Concluded Case

Prostatic cyst - significance?

18 years old male with history of pain supraumbilical region off and on with dysuria . No relief after repeated course of antibiotics although urine examination is normal .USG KUB area shows a prostatic cyst 1.56 × 0.96 cms on right side almost touching midline. Management and treatment of cyst and patient's symptoms welcomed

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Concluded answer
Supraumbilical pain may be unrelated to dysuria symptoms Supraumbilical pain which occurs intermittently can be secondary to acid peptic disease Prostatic cyst - They ate usually incidental finding observed on sonography. They usually do not produce symptoms. They need regular observation and follow up. Dysuria - it can be occasionally because of prostatitis. Urine examination during prostatitis may show normal finding. It requires prostatic massage and examination of urine, after prostatic massage urine examination shows bacteriuria. Per rectal examination in prostatitis shows tender prostate. PSA test shows raised PSA. Appropriate antibiotic for prolonged period is required for treatment of prostatitis.
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Though the incidence of prostatic cyst is very rare are usually found accidental finding in USG for other causes. May not have any symptoms but may present with A. Low back pain or discomfort B. Urinary tract infection with dysuria C. Only dysuria C. Postvoid incontinence D. Epidydymitis E. Painful ejaculation F. Oligospermia. Specific prostatic antigen is raised Dismissed by USG.CT or MRI or transrectal USG Very important part is make the differential diagnosis it is very important for dealing with prostatic cyst D/D A. Bladder diverticulam B. E seminal vesicle cyst C. Teratoma D. Adenocarcinoma where PSA raised. Treatment A trans urthral resection B endoscopic mersupialization C transurethral urethrotomy and resection. D trans rectal USG guided aspiration with or without sclerotheraphy..
Supraumbilical pain may be unrelated to dysuria symptoms Supraumbilical pain which occurs intermittently can be secondary to acid peptic disease Prostatic cyst - They ate usually incidental finding observed on sonography. They usually do not produce symptoms. They need regular observation and follow up. Dysuria - it can be occasionally because of prostatitis. Urine examination during prostatitis may show normal finding. It requires prostatic massage and examination of urine, after prostatic massage urine examination shows bacteriuria. Per rectal examination in prostatitis shows tender prostate. PSA test shows raised PSA. Appropriate antibiotic for prolonged period is required for treatment of prostatitis.
I agree
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The prostatic cyst is unrelated to the symptoms. Prostatic cysts of this type are usually associated with oligozoo or azoospermia and present with male infertility. This is an incidental finding in this case. I had presented a video of Distal obstructive azoospermia as a cause of Male infertility at a USICON in 1998 at Bombay. It needs to be confirmed with a semen analysis and any count below 4 million should be treated as a case of obstructive azoospermia.He may need surgery if the count is less than 4 million.In that case he will need endoscopic deroofing/ opening up of the cyst. Again the symptoms are totally unrelated to the cyst.
Valuable opinion
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SUGGESTIVE OF PROSTATIC CYST ADVISABLE ...TR USG ... GUIDED. DRAINAGE .. TRANSURETHRAL ... URETHROTOMY
Cyst should be removed surgically
Splenomegaly This the case termed in ayurveda Raktavriddhi , where raktavaha moola sarakta medas is functioning more and the other moolas liver and spleen are also affected. As she is going through chemotherapy we can'nt stop that treatment, even though the prognosis is poor;one can try Siravyadhana / Jalaaukavacharana Which reduces the viscosity of the blood The agni lepana can be done over the body with drugs pippali,shunthi, shigru , lashuna, tulasi, vasa etc... by this the thinning of the blood takes place . * Every day vatanulomanartha mild purgatives can be advised.
BLOOD.PSA IF NORMAL = TURP IF RAISED = FINESTERIDE IF COMES TO NORMAL = TURP IF REMAINS HIGH PROSTECTOMY HISTOPATHOLOGY EACH TIME
Prostatic cyst is unlikely cause of dysurea. May be incidental . Suggest urologist opinion, cystoscopy .
Nitrofurantoin 100 mg 1-1 x 21 days Liq. Urine Alkalizer Ellervil SR

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