Manejo endoscópico del utrículo prostático sintomático en pacientes pediátricos : reporte de dos casos y revisión de la literatura

Se realiza la revisión de dos historias clínicas de pacientes con hallazgo de megaquistes del utrículo prostático, sintomáticos, a quienes se les realizó manejo endoscópico como parte de su tratamiento. Ambos consultaron por infección urinaria febril y síntomas obstructivos bajos; el ultrasonido de vías urinarias en los dos casos mostró una lesión quística retrovesical en la línea media. Como diagnósticos diferenciales se consideraron los quistes de duplicación intestinal, quistes del utrículo prostático y valvas de la uretra posterior. La valoración se completó con resonancia magnética nuclear, cistouretrografía y cistoscopia bajo anestesia general, identificando en esta última el orificio de drenaje del utrículo a la uretra prostática en los dos casos. El tratamiento consistió en resección endoscópica de la boca del utrículo, obteniendo una cavidad amplia y facilitando su drenaje. Los pacientes han tenido una evolución satisfactoria, con un seguimiento de 7 y 3 meses respectivamente, sin nuevos episodios de infección urinaria y sin síntomas obstructivos. Las imágenes de seguimiento han mostrado disminución del volumen del utrículo. Se discuten detalladamente las modalidades diagnósticas y terapéuticas de esta patología.84-88We review the clinical records of two patients who were diagnosed with symptomatic mega prostatic utricle cysts, treated endoscopically. Both of them presented with febrile urinary tract infections and lower urinary tract symptoms. Abdominal ultrasound was performed in both cases, with the finding of a retrovesical, midline cystic mass. Intestinal duplication cysts, prostatic utricle cysts and posterior urethral valves were considered as possible causes. The study was completed with MRI, cystourethrography and cystoscopy performed under general anesthesia. The the cysts mouth was identified during the cystoscopy in the prostatic urethra. Treatment consisted of an endoscopic resection of the utricle mouth, obtaining a large cavity that allowed an easy drainage. Patients have had a satisfactory outcome, with a follow up of 7 and 3 months respectively, without further episodes of urinary tract infection and without obstructive symptoms. The follow-up images showed a reduction in the utricle volume. We discuss in detail the diagnostic and treatment modalities of this diseas

Impact of rectal swabs on infectious complications after transrectal prostate biopsy

Q4Q2340-346Objectives: To determine the impact of rectal swabs (RSs) on infectious complications (IC) following prostate biopsy (PB). Methods: A retrospective cohort study was conducted including all patients subjected to PB between 2009 and 2013. Group B consisted of patients with a RS and group A of patients without. RS reported the presence of gram-positive or negative germs, sensitive or resistant to ciprofloxacin. Antimicrobial prophylaxis was adjusted to the result. Frequency of IC in each group was determined. Results: Group B had 548 (47.20%) patients and group A 613 (52.80%). From group B, 250 (45.62%) of the RSs showed fluoroquinolone (FQ)-resistant germs. Forty nine (16.44%) patients with sensitive germs vs. 147 (59.51%) with resistant germs had a history of previous FQ treatment (p < 0.0001). IC were observed in 33 (5.49%) patients from group A and in 7 (1.28%) patients from group B (p < 0.0001), requiring hospitalization in 4.99 vs. 1.28%, respectively. IC and hospital admissions were reduced in 76.68 and 74.34%, respectively, following the implementation of RS. Conclusions: RS and targeted antibiotic prophylaxis prior to PB was associated with a significant reduction in IC and hospital admissions. Ceftriaxone could be an alternative in cases of known resistance. Past history of FQ treatment is associated with increased resistance

Photoselective vaporization with KTP 180-w green laser for the treatment of lower urinary symptoms secondary to benign prostatic enlargement : effectiveness and safety at midterm follow-up

Q3Q11253-1257Objectives: To determine safety, efficacy, and improvement in patient's quality of life (QoL) with 180-W green light laser prostate photovaporization in medium-term follow-up. Methods: Observational descriptive analysis. All the patients who were treated with photoselective vaporization with potassium titanyl phosphate crystal 180-W green laser between January 2012 and February 2014 were included. The primary outcome was the change of the International Prostate Symptom Score (IPSS). A descriptive analysis was conducted. Statistic inference was made using nonparametric measurements according to the findings. The Wilcoxon signed-rank test was applied to paired data. Finally, survival curves were used to determine the effectiveness. Results: Two hundred one subjects were included. The mean follow-up was 13.1 months (2-28). Prostate volume was 75.46 ml (30-240). Mean surgical time was 73.29±29.74 minutes, laser time was 44.27±21.03 minutes, and the mean energy used was 271.5±140.1 kJ. Postoperative indwelling catheter time was 15.81±8.87 hours. IPSS decreased 12.79 points, from 19.13±7.79 to 6.34±5.91 (p=0.0001). QoL question of the IPSS shows improvement from 4.16 to 1.27 (p=0.00001). In a maximum follow-up period of 28 months, 85.2% of patients showed an improvement of four points in IPSS. Visual scale of improvement perception showed an increase from 36.49 to 89.84 (p=0.0001). No major complications were reported. Conclusion: Prostate photoselective vaporization with a 180-W green light laser is a safe and effective treatment option for patients with lower urinary symptoms secondary to benign prostate enlargement

Histological Findings in Very Low Risk Prostate Cancer Patients Managed with Radical Prostatectomy

AbstractObjectives: To describe the histological findings in patients with prostate cancer (PCa) clinically classified as very low risk who underwent treatment with radical prostatectomy (RP). Material and methods: A retrospective observational study was conducted. Clinical records of patients who underwent RP between 2007-2015 who met Epstein criteria for very low risk disease were reviewed. Histological diagnosis was described and analyzed to determine if such criteria predicted very low risk. Results: A total of 609 records were reviewed; 83 (13.6%) met Epstein’s criteria. Mean age was 59 (SD±7) years and median PSA at diagnosis was 5.4 ng/dl (IQR 4.3 – 6.8). Pathology showed a median tumor volume of 4% (IQR 1 – 10%). Gleason score was 3+3 in 55 (66.3%) cases, but 28 (33.7%) were reclassified to a greater score. Two (2.4%) patients were reclassified as pT3a, 80 (96.4%) as pT2 and 1 (1.2%) was found to be pT0. In those subjected to pelvic lymphadenectomy (42.2%) no positive lymph nodes were found. Conclusions: Up to one-third of the patients clinically classified with very low risk PCa had a greater Gleason score. Only 3% had locally advanced tumors, which is comparable to previous studies. Epstein’s criteria seem to be adequate in predicting organ-confined disease.