Infrequent organ involvement in immunoglobulin G4-related prostate disease: A case report

BACKGROUND Immunoglobulin G4-related prostate disease(IgG4-RPD)characterized by a high count of IgG4-positive plasma cells has distinctive serological and radiological findings.Here we report a case of a patient who was successfully treated for IgG4-RPD,which manifested as frequent micturition,dysuric,and systemic lymphadenopathy.CASE SUMMARY The patient was a 33-year-old man who was referred to our hospital because of urinary tract symptoms that had persisted for 4 years.A physical examination revealed systemic lymphadenopathy and blood tests showed hyperglobulinemia with an IgG level of 18.90 g/L and an IgG4 level of 18.40 g/L.Computed tomography(CT)revealed bilateral lacrimal gland,right parotid gland and prostatic enlargement.Based on these findings,IgG4-RD was suspected,and further pathological examination and follow-up results showed expected results.Finally,the patient was diagnosed with IgG4-RPD based on clinical symptoms,pathological examination,therapeutic effects,and follow-up results.He received 50 mg oral prednisolone(the dose was gradually reduced and a low dose was used for long-term maintenance)in combination with cyclophosphamide 1.0 g via an intravenous drip for 6 mo.One year after the treatment was initiated,he was free of urinary or other complaints and his serum IgG4 level normalized.CONCLUSION In IgG4-RPD with severe urinary tract symptoms,radiological findings should be carefully examined.IgG4-RPD prognosis is good because the disease responds well to glucocorticoids.Furthermore,it is urgent for clinicians and pathologists to improve their understanding of IgG4-RPD.

Effect of precise nursing service mode on postoperative urinary incontinence prevention in patients with prostate disease

BACKGROUND Patients with benign prostatic disease often experience detrusor morphological changes and dysfunction.In severe cases,it leads to bladder detrusor dysfunction,resulting in dysuria,frequent urination,urgent urination,incomplete urination,and other symptoms including renal function injury.An operation to restore normal urination function and to control postoperative complications,as far as possible,is the most common method for benign prostatic disease.AIM To observe the effect of precise nursing service mode on postoperative urinary incontinence prevention in patients with prostate disease.METHODS In total,130 patients diagnosed with benign prostatic disease,from January 2018 to June 2021,in our hospital,were selected and divided into observation and control groups according to their treatment options.Sixty-five cases in the control group were given routine nursing mode intervention and 65 cases in the observation group received precise nursing service mode intervention.The intervention with the observation group included psychological counseling about negative emotions,pelvic floor exercises,and post-hospital discharge care.The complications of the two groups were counted,and the general postoperative conditions of the two groups were recorded.The urinary flow dynamics indexes of the two groups were detected,and differences in clinical international prostate system score(IPSS)and urinary incontinence quality of life questionnaire(I-QOL)scores were evaluated.RESULTS Postoperative exhaust time(18.65±3.23 h and 24.63±4.51 h),the time of indwelling catheter(4.85±1.08 d and 5.63±1.24 d),and hospitalization time(8.78±2.03 d and 10.23±2.28 d)in the observation group were lower than in the control group.The difference was statistically significant(P<0.05).After the operation,the maximum urinary flow rate(Qmax)increased(P<0.05),the residual urine volume(RUV)decreased(P<0.05),and the maximum closed urethral pressure(MUCP)was not statistically significant(P>0.05)compared to pre-operation.The Qmax of the observation group was higher than that of the control group,while the RUV was lower than that of the control group.There was no significant difference in MUCP between the observation and control groups(P>0.05).The I-QOL score of the two groups improved(P<0.05),and the IPSS decreased(P<0.05).After the operation,the I-QOL score of the observation group was higher than that of the control group,and the IPSS was lower than that of the control group(P<0.05).There were no significant differences in the incidence of urethral injury(1.54%and 3.08%),bladder spasm(0.00%and 1.54%),and secondary bleeding(1.54%and 4.62)between the observation and control groups(P>0.05).CONCLUSION The precise nursing service mode can reduce the incidence of postoperative urinary incontinence in patients with prostate disease,thus improving postoperative urodynamics and rehabilitation,and quality of life.

Incidental seminal vesicle amyloidosis observed in diagnostic prostate biopsies--are routine investigations for systemic amyloidosis warranted？

Seminal vesicle （SV） amyloidosis is a well-documented histological entity, but it is observed infrequently. Its incidence is on the rise, which is probably related to the increasing use of prostate biopsies to investigate patients with elevated serum prostate-specific antigen levels. Here, we report seven cases of incidental SV amyloidosis over a 3-year period and consider their relationship to the previously suggested aetiological factors. Based on our series, we conclude that incidental localized SV amyloidosis observed in diagnostic prostate biopsies does not warrant formal investigations for systemic amyloidosis.

Prostate sclerosing adenopathy:A clinicopathological and immunohistochemical study of twelve patients

BACKGROUND Although sclerosing adenopathy of the prostate is a very rare benign disease,an effective differential diagnosis is required.Here,we report the clinicopathological and immunohistochemical morphological features of 12 cases of sclerosing adenopathy of the prostate to improve understanding of the disease.AIM To investigate the clinicopathological features,diagnosis,and immunohistochemical phenotypes that distinguish prostate sclerosing adenopathy from other conditions.METHODS The clinical data,laboratory tests,pathological morphology,and immunohistochemical phenotypes of 12 cases of prostatic sclerosing adenopathy were retrospectively analyzed,and the relevant literature was reviewed.RESULTS All patients were elderly men(mean age,71.7 years;62–83 years).Eleven of them had hematuria,urinary frequency,urinary urgency,difficulty in urination,and serum total prostate-specific antigen values within the normal range.One patient had increased blood pressure.Enlarged prostates with single to multiple calcifying foci were observed.Moreover,prostate tissue hyperplastic changes were observed in all patients.Small follicular hyperplastic nodules without an obvious envelope,with a growth pattern mimicking the infiltration pattern of"prostate adenocarcinoma"were noted.Basal cells expressed AR,CKH,P63,and CK5/6,and myoepithelial markers,such as calponin,S100,and smooth muscle actin.No recurrence or exacerbation of the lesions was observed,except for one case of death due to bladder cancer.CONCLUSION Prostatic sclerosing adenopathy is highly misdiagnosed as prostate adenocarcinoma or other tumor-like lesions.Therefore,it should attract the attention of clinicopathologic researchers.

Androgens and male aging：current evidence of safety and efficacy

Many signs of aging,such as sexual dysfunction,visceral obesity,impaired bone and muscle strength,bear a close resemblance to features of hypogonadism in younger men. The statistical decline of serum testosterone in aging men is solidly documented. It has been presumed that the above features of aging are related to the concurrent decline of androgens,and that correction of the lower-than-normal circulating levels of testosterone will lead to improvement of symptoms of aging. But in essence,the pivotal question whether the age-related decline of testosterone must be viewed as hypogonadism,in the best case reversed by testosterone treatment,has not been definitively resolved. Studies in elderly men with lower-than-normal testosterone report improvement of features of the metabolic syndrome,bone mineral density,of mood and of sexual functioning. But as yet there is no definitive proof of the beneficial effects of restoring testosterone levels to normal in elderly men on clinical parameters. Few of these studies meet as yet rigorous standards of scientific enquiry：double-blind,placebo-controlled design of the study. The above applies also to the assessment of safety of testosterone administration to elderly men. There is so far no convincing evidence that testosterone is a main factor in the development of prostate cancer in elderly men and guidelines for monitoring the development of prostate disease have been developed. It is of note that there are presently no long-term safety data with regard to the prostate. Polycythemia is another potential complication of testosterone treatment. It is dose dependent and can be managed with dose adjustment.

Update on minimally invasive surgery and benign prostatic hyperplasia

Transurethral resection of the prostate(TURP)became the gold standard surgical treatment for benign prostatic obstruction without undergoing randomized controlled trials against the predecessor standard in open suprapubic prostatectomy.TURP has historically been associated with significant morbidity and this has fuelled the development of minimally invasive surgical treatment options.Improvements in perioperative morbidity for TURP has been creating an ever increasing standard that must be met by any new technologies that are to be compared to this gold standard.Over recent years,there has been the emergence of novel minimally invasive treatments such as the prostatic urethral lift(PUL;UroLift System),convective WAter Vapor Energy(WAVE;Rezum System),Aquablation(AQUABEAM System),Histotripsy(Vortx Rx System)and temporary implantable nitinol device(TIND).Intraprostatic injections(NX-1207,PRX-302,botulinum toxin A,ethanol)have mostly been used with limited efficacy,but may be suitable for selected patients.This review evaluates these novel minimally invasive surgical options with special reference to the literature published in the past 5 years.

Are prostatic calculi independent predictive factors of lower urinary tract symptoms？

We determined the correlation between prostatic calculi and lower urinary tract symptoms （LUTS）,as well as the predisposing factors of prostatic calculi. Of the 1 527 patients who presented at our clinic for LUTS,802underwent complete evaluations,including transrectal ultrasonography,voided bladder-3 specimen and international prostatic symptoms score （IPSS）. A total of 335 patients with prostatic calculi and 467 patients without prostatic calculi were divided into calculi and no calculi groups,respectively. Predictive factors of severe LUTS and prostatic calculi were determined using uni/multivariate analysis. The overall IPSS score was 15.7±9.2 and 14.1±9.1 in the calculi and no calculi group,respectively （P = 0.013）. The maximum flow rate was 12.1±6.9 and 14.2±8.2 mL s^（-1） in the calculi and no calculi group,respectively （P = 0.003）. On univariate analysis for predicting factors of severe LUTS,differences on age （P = 0.042）,prostatic calculi （P = 0.048） and prostatitis （P = 0.018） were statistically significant. However,on multivariate analysis,no factor was significant. On multivariate analysis for predisposing factors of prostatic calculi,differences on age （P〈0.001） and prostate volume （P = 0.001） were significant. To our knowledge,patients who have prostatic calculi complain of more severe LUTS. However,prostatic calculi are not an independent predictive factor of severe LUTS. Therefore,men with prostatic calculi have more severe LUTS not only because of prostatic calculi but also because of age and other factors. In addition,old age and large prostate volume are independent predisposing factors for prostatic calculi.

Application of 3-D Sonography in the Diagnosis of Prostatic Diseases.

Transbdominal and transrectal 3-D ultrasonography were carried out simultaneously for 301 cases of prostatic

Effects of different Chinese herbal prescriptions on cytokines in autoimmune prostatitis rats

OBJECTIVE:To observe and compare the effects of Chinese herbal prescriptions for promoting blood circulation,clearing heat,removing toxicity,and dispersing stagnated liver-Qi on cytokines in model rats with experimental autoimmune prostatitis(EAP) to provide an experimental basis for the use of Chinese herbal prescriptions in the treatment of chronic prostatitis.METHODS:One-hundred and ten male Wistar rats were randomly divided into 11 groups:blank group;model group;Huoxuehuayu(promoting blood circulation to remove blood stasis) high,middle,and low dose groups;Qingrejiedu(clearing heat and removing toxicity) high,middle,and low dose groups;and Shuganliqi(dispersing stagnated liver-Qi) high,middle,and low dose groups.Except the blank group,rats in all groups were injected subcutaneously in multiple points on days 0 and 30 with prostatic protein extractive solution(60 mg/ml_),and intraperitoneally injected with diphtheria-pertussis and tetanus vaccine(DPT vaccine) to establish the EAP model.Model rats were administrated high,middle,and low doses of Chinese herbal prescriptions and were sacrificed after 4 weeks.Pathological changes in the prostate gland were observed with HE staining and changes in serum interleukin-6(IL-6),interleukin-8(IL-8),and prostaglandin E_2(PGE_2) levels were detected with enzyme-linked immunosorbent assay.RESULTS:Compared with the blank group,serum PGE_2,IL-6,and IL-8 levels in the model group were significantly higher(P < 0.05).Compared with the model group,serum PGE_2,IL-6,and IL-8 levels in the Qingrejiedu low dose and middle dose groups were significantly lower(P < 0.05),with the lower dose having a more obvious effect.Serum PGE_2,IL-6,and IL-8 levels in the Huoxuehuayu high dose group(P < 0.05),IL-6 and IL-8 levels in the Huoxuehuayu middle dose group(P < 0.05),and the IL-8level in the Huoxuehuayu low dose group were significantly lower than those in the model group(P < 0.05).There were significant differences in PGE_2 and IL-6 levels among the different dose groups of Shuganliqi drugs(P < 0.05).Compared with the model group,serum PGE_(2/) IL-6,and IL-8levels in the Shuganliqi high dose group(P <0.05) and IL-8 level in the Shuganliqi low dose group were significantly lower(P < 0.05),while the Shuganliqi middle dose group did not change significantly(P > 0.05).CONCLUSION:Therefore,in TCM treatment of autoimmune prostatitis,different treatment methods should select different doses.For prescriptions that clear heat and remove toxicity,low doses should be used.For prescriptions that promote blood circulation to remove blood stasis and for prescriptions that disperse stagnated liver-Qi,high doses should be used.

NOTICE

Transbdominal and transrectal 3-D ultrasonography were carried out simultaneously for 301 cases of prostatic