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TRANSRECTAL US (TRUS) IN PROSTATITIC INFLAMATIONS

TRANSRECTAL US (TRUS) IN PROSTATITIC INFLAMATIONS. Dr. Joseph shmueli Rabin medical center. TRUS & PROSTATITIS. Is TRUS a diagnostic tool in evaluation of patients with clinical symptoms of prostatitis?. NO. Will TRUS be done during the evaluation ?. Probably – YES!!!.

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TRANSRECTAL US (TRUS) IN PROSTATITIC INFLAMATIONS

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  1. TRANSRECTAL US (TRUS) IN PROSTATITIC INFLAMATIONS Dr. Joseph shmueli Rabin medical center

  2. TRUS & PROSTATITIS Is TRUS a diagnostic tool in evaluation of patients with clinical symptoms of prostatitis? NO Will TRUS be done during the evaluation ? Probably – YES!!!

  3. Common TRUS findings • Prostatic calcifications • Ejaculatory duct calculi • Dilated ejaculatory ducts • Dilated seminal vesicles • Calcifications in seminal vesicles • Mid line cyst

  4. Common findings in acute prostatitis As a rule there is no justification for sonographic workup during acute illness! • Change the external shape of gland. • Enlarged TZ more than PZ. • Increased periprostatic vascularization. • Decreased echogenicity.

  5. TRUS & acute bacterial prostatitis: clinical study. • 45 patients • TRUS on admission and after a month of antibiotic therapy. • Mean prostatic volume on admission 40.5 +/- 17.9 ml. • 21 patients (46.6%) - accompanied lesions in peripheral prostatic lobules. • Horcajada JP Scand J Infect Dis. 2003;35(2):114-20

  6. Trus & acute bacterial prostatitis • After treatment, in 61.1% of patients the TRUS findings resolved and prostatic volume reduced to 24.3 +/- 10.5 ml (p < 0.0005) • TRUS is indicated in ABP only to exclude an evolving prostatic abscess. Horcajada JP Scand J Infect Dis. 2003;35(2):114-20

  7. Chronic prostatitis: Typical TRUS findings • In most of the patients the scan demonstrate normal prostatic size and shape! Occasional findings: • Scattered areas of low echogenicity (focal inflammation ?) • Diffuse calcifications. • Echogenicity changes in the periurethral tissue.

  8. 7 pts. with pathologically proven chronic prostatitis 5 pts. demonstrated prominent peripheral hypoechoic prostatic rim. The histopathologic findings: “Loose stromal tissues, few prostatic glands, sparse infiltration by inflammatory cells”. Chronic prostatitis:Histopathologic correlates of TRUS findings • Yagci C, Clin Imaging. 2004 Jul-Aug;28(4):286-90

  9. chronic pelvic pain & prostatic lithiasis • Type A - small multiple -71.3% , Type B - larger, coarser calculi -28.7%. • Localization (central/periurethral) was not correlated with other parameters. • Type B - associated with symptoms and chronic Prostatitis(p=0.007). Geramoutsos I Eur Urol. 2004 Mar;45(3):333-7;

  10. chronic pelvic pain & prostatic lithiasis • Type A - are a normal.-result of age rather than a pathologic entity. • Type b - larger prostatic calculi- PROBABLY underlying inflammation - require further evaluation and possibly treatment. Geramoutsos I Eur Urol. 2004 Mar;45(3):333-7;

  11. TRUS & Granulomatous prostatitis • Granulomatous prostatitis -benign inflammatory condition which can be mistaken for prostatic carcinoma both clinically and on ultrasound, but is distinguishable histologically. • Naik KS, Clin Radiol. 1999 Mar;54(3):173-5.

  12. TRUS & Granulomatous prostatitis • There is no pattern of clinical, biochemical, ultrasound or MRI findings that allows a specific diagnosis of granulomatous prostatitis. • Naik KS, Clin Radiol. 1999 Mar;54(3):173-5.

  13. Conclusions • TRUS can detect any textural or vascular changes related to acute inflammation • TRUS - abscess • TRUS is a noninvasive, safe method for investigating various common prostatic related diseases. • The major role of TRUS is reassurance for both the patient and the doctor.

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