ABSTRACT:We report on a case of prostate multilocular cystadenoma presenting with primary infertility and obstructive azoospermia. Our patient is a 36-year-old presenting with primary infertility in addition to mild deep pelvic pain. Semen analysis revealed azoospermia with positive fructose. His prostate-specific antigen was 0.7 ng/dL and his imaging revealed a large multilocular cystic mass with multiple internal enhancing septa. Transrectal ultrasonography-guided aspiration and biopsies revealed a lining of regular low cuboidal cells. Surgical removal was undertaken through a transperitoneal/retroperitoneal approach and pathology was consistent with a prostatic multilocular cystadenoma. Further studies are needed to characterize and classify cystic lesions of the prostate.J Androl 2011;32:364-366 Multilocular cystadenoma of the prostate is a rare tumor, with only 14 cases reported in the literature (Park et al, 2007;Tuziak et al, 2007;Chowdhury and Abdulkarim, 2009). It usually presents clinically as a multiseptate large cystic pelvic mass, with associated symptoms including lower urinary tract symptoms (LUTS), urinary retention, and pain (Galosi et al, 2009). We report on a case of prostate multilocular cystadenoma presenting with primary infertility and obstructive azoospermia. Case ReportOur case is a 36-year-old patient presenting with primary infertility. He was evaluated by complete history and physical examination, semen analysis, prostate-specific antigen (PSA), and imaging by transrectal ultrasonography (TRUS) and magnetic resonance imaging (MRI) with TRUS-guided biopsies, and finally the multilocular cystadenoma was resected through a lower midline transperitoneal/retroperitoneal approach. The study was approved by the institutional review board. ResultsThe patient presented with primary infertility. He also complained of mild deep pelvic pain and perineal discomfort for more than 10 years. His semen analysis revealed azoospermia with positive fructose. His scrotal examination revealed the testes to be normal in size and consistent with bilaterally palpable vasa deferentia and no epididymal or spermatic cord abnormality. The patient's serum testosterone and follicle-stimulating hormone were within normal. His PSA was 0.7 ng/dL, and imaging with TRUS and pelvic MRI (Figures 1 and 2) revealed a large multilocular cystic mass (9.067.066.0 cm) in the pelvic cavity encircling and stretching the urethra with multiple internal enhancing septa. The mass displaced the urinary bladder and seminal vesicles superiorly and anteriorly with no evidence of invasion, being posteriorly related to the rectosigmoid with preserved cleavage plane. It extended caudally to the level of the origin of penile crura.TRUS-guided aspiration and biopsies revealed the lining of the septa to be formed of regular low cuboidal cells with no evidence of malignancy. Surgical removal of the mass (partial prostatectomy) was undertaken through a transperitoneal/retroperitoneal approach. The final pathology was consistent with a prostat...
Objectives: To assess the effects of a 4-week levofloxacin course on PSA in asymptomatic men with elevated prostate-specific antigen (PSA) and on prostate biopsy decision. Methods: Fifty asymptomatic men with elevated PSA (4.0–10.0 ng/dl) were given levofloxacin 500 mg/day for 4 weeks followed by repeat PSA. Prostate biopsy was recommended at the end of the study. We compared pre- and post-treatment PSA as well as PSA changes between prostate cancer cases and non-cancer patients. Results: Mean (±SD) PSA decreased from 6.91 ± 2.13 to 6.05 ± 3.0 ng/dl after antimicrobial treatment (p = 0.025). Twenty-five (56.8%) patients had a post-treatment decrease in PSA, including 20 (45.5%) patients to <4.0 ng/dl and/or >25% of the initial PSA value. The difference in PSA change between prostate cancer and non-cancer patients was not statistically significant (p = 0.104). Conclusions: Levofloxacin resulted in an overall decrease in PSA for asymptomatic men with PSA in the 4–10 ng/dl range. PSA changes, however, were not significantly different between patients with prostate cancer and non-cancer patients. Prostate cancer was detected in 20% of patients with a clinically relevant PSA decline.
Introduction:Chronic prostatitis is a common urological problem in men <50-year-old. Untypical uropathogens and an intact blood prostate barrier cause difficulty in using antibiotics to treat the infection.Patients and Methods:In this open-label, observational study, levofloxacin 500 mg was given once daily for 28 days for treatment of chronic prostatitis. The primary efficacy measurement was the disappearance of all pre-treatment symptoms. Efficacy analysis is based on the per protocol population (PPP), all other analyses use the intent to treat (ITT) population.Results:The ITT included 154 men and the PPP included 151 (results are for the ITT unless otherwise indicated). Mean age was 42 ± 9 years, common concomitant conditions were diabetes mellitus (7%) and hypertension (5%). All symptoms decreased at day 28. Notably, the rate of dysuria decreased from 86.1% to 10.6%, painful ejaculation from 71% to 2.6% and perineal discomfort from 60.3% to 7.3%. A cure of condition was identified in 58.9%. No treatment failures were reported. Physician-reported adherence to study medication was 96.8%.Conclusion:Levofloxacin appears to be an effective antibiotic for treating symptoms of chronic bacterial prostatitis. Levofloxacin was well-tolerated in this population.
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