Objective:To investigate the clinical characteristics of prostatic abscesses (PA)primarily presenting as urinary retention in the elderly patients and the therapeutic effect of TURP.Methods:A retrospective analysis was conducted on the case records of four elderly patients with PA who presented primarily with urinary retention and were admitted to our hospital between July 2020 and August 2022. The median age of the four patients was 68.0 (62.0, 77.0) years, all of whom were admitted to the hospital due to progressive difficulty of urination and inability to urinate. All four patients exhibited chills and high fever, with three cases presenting prior to admission and one case post-admission. One patient developed secondary sepsis, and 2 patients experienced perineal pain. Two patients had a history of diabetes, and 2 had a history of hypertension. The rectal digital examination of these four patients revealed prostate enlargement, with 2 cases of tenderness and one case of fluctuation sensation on the prostate. Blood and urine bacterial cultures were carried out in 4 patients, of which 3 patients were positive of blood culture with 2 cases of Escherichia coli and one case of Klebsiella pneumoniae, 2 patients were positive of the urine culture with one case of Escherichia coli and one case of Klebsiella pneumoniae, and one patient was negative of blood and urine culture.Serum C-reactive protein (CRP)and procalcitonin (PCT) increased in these 4 patients, with 118-190 mg/L and 1.39-13.45 ng/ml respectively. One of the 4 patients had elevated serum PSA levels, with a value of 16.95 ng/L, while the remaining 3 patients had normal serum PSA levels. The median international prostate symptom score (IPSS) score before surgery was 31.5(28.7, 34.3) points for these 4 patients, and the median quality of life (QOL) score was 5.0(4.2, 5.8) points. The transabdominal ultrasound examination of these 4 patients showed that the prostate was enlarged and the echo of the prostate was uneven, and the hypoechoic area in the prostate was found in 2 cases. On plain CT scan of the prostate in these cases, the prostate was enlarged, and there was an area of uneven reduction in density. MRI plain scan of the prostate in 2 cases showed abscess in the peripheral zone of the prostate. Among the 4 cases of PA, 3 cases were diagnosed before operation. The size of abscess was 1.7-5.8 cm, including one case of multiple abscess. Another case of PA was found during TURP for benign prostatic hyperplasia. Four patients were undergoing TURP after antibiotic treatment. During the operation, the pus cavity was found at the prostatic capsule, and the pus cavity wall at the urethral side was removed to make the pus cavity fully open. Three-chamber F20 Foley catheter was placed in the urethra eventually.Results:The operation was successfully completed in these 4 patients, and the operation time was 30 to 90 minutes. Postoperative pathology reported benign prostatic hyperplasia with acute/chronic inflammatory cell infiltration. One patient developed fever on the day after operation, with the highest temperature of 38.6 ℃, and improved after pharmaceutical treatment. Urinary catheter was retained for 5 days postoperatively. Five days after surgery, the urinary catheter was removed and all 4 patients had unobstructed urination. One patient experienced transient urinary incontinence caused by urinary tract infection, which improved after 2 weeks of treatment with increased water intake and oral antibiotics. One month after the operation, the abscess cavity of all patients was completely disappeared and urination was smooth. One-month postoperative follow-up revealed complete resolution of abscess cavities in all patients by prostate CT. The median postoperative IPSS was 13.5(8.5, 17.0)( P=0.0286), and the median QOL score was 1.0(0.3, 1.8)( P=0.0284), both showing statistically significant differences compared to preoperative values. Over the follow-up period ranging from 19 to 44 months, no abscess recurrence was noted in the 4 cases, and retrograde ejaculation was noted in 2 cases. Complications such as urethral stricture, urinary incontinence, and urinary retention did not occur. One patient developed epididymitis and orchitis 6 weeks post-surgery, which improved following 2 weeks of conservative treatment. Conclusions:The symptoms of elderly PA patients primarily presenting as urinary retention were severe. TURP can relieve the symptoms of lower urinary tract obstruction while draining the pus cavity, and the therapeutic effect is satisfactory.

Objective:To investigate the clinical characteristics of prostatic abscesses (PA)primarily presenting as urinary retention in the elderly patients and the therapeutic effect of TURP.Methods:A retrospective analysis was conducted on the case records of four elderly patients with PA who presented primarily with urinary retention and were admitted to our hospital between July 2020 and August 2022. The median age of the four patients was 68.0 (62.0, 77.0) years, all of whom were admitted to the hospital due to progressive difficulty of urination and inability to urinate. All four patients exhibited chills and high fever, with three cases presenting prior to admission and one case post-admission. One patient developed secondary sepsis, and 2 patients experienced perineal pain. Two patients had a history of diabetes, and 2 had a history of hypertension. The rectal digital examination of these four patients revealed prostate enlargement, with 2 cases of tenderness and one case of fluctuation sensation on the prostate. Blood and urine bacterial cultures were carried out in 4 patients, of which 3 patients were positive of blood culture with 2 cases of Escherichia coli and one case of Klebsiella pneumoniae, 2 patients were positive of the urine culture with one case of Escherichia coli and one case of Klebsiella pneumoniae, and one patient was negative of blood and urine culture.Serum C-reactive protein (CRP)and procalcitonin (PCT) increased in these 4 patients, with 118-190 mg/L and 1.39-13.45 ng/ml respectively. One of the 4 patients had elevated serum PSA levels, with a value of 16.95 ng/L, while the remaining 3 patients had normal serum PSA levels. The median international prostate symptom score (IPSS) score before surgery was 31.5(28.7, 34.3) points for these 4 patients, and the median quality of life (QOL) score was 5.0(4.2, 5.8) points. The transabdominal ultrasound examination of these 4 patients showed that the prostate was enlarged and the echo of the prostate was uneven, and the hypoechoic area in the prostate was found in 2 cases. On plain CT scan of the prostate in these cases, the prostate was enlarged, and there was an area of uneven reduction in density. MRI plain scan of the prostate in 2 cases showed abscess in the peripheral zone of the prostate. Among the 4 cases of PA, 3 cases were diagnosed before operation. The size of abscess was 1.7-5.8 cm, including one case of multiple abscess. Another case of PA was found during TURP for benign prostatic hyperplasia. Four patients were undergoing TURP after antibiotic treatment. During the operation, the pus cavity was found at the prostatic capsule, and the pus cavity wall at the urethral side was removed to make the pus cavity fully open. Three-chamber F20 Foley catheter was placed in the urethra eventually.Results:The operation was successfully completed in these 4 patients, and the operation time was 30 to 90 minutes. Postoperative pathology reported benign prostatic hyperplasia with acute/chronic inflammatory cell infiltration. One patient developed fever on the day after operation, with the highest temperature of 38.6 ℃, and improved after pharmaceutical treatment. Urinary catheter was retained for 5 days postoperatively. Five days after surgery, the urinary catheter was removed and all 4 patients had unobstructed urination. One patient experienced transient urinary incontinence caused by urinary tract infection, which improved after 2 weeks of treatment with increased water intake and oral antibiotics. One month after the operation, the abscess cavity of all patients was completely disappeared and urination was smooth. One-month postoperative follow-up revealed complete resolution of abscess cavities in all patients by prostate CT. The median postoperative IPSS was 13.5(8.5, 17.0)( P=0.0286), and the median QOL score was 1.0(0.3, 1.8)( P=0.0284), both showing statistically significant differences compared to preoperative values. Over the follow-up period ranging from 19 to 44 months, no abscess recurrence was noted in the 4 cases, and retrograde ejaculation was noted in 2 cases. Complications such as urethral stricture, urinary incontinence, and urinary retention did not occur. One patient developed epididymitis and orchitis 6 weeks post-surgery, which improved following 2 weeks of conservative treatment. Conclusions:The symptoms of elderly PA patients primarily presenting as urinary retention were severe. TURP can relieve the symptoms of lower urinary tract obstruction while draining the pus cavity, and the therapeutic effect is satisfactory.

Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) in preoperative classification for hilar cholangiocarcinoma. Methods Forty-six patients with 46 hilar cholangiocarcinoma were diagnosed by surgical pathology in Zhongshan Hospital of Fudan University from January 2007 to April 2013. The echogenicity difference on conventinal ultrasound and CEUS were compared with chi-square test. The accuracy of conventinal ultrasound and CEUS for evaluating invaded bile duct, detective rates for portal vein invasion and displaying rate of metastatic hilar lymph nodes were compared with chi-square test or Fisher’s Exact test according to the golden standard of operative exploration. Results On CEUS, 82.6%(38/46) and 91.3%(42/46) hilar cholangiocarcinoma were hypoechoic in portal vein phase and delayed phase respectively, while 63.0%(29/46) hilar cholangiocarcinoma were isoechoic on conventinal ultrasound with vague margin. The clearly displaying rates were 37.0%(17/46), 84.8%(39/46) and 91.3%(42/46) in conventinal ultrasound, portal vein and delayed phase of CEUS and the echogenicity was signiifcantly different. The evaluation accuracy of hilar cholangiocarcinoma invading bile duct was improved from 80.4%(37/46, conventinal ultrasound) to 100%(46/46, CEUS) significantly (χ2=7.882,P=0.005). Portal vein invasion were found in 9 cases during operative exploration and the detective rates on conventinal ultrasound and CEUS were 78%(7/9) and 89%(8/9) without signiifcant difference (P=1.000). Metastatic hilar lymph nodes were found in 8 cases and the displaying rates on conventinal ultrasound and CEUS were the same (75%, 6/8) without signiifcant difference (P=1.000). Conclusions CEUS could signiifcantly improve the clearly displaying rate of hilar cholangiocarcinoma and improve the evaluation accuracy for invaded bile duct comparing with conventinal ultrasound.