PROSTATE ABSCESS FOLLOWING INTRAVESICAL BACILLUS CALMETTE-GUERIN TREATMENT
| Autor: | Joseph A. Veys, Christopher C. Thacker, Brian R. Matlaga, Dean G. Assimos |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry Carcinoma in situ Urology Prostatitis Cystoscopy medicine.disease medicine.icd_9_cm_classification Perineum Transitional cell carcinoma medicine.anatomical_structure medicine Radiology Microhematuria Abscess business Urine cytology |
| Zdroj: | The Journal of Urology. :251 |
| ISSN: | 0022-5347 |
| Popis: | A 47-year-old man was evaluated for irritative voiding symptoms and microhematuria in August 1997. Voided urine cytology at that time was consistent with urothelial carcinoma. Upper tract imaging was normal and subsequent cystoscopy revealed a papillary bladder tumor on the right lateral wall. This lesion was biopsied and histological analysis confirmed grade 3/3 transitional cell carcinoma invading the lamina propria with accompanying carcinoma in situ. Subsequent cystoscopic examinations and urine cytology were normal, and the patient was treated with BCG therapy. He received a 6-week induction course followed by 3 weekly maintenance treatments at 3, 6 and 12 months, and then at 6-month intervals until presentation. Full strength, Connaught strain, BCG was always used, and there was never any difficulty with instillation, any evidence of BCG toxicity and no recurrent bladder tumor. In April 2001 perineal pain developed. Physical examination was normal except for slight induration of the right side of the prostate. Tentative diagnosis was prostatitis and levofloxacin was prescribed. The symptoms worsened during the following week, and he returned for further evaluation. Temperature was 102 Fahrenheit and a fluctuant, left perineal mass was detected. Computerized tomography of the pelvis revealed a hypoattenuating mass extending from the perineum through the apical portion of the prostate (see figure). The physical and radiographic findings were consistent with a prostatic abscess. Open transperineal surgical drainage of the mass confirmed the diagnosis. Examination of the purulent drainage demonstrated numerous acid-fast bacilli on Kinyoun and Auramine smears. The patient was placed on 2-drug antimycobacterial therapy with isoniazid and ethambutol while culture results were pending. Final identification of the acid-fast bacilli was Mycobacterium bovis. The patient is currently undergoing a 12-month antimycobacterial treatment regimen. |
| Databáze: | OpenAIRE |
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