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Extensive Prostatic Abscess in an Elderly Patient Requiring Multidisciplinary Drainage.

ABSTRACT: Background. Prostatic abscess is rare and mainly affects immunocompromised individuals, classically presenting with both systemic and lower urinary tract symptoms. Our case is unique as the patient presented with an exceptionally long duration of symptoms prior to seeing a health-care provider, had no systemic symptoms, and was managed via a multidisciplinary approach. Case Presentation. We present a case of a 70-year-old man with type-two diabetes who endured two months of lower urinary tract symptoms and constipation without systemic symptoms prior to seeking medical attention. He had a positive urinalysis and culture and was initially thought to have a urinary tract infection; however, computed tomography scan revealed a large, complex, and multiloculated prostatic abscess. Multidisciplinary drainage of the abscess was performed by interventional radiology and urology. A postoperative Foley catheter was left in place, and the patient recovered without complications. Discussion. Prostatic abscess is uncommon and presents almost exclusively in patients with immunocompromising conditions such as diabetes. Prior to the advent of antibiotics, the major causes were gonorrheal and Staphylococcus aureus infections, but with the advent of antibiotics, microbial culprits have shifted to gram-negative organisms. Patients typically present with lower urinary tract symptoms, perineal or lower back pain, and systemic symptoms. Management often consists of intravenous antibiotics and surgical drainage either by transrectal ultrasound-guided needle aspiration, or transurethral deroofing of the prostate. Our case highlights the following: (a) the importance of a high index of suspicion for a prostatic abscess in an immunocompromised patient with persistent leukocytosis and perineal pain after treatment with antibiotics and (b) the potential for an early multidisciplinary approach to draining extensive, loculated prostatic abscesses.

SUBMITTER: Nesemann JM

PROVIDER: S-EPMC7298311 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Extensive Prostatic Abscess in an Elderly Patient Requiring Multidisciplinary Drainage.

Nesemann John Michael JM Huen Kathy K Bergman Jonathan J

Case reports in urology 20200606

<i>Background.</i> Prostatic abscess is rare and mainly affects immunocompromised individuals, classically presenting with both systemic and lower urinary tract symptoms. Our case is unique as the patient presented with an exceptionally long duration of symptoms prior to seeing a health-care provider, had no systemic symptoms, and was managed via a multidisciplinary approach. <i>Case Presentation.</i> We present a case of a 70-year-old man with type-two diabetes who endured two months of lower u ...[more]

PMID: 32566352

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Project description:X-linked hypophosphatemic rickets (XLH) is the commonest inherited form of rickets. It is caused by an impaired regulation of fibroblast growth factor 23 (FGF23) due to a PHEX gene mutation, which leads to reduced tubular reabsorption of phosphate and renal 1α-hydroxylase activity and increased renal 24-hydroxylase activity. Hypophosphatemia associated with renal phosphate wasting, normal serum levels of calcium, parathyroid hormone, and 25-hydroxyvitamin D represents the main biochemical sign in affected patients. Patients with XLH show rickets and osteomalacia, severe deformities of the lower limbs, bone and muscular pain, stunted growth, and reduced quality of life. However, XLH is a multisystemic disorder requiring multidisciplinary approaches in specialized subdisciplines. Severe complications may occur in patients with XLH including craniosynostosis, hearing loss, progressive bone deformities, dental and periodontal recurrent lesions, and psychosocial distress. Moreover, long-term conventional treatment with active vitamin D metabolites and oral inorganic phosphate salts may cause endocrinological complications such as secondary or tertiary hyperparathyroidism, and adverse events in kidney as hypercalciuria, nephrocalcinosis, and nephrolithiasis. However, conventional treatment does not improve phosphate metabolism and it shows poor and slow effects in improving rickets lesions and linear growth. Recently, some trials of treatment with recombinant human IgG1 monoclonal antibody that targets FGF23 (burosumab) showed significant improvement of serum phosphate concentration and renal tubular reabsorption of phosphate that were associated with a rapid healing of radiologic signs of rickets, reduced muscular and osteoarticular pain, and improved physical function, being more effective for the treatment of patients with XLH in comparison with conventional therapy. Therefore, a global management of patients with XLH is strongly recommended and patients should be seen regularly by a multidisciplinary team of experts.

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Extensive Prostatic Abscess in an Elderly Patient Requiring Multidisciplinary Drainage.

Publications

Extensive Prostatic Abscess in an Elderly Patient Requiring Multidisciplinary Drainage.

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