Ipertrofia prostatica: Intervento con laser ad Holmio
Language: English Italian. To illustrate the TRUS della prostata a Chelyabinsk detected with transrectal ultrasound TRUS in patients with hematospermia. This study included 74 male patients 25—73 years old affected by hematospermia. Clinical history was obtained and all patients underwent rectal examination as well as TRUS examination in both axial and coronal planes to evaluate the prostate, ejaculatory ducts and seminal vesicles.
Biopsy was performed in 10 patients. Abnormalities were detected in 59 patients. Seminal vesicle cysts were detected in 2 patients. Our conclusion is that TRUS is a safe, non-invasive technique which can be used to detect lesions of the prostate, seminal vesicles TRUS della prostata a Chelyabinsk the ejaculatory ducts in patients with hematospermia.
Illustrare le lesioni identificate con ecografia prostatica transrettale in pazienti con ematospermia. Il presente studio include 74 pazienti di sesso maschile 25—73 anni con ematospermia.
Tutti i pazienti successivamente sono stati sottoposti a esame ecografico prostatico transrettale sui piani assiale e coronale della prostata, dei dotti eiaculatori e delle vescichette seminali dopo aver effettuato l'anamnesi e l'esplorazione rettale.
La biopsia è stata effettuata in 10 pazienti. In 59 pazienti sono stati identificati reperti patologici. The international nomenclature of human semen parameters defines hematospermia as the presence of fresh or altered blood in the ejaculate that appears brown. There are several reasons why hematospermia may occur. It may be caused by inflammation, neoplastic formations or obstructive cystic lesions along the course of the ejaculatory ducts, and it may also be idiopathic.
Differentiation between the different causes is extremely important in order to plan adequate treatment in these patients. Hematospermia is mainly of inflammatory origin in young patients, but in older patients, it is usually due to a benign or malignant prostatic tumor [1—4].
Non-invasive imaging is essential in the diagnostic work-up of men with hematospermia. Different imaging modalities have been used in the diagnosis. CT scan is not helpful due to poor visualization of the distal duct system . MR imaging using an endorectal coil can depict the distal duct system, but it is expensive [5—7].
Transrectal ultrasound TRUS is more accurate in the visualization of the distal duct system and the various abnormalities that can provide diagnosis and etiological factors of hematospermia [8—12]. The aim of this work is to illustrate the lesions which were detected using TRUS in patients with hematospermia. A thorough clinical history was obtained and all patients underwent rectal examination of the prostate and seminal vesicle for swellings, nodules, and tenderness.
Laboratory tests were expressed prostatic secretions EPS and semen analysis. Semen was tested for peroxidase-positive white blood cells WBCsfructose level and for bacterial cultures using suitably prepared semen dilutions. Prostatic specific antigen PSA was evaluated in 10 patients. The study was performed according to the ethical principles for medical research contained in the declaration of Helsinki, and informed consent was obtained from all patients.
All examinations were carried out by a radiologist with 15 years' experience in TRUS examinations. Patients were instructed to self-administer a cleansing enema the night before the examination. Examination was performed with the bladder half-full and the patient in left lateral decubitus position and the hips fully flexed. The prostate, ejaculatory ducts and seminal vesicles were examined in axial and sagittal planes.
Final diagnosis was made on the basis of typical sonographic appearance and site of TRUS della prostata a Chelyabinsk and cystic lesions.
Chronic prostatitis was confirmed by pus cells in the semen analysis and EPS. Prostate cancer and tuberculous prostatitis were confirmed by TRUS guided biopsy.
In 15 patients TRUS revealed no abnormality. Calculi were either diffuse or segmental TRUS della prostata a Chelyabinsk. They were associated with increased wall thickness of the TRUS della prostata a Chelyabinsk duct in 6 patients. Calculi of the prostate. Axial TRUS image shows two calculi with bright echogenic texture and posterior acoustic shadow in both ejaculatory ducts.
Chronic prostatitis appeared as multiple hyperechoic areas associated with hypoechoic areas scattered within the prostatic parenchyma and around the ejaculatory ducts in 11 patients. A hypoechoic lesion was seen in the periurethral region in 3 patients Fig. The prostate was normal size but with irregular, capsular thickening. Chronic prostatitis.
A Axial TRUS image shows multiple discrete hyperechoic areas in the periurethral region associated with dilated and thickened wall of the ejaculatory duct. B Axial TRUS image demonstrates mildly enlarged seminal vesicles with a few discrete hyperechoic regions. Axial TRUS image shows a hypoechoic area within the periurethral region. Granulomatous prostatitis was detected in 3 patients. Bilharzial prostatitis was associated with enlargement of both seminal vesicles TRUS della prostata a Chelyabinsk discrete areas of calcification in one patient.
Tuberculous prostatitis. Axial TRUS image shows multiple discrete hyperechoic areas and multiple discrete areas of calcification scattered within the prostate. Prostate carcinoma appeared as a hypoechoic focal lesion in the peripheral zone of the prostate in 3 patients, while 2 patients presented heterogeneous texture of the prostate Fig.
Cancer prostate. Axial TRUS image shows TRUS della prostata a Chelyabinsk discrete hypoechoic focal lesions scattered within the prostate mainly in the peripheral zone. Median cysts included utricular and Mullerian duct cysts; paramedian cysts included seminal vesicle cysts and ejaculatory duct cysts. They were thin walled with TRUS della prostata a Chelyabinsk areas of calcification or coarse echoes.
Utricular cyst. Axial TRUS image shows a small sized, tubular, thin walled midline TRUS della prostata a Chelyabinsk. Mullerian TRUS della prostata a Chelyabinsk cyst. Axial TRUS image shows awell-defined, large, thin walled midline cyst. Ejaculatory duct cyst. Axial TRUS image shows a TRUS della prostata a Chelyabinsk walled cyst located along the course of the ejaculatory duct slightly off the midline.
In this study, the commonest cause of hematospermia was calculi associated with chronic prostatitis. Hematospermia can occur for many reasons such as infectious or inflammatory disorders, prostate cancer or cystic lesions, or it may be idiopathic. Several studies of hematospermia carried out using TRUS have revealed that the commonest cause of hematospermia is prostate calculi. Other causes include cysts, chronic prostatitis, prostatic hypertrophy and malignant lesions [8—12]. At TRUS, prostatic calculi appear as well circumscribed focal foci of increased echogenicity with or without posterior acoustic shadowing, situated in the prostate gland or seminal tract.
Patients affected by chronic prostatitis present diffuse, focal or multifocal hypoechoic lesions in the peripheral zone. These hypoechoic lesions are most commonly multifocal patchy areas but may also involve confluent areas of the peripheral zone. A hypoechoic rim along the outer periphery of the prostate has also been described in patients with chronic prostatitis, and histological analysis showed correlation with the degree of stromal fibrosis.
Inflammatory infiltration rarely appears as a focal hypoechoic lesion similar to prostate carcinoma; however, capsule deformity is uncommon and there is no capsular interruption. High-density echoes represent corpora amylacea deposition, and hypoechoic areas represent fibrosis and inflammation. Chronic prostatitis may be associated with seminal vesiculitis. In mycobacterial infection, US shows multiple TRUS della prostata a Chelyabinsk areas of calcification of the prostate gland, seminal vesicles TRUS della prostata a Chelyabinsk urinary bladder wall which may be associated with hypoechoic regions or abscess formation.
The infection is a result of upper urinary tract seeding or primary genital tuberculosis [17,18]. Bilharzial infection of the prostate gland and seminal vesicles should be suspected when calcification of the prostate and seminal vesicles is detected at TRUS and associated with multiple echogenic foci in the prostate with occasional dilation of the ejaculatory duct or seminal vesicle due to distal obstruction caused by fibrosis.
In this study, granulomatous lesions due to TRUS della prostata a Chelyabinsk and bilharziasis of the prostate and seminal vesicle were associated with hematospermia. Prostate cancer is the commonest cause of cancer in men. The association between prostatic cancer and hematospermia has been established.
Prostate cancer most commonly arises from the peripheral zone of the prostate gland and, occasionally, from the central zone. On TRUS, prostate carcinoma is most often hypoechoic relative to the normal peripheral zone but may sometimes be isoechoic or even hyperechoic.
Asymmetry in prostate size, particularly in the peripheral zone, capsular TRUS della prostata a Chelyabinsk, and loss of differentiation between the central gland and the peripheral zone may also be seen [20,21].
Utricular and Mullerian duct cysts typically occur in the midline of the prostate gland where ejaculatory duct cysts usually occur in paramedian location along the expected course of the ejaculatory duct. Mullerian duct cysts are often teardrop shaped and may extend beyond the posterosuperior margin of the prostate gland, particularly when they are large, whereas utricular cysts tend to be confined within the prostate gland. Mullerian duct cysts do not normally communicate with the urethra or ejaculatory duct, whereas TRUS della prostata a Chelyabinsk cysts may present this characteristic [22—26].
Ejaculatory duct cysts appear as simple or minimally complex cysts along the course of the ejaculatory duct, which may or may not contain calculi. Seminal vesicle cysts appear as rounded or oval anechoic lesions TRUS della prostata a Chelyabinsk the seminal vesicle, often displaying the urinary bladder. Simple cysts are anechoic, thin walled, rounded or oval in shape, whereas complex cysts show increased echogenicity due to proteinaceous or hemorrhagic contents and may furthermore present internal septations, be thick walled and contain calculi [22,27,28].
We concluded that TRUS della prostata a Chelyabinsk is a safe, inexpensive, non-invasive, radiation-free imaging technique which can be used to detect lesions of the prostate, seminal vesicles and the ejaculatory ducts in patient with hematospermia.
National Center for Biotechnology InformationU. Journal List J TRUS della prostata a Chelyabinsk v. J Ultrasound. Published online Oct Elhanblyb and A. Eldeak c. Author information Copyright and License information Disclaimer. Razek: ge. This article has been cited by other articles in PMC.