Diagnosis and treatment of prostate abscess:Report of 6 cases

Objective:Toimprove the diagnosis and treatment of prostate abscess by summing up experience of 6 cases of prostatic abscess.Methods:From May 2014 to October 2019,6 cases of prostatic abscess were diagnosed by means of clinical manifestations combined with digital rectal examination(DRE),ultrasound and computed tomography(CT).Five cases were performed transurethral incision and drainage for prostatic abscess,and 1 case underwent ultrasound-guided perineal drainage.Results:The symptoms of the 6 patients disappeared after drainage and recovered well without recurrence.Conclusions:The clinical manifestations combined with DRE,ultrasonography and CT are beneficial to the diagnosis of prostatic abscess.Both transurethral incision and drainage and ultrasound-guided perineal drainage are effective way to treat prostate abscess.

Prostatic abscess of Klebsiella pneumoniae complicating septic pulmonary emboli and meningitis: A case report and brief review

Prostatic abscess is a rare entity with an incidence of 0.5% to 2.5% in all prostate diseases and usually occurs in the 5th and 6th decades of life with immunocompromised status,Prostatic abscess might be a process of evolution from acute prostatitis,Klebsiella pneumoniae is the leading microorganism in the diabetic patients of prostatic abscess in Taiwan,A 60-year-old diabetic man,with a one-week history of acute bacterial prostatitis was reported in this study,presenting to the emergency department with sudden altered mental status,The abdominal computed tomographic scan demonstrated lobulated prostatic abscess and multiple septic pulmonary emboli with lung abscesses,Analysis of cerebrospinal fluid showed white blood cells of 10 771 counts/mm3 with segmented neutrophils of 99%,Cultures of blood,cerebrospinal fluid and sputum yielded Klebsiella pneumoniae,We concluded that computed tomographic scan can make a definite diagnosis of prostatic abscess associated with complications and management with empiric antibiotics and adequate drainage is suggested.

Prostatic Abscess Due to Idiopathic Granulomatous Disease: A Rare Complication of a Chameleon Disorder —Prostatic Abscess Due to Idiopathic Granulomatous Disease

Background: Prostatic abscesses are usually diagnosed in the setting of bacterial prostatitis. Rarely, they reveal or complicate granulomatous prostatitis (GP). Four cases of idiopathic xanthogranulomatous GP have been described previously and the present case report is the first of typical idiopathic variety. The case: A 60-year-old man presented with urine retention that was associated with pyuria and massively enlarged prostate. Cystoscopy revealed prostatic abscess (PA) that was opened. Urine and prostatic culture were negative for bacteria. Prostatic biopsy revealed multiple non-caseating granulomata surrounded by lymphocytes, plasma cells yet without foamy histiocytes, parasites and vasculitis. Special stains were negative for vasculitis, fungiand acid-fast organisms. The patient was treated with Solumedrol 1 g intravenously daily for 3 days followed by Prednisone 1 mg/kg/day for 1 month followed by gradual tapering till discontinuation by 3rd month. Moreover, he had received Mycophenolate mofetil (MMF) 1 g twice/daily. By the end of 2nd month;he was asymptomatic and without pyuria. Repeat cystourethroscopy and MRI scan of the prostate showed near normal prostate. In Conclusion: Idiopathic GP can present with PA that requires proper drainage and since it is a locally hyperimmune disease with genetic predisposition;MMF therapy will be maintained for a total of 2 years to prevent future disease-relapse.

Transrectal ultrasonography in infertile patients with persistently elevated bacteriospermia

Aim： To identify and define prostate and seminal vesicle abnormalities in patients with chronic male accessory gland infection （MAGI） who failed to respond to antibacterial treatment. Methods： We selected 67 consecutive patients with MAGI and persistently elevated bacteriospermia （≥ 10^6 colony forming units [CFU]/mL） after three antibiotic courses. Fourteen infertile patients with initial chronic microbial （≥ 10^6 CFU/mL） MAGI who responded to antibacterial treatment （〈 10^3 CFU/mL） served as a control group. All patients and controls underwent transrectal ultrasonography （TRUS） scans and semen analysis. Patients with low seminal plasma volume （〈 1.5 mL） underwent both preejaculatory and post-ejaculatory TRUS examination. Results： TRUS revealed multiple abnormalities indicative of： （i） bilaterally extended prostato-vesiculitis （group A： 52 cases, 77.6%） （nine of these patients also had micro-emphysematous prostate abscess）; and （ii） prostato-vesiculitis with unilateral or bilateral sub-obstruction of the ejaculatory ducts （group B： 15 cases, 22.4%）. Mean sperm concentration, total sperm number, ejaculate volume and pH value were significantly higher in group A than in group B. In addition, sperm forward motility and the percentage of normal forms were significantly worse than in controls, whereas leukocyte concentration was significantly higher in group A. Group B patients had all sperm parameters, but their pH values, significantly different from those of controls. Conclusion： Although antibiotic therapy is considered suitable when microbial MAGI is suspected, it is impossible to account for a poor response to antibiotics merely on the basis of conventional criteria （clinical history, physical and ejaculate signs）. Thus, TRUS may be helpful in the follow-up of these patients.

Fatal systemic emphysematous infection caused by Klebsiella pneumoniae:A case report

BACKGROUND Systemic emphysematous infection caused by Klebsiella pneumoniae(K.pneumoniae)is a rare but severe infection which can be lethal if the diagnosis is delayed.CASE SUMMARY We report a rare case of systemic emphysematous infection via hematogenous dissemination from a liver abscess caused by K.pneumoniae,complicated by multiple organ dysfunction syndrome,septic shock,bacteremia,emphysematous cystitis,prostate and left seminal vesicle abscesses in a diabetic patient.The patient simultaneously presented with spontaneous pneumoperitoneum secondary to rupture of the emphysematous liver abscess.His condition after admission deteriorated rapidly and he died within a short period.This disease is a great challenge for the clinician as K.pneumoniae can cause multifocal emphysematous infections and fulminant septic shock.Pneumoperitoneum following spontaneous rupture of the liver abscess can result in intra-abdominal sepsis that further increases mortality rate.Moreover,appropriate site-specific intervention and adequate drainage of numerous emphysematous liver lesions are difficult.CONCLUSION Early diagnosis followed by efficient antibiotic therapy and surgical management are essential for systemic emphysematous infection.