fine-needle aspiration.

Prostate Cystadenoma Presenting With Obstructive Azoospermia

We report on a case of prostate multilocular cystadenoma presenting with primary infertility and obstructive azoospermia. Our patient is a 36-year-old presenting with primary infertility in addition to mild deep pelvic pain. Semen analysis revealed azoospermia with positive fructose. His prostate-specific antigen was 0.7 ng/dL and his imaging revealed a large multilocular cystic mass with multiple internal enhancing septa. Transrectal ultrasonography-guided aspiration and biopsies revealed a lining of regular low cuboidal cells. Surgical removal was undertaken through a transperitoneal/retroperitoneal approach and pathology was consistent with a prostatic multilocular cystadenoma. Further studies are needed to characterize and classify cystic lesions of the prostate.

Congenital Seminal Vesicle Cyst Associated with Ipsilateral Renal Agenesis Mimicking Bladder Outlet Obstruction: A Case Report and Review of the Literature

Seminal vesicle cysts combined with genitourinary anomalies are uncommon. We present a 43-year-old married man who suffered from difficulty in urination and irritating voiding symptoms for 3 years. The symptoms worsened in the last 6 months. Digital rectal examination revealed a palpable large soft mass behind the prostate. Diagnostic imaging showed a left seminal vesicle cyst with an intravesical protrusion. The ipsilateral kidney and ureter were absent. Transrectal aspiration of the cyst was performed, which improved the clinical genitourinary symptoms. The maximal and mean urinary flow rates increased from 18 to 37 mL/s and from 6 to 16 mL/s, respectively.

Transrectal Ultrasound-Guided Needle Aspiration of a Prostatic Abscess

Transrectal Ultrasound-Guided Needle Aspiration of a Prostatic Abscess

Seminal vesicle cyst forming an abscess and fistula with the rectum Review of perianal drainage and treatment

The clinical presentation and treatment modalities of seminal vesical abscesses are not well documented. The first case of a seminal vesicle cyst which formed an abscess after transrectal aspiration with subsequent formation of a fistula with the rectum is reported herein. The abscess was drained perianally, an approach that has not previously been reported. A brief comparison of the reported treatment modalities is also provided.

Anterior Sacral Meningocele With Presacral Cysts: Report of a Case

Anterior sacral meningocele is a rare anomaly most frequently presenting as a presacral mass. Since the first description in 1837, approximately 150 cases have been reported. The case presented is a 37-year-old female in whom an asymptomatic presacral mass was discovered during her first delivery. Because normal delivery was impossible, a cesarean section was performed. A year later, in a regional hospital a "cystic presacral tumor" was treated with biopsy and drainage. Four years later, she developed constipation caused by perineal compression for which she was admitted to our department in which two anterior presacral cysts were excised. The recovery was complicated with meningitis, which was successfully treated with antibiotics. Whenever a presacral mass is found, anterior sacral meningocele has to be a diagnostic consideration. The symptoms are usually related to the compression on rectum, bladder, and sacral nervous plexus. Rectal examination and radiography of the pelvis with the sacral bone showing the "scimitar sign" are the main diagnostic methods. Myelography, computed tomography, and magnetic resonance imaging are the best methods for identifying the precise anatomy of sacral meningocele and for proper planning of the operation. Transvaginal or transrectal aspiration and drainage are not advised, because they may result in a lethal outcome caused by sepsis.

Endoscopic ultrasound-guided transrectal aspiration of pelvic fluid collections.

The aim of this study was to evaluate the feasibility, safety, and diagnostic accuracy of endorectal ultrasound-guided aspiration and drainage of pelvic fluid collections. All patients who underwent endorectal ultrasound-guided aspiration and/or drainage of pelvic fluid collections were included in this prospective study. Patients were prepared using bowel lavage and a single-dose antibiotic combination. The procedure was carried out in the lithotomy position usually without sedation. All aspirates were examined microbiologically and/or cytologically. Twenty-nine patients [18 females and 11 males; median age, 67 years (range, 18-79)] underwent 33 endosonographic controlled aspirations. No procedure-related complications were encountered. In 22 cases (76%) the lesions were encountered following a surgical procedure. Fluid amounts varied between 5 and 750 ml. Fluids were sterile in 14 cases (42%). These fluid collections were hematomas, seromas, peritoneal cysts, and a mucocele. Microorganisms were found in the remaining 19 aspirations (58%), i.e., abscesses (n = 16) and infected hematomas (n = 3). A transrectal (n = 14) or transvaginal (n = 2) drainage catheter was placed in 16 patients under endosonographic guidance. Only two patients required a subsequent laparotomy for definitive treatment of their septic focus, whereas all other patients could be treated successfully by this conservative approach. Endoscopic ultrasound-guided transrectal aspiration and drainage of pelvic fluid collections is a safe method with a favorable outcome because it avoids unnecessary operations in selected patients.

Laparoscopic Excision of a Seminal Vesicle Cyst in a Child

Seminal vesicle cyst is an exceedingly rare lesion, manifesting in less than 0.005% of the population.1 Most seminal vesicle cysts are small and asymptomatic. However, when symptoms occur it is usually during the early sexually active period (ie in the second and third decades of life in men).2 Symptoms at presentation may include irritative lower urinary tract problems, abdominal and perineal pain, lower abdominal mass, hemospermia and, rarely, hematuria. The seminal vesicle cyst is often associated with other urological anomalies, including renal agenesis, renal dysplasia and ureteral ectopia.3 Surgical management consists of transrectal aspiration, transurethral unroofing, transurethral resection of the ejaculatory duct, transurethral endoscopic examination and aspiration or open surgical excision. 4–6 The open surgical approach is considered the definitive form of treatment. However, it can be technically challenging and morbid. Recently, the laparoscopic approach has had a significant impact on the management of several urological disorders, including seminal vesicle cysts.7–9 We report the tenth case, and only the second known pediatric case, of a laparoscopic seminal vesicle cyst excision. In this case dissection of the cyst was facilitated by filling the cyst with indigo carmine cystoscopically immediately before laparoscopic excision. CASE REPORT A 7-year-old boy presented elsewhere with a 2-week history of suprapubic pain and dysuria. Initial antibiotic therapy for a presumed urinary tract infection was ineffective. Right testicular swelling subsequently developed and the patient was referred to a urologist. He underwent scrotal exploration, which identified only right epididymitis. Additional antibiotic therapy was given but the symptoms failed to resolve. He was referred to our institution with persistent orchitis. Physical examination revealed an unremarkable abdomen. Scrotal examination demonstrated a mildly enlarged and firm right testicle that was exquisitely tender on palpation. The right epididymis was also enlarged and tender but the spermatic cord was unremarkable. The rest of the examination did not show any other abnormalities. Abdominal, pelvic and scrotal ultrasound revealed an anechoic lesion posterior to the bladder and a mildly enlarged right epididymis along with an absent right kidney. Pelvic magnetic resonance imaging confirmed the absence of the right kidney and the presence of a pelvic cyst located to the right of the midline, consistent with a seminal vesicle cyst (fig. 1). Laparoscopic excision of the seminal vesicle cyst was elected. After induction of general anesthesia cystoscopy was performed with an 11Fr pediatric cystoscope. Examination of the bladder demonstrated elevation of the trigone and bladder base due to the seminal vesicle cyst. The left ureteral orifice was found in an orthotopic position. However, the right ureteral orifice and hemitrigone were absent. The posterior urethra was unremarkable. The ejaculatory duct was cannulated without difficulty using a 75 cm 3Fr ureteral

Drainage of deep pelvic abscesses using therapeutic echo endoscopy.

The purpose of this study was to evaluate the clinical efficacy of endosonographically guided transrectal aspiration and drainage by plastic stent of deep pelvic abscesses, using a therapeutic echo endoscope device. Between September 2000 and June 2001, 12 patients (nine men, three women, mean age 67 years) were treated for a perirectal or a pelvic abscess using an endoscopic ultrasound (EUS) technique. The drainage of these fluid collections was performed under EUS guidance, using therapeutic EUS scopes with a large working channel. No major complication occurred during this study. Transrectal stent insertion succeeded in nine patients. In three patients, only aspiration was possible. Among the nine patients in whom a stent was successfully introduced into the fluid collection, complete drainage without relapse was achieved in eight patients (mean follow-up 10.6 months, range 6-14 months). The stent was removed endoscopically after 3 to 6 months. Drainage was incomplete in one patient (with a large abscess, diameter > 8 cm), who subsequently underwent surgical drainage. However, two out of the three patients in whom aspiration alone was performed developed a recurrence of the abscess and required surgical treatment. EUS-guided drainage of deep pelvic abscesses could offer an alternative treatment to surgery in the management of these postoperative complications.

Screening for prostate cancer in Romania.

In Romania, more than 95% of patients present with advanced stage prostate cancer at the time of diagnosis. Our purpose was to detect early prostate cancer in the Romanian city of Oradea, with a screening based on digital rectal examination and fine needle aspiration biopsy. We performed digital rectal examinations on 701 men, between 50 to 80 years of age. Four men with a history of prostate cancer were excluded from the study. Transrectal fine-needle aspiration biopsies were done in 15 men who presented with suspicious findings at the digital rectal examination. Prostate cancer was cytologically proven in eleven men. Nine of these were low- to intermediate grade (GI-II) and clinically localized (T2). Two patients had clinical stage T3 tumors. The prostate cancer detection rate in the screened population was 1.6% (11/697). Currently, eight men have undergone total retropubic prostatectomy. One patient presented with pelvic lymph node metastases and, after a staging lymphadenectomy, only a bilateral orchiectomy was performed. This first Romanian mass screening study for prostate cancer revealed a great interest in early cancer detection among the general public. Continued effort to make asymptomatic men aware of the disease may ultimately lead to an overall stage reduction at the time of diagnosis in Romania.

Transrectal ultrasonographically guided drainage of gynecologic pelvic abscesses

Objective: This study assessed the feasibility of ultrasonographically guided transrectal aspiration of gynecologic pelvic abscesses to treat patients for whom intravenous antibiotic therapies failed and whose abscesses were not optimally amenable to colpotomy drainage or transabdominal or transvaginal ultrasonographically guided aspiration. Study Design: This was a retrospective review of the first 15 women with pelvic abscesses that resulted from salpingitis or complications of gynecologic surgery who underwent transrectal pelvic abscess drainage after failure of antibiotic therapy. Results: Purulent material was aspirated from the abscesses in 14 of the 15 women. All 14 women with aspirated material were successfully treated with real-time ultrasonographically guided transrectal drainage; only 4 of the 14 had indwelling catheter placement. Conclusion: Ultrasonographically guided transrectal drainage of gynecologic pelvic abscesses is a safe and effective treatment of pelvic abscesses for women who do not have an adequate response to antibiotic therapy. (Am J Obstet Gynecol 2000;182:1382-8.)

Zytopathologie der Prostata

Transrectal fine-needle aspiration biopsy (FNAB) of the prostate under digital control is a cheap and rapid method for diagnostic evaluation of palpable and non-palpable nodules, yielding high sensitivity (ca. 95%) and a low complication rate (< 1%). Its specificity amounts to > 97%. The scarcity of urologists trained in the FNAB method and of pathologists experienced in cytology of the prostate limit the clinical application so far. Besides various forms of prostatitis, five different types of cancer can cytologically be differentiated. While PIN I cannot be cytologically identified, PIN II/III lesions may lead to false-positive diagnoses. Cytologic grading of adenocarcinomas of the prostate is of statistically proven prognostic validity and strictly correlated with its histologic counterpart. Preoperative, radiologically controlled FNAB of pelvic and paraortal lymph nodes has sensitivity of ca.86% and specificity of 100%. It thus helps to avoid unnecessary prostatectomies if nodal tumor spread has preoperatively been proven. Diagnostic DNA cytometry is able to identify those prostatic cancer patients who do not reveal significantly increased risk of tumor progression or decreased survival probability, even without therapy (constantly and representatively diploid and tetraploid patterns). Patients with DNA tetraplid histograms may show deteriation of prognosis under hormonal therapy. DNA-aneuploid prostatic cancers should not be subjected to a "wait and see" strategy; they do not respond to hormonal therapy.

Image guided transvaginal and transrectal aspiration and drainage of pelvic collections: Technical details and results over a 3 year period

Image guided transvaginal and transrectal aspiration and drainage of pelvic collections: Technical details and results over a 3 year period