Sex: Male, Age: 46 years old
Diagnosis: Prostatic pathology
Symptomatic beginning in 2005 with appearance of a persistent sensation “heat/pain” in the scrotum-perineal region after taking on the seated position during the days of heat.
On August 2005 a scrotal echotomography was, therefore, performed with evidence “at the level of the head of the right epididym of cyst with anecogenic mass of about 18 mm in diameter”.
At the end of the summer 2005 the symptoms disappeared without any treatment.
In 2006 follow-up blood examinations were performed with evidence of PSA 0.289.
On January 2007 a follow-up urological visit was performed with evidence of: bilobed prostate as parenchymatous chestnut.
During the period July-August 2007 analogous symptoms to those in 2005 appeared with “persistent sensation of heat/ pain in perineal region when in seated position”.
Also in this case, the symptoms disappeared at the end of the summer without any treatment.
On January 2008 appearance of pain and soreness in the lumbosacral region with finding, during the following days, of a cold sensation in the same region.
On February 2008 an abdominal echography was performed, it resulted within normal limits.
On February 2008 an urological visit was performed following the appearance of dysuria and pollakiuria with finding of “subacute prostatitis”; for this reason a therapy with Uniprox 500 mg at a dosage of 1tablet X 5 days + Prostamen (homeopathic remedy with a base of serenoa repens, uva ursi, urtica, etc.) for 2 months was defined.
On April 2008 due of the persisting slight burning sensation symptoms during miction and pollakiuria with a soreness sensation in the perineal region when in seated position, a further urological visit was performed with therapy with Levoxacin 500 mg at a dosage of 1 tablet for 10 days a month for 3 months (April-May-June).
On June 2008 a new transrectal prostatic echography was performed with evidence of “dishomogeneous prostate parenchyma due to the presence of adenoma with well represented surgical cleavage plane. In the context of the adenoma and in the "real" prostate several calcifications and retention microcysts were observed, results of chronic phlogosis. In the gland periphery suspect areas of hypoechogenic tissue are not appreciated.
Prostate diameters: 4.25x2.88x3.21 cm à total volume of 20.57 cc.
Adenoma diameters: 3.42x2.23x2.65 cm à total volume of 11 cc”.
In the meantime a bladder echography was performed too. It shows “relaxed bladder, lack of lesions protruding into the lumen. Elevation of the bladder base due to prostatic impression”. Still suffering from slight and occasional burning sensation symptoms during miction, with considerable discomfort due to soreness in perineal region if he remains in the seated position for more than ten minutes, the patient performed on July 2008 urine culture + complete urine test that were negative and, in the meantime, his wife performed a vaginal tampon with negative results. Diagnostic deepening on July with performance of cytologic examination of urine that, at a microscopic level, is indicative of “inadequate cytologic sample due to shortage of urothelial cells, made up of: floor cells, superficial and deep urothelial cells without atypia. Therefore, the diagnostic conclusion of this examination is the following one: “Not relevant material for diagnosis. A repetition of the examination is advised”. Complete hemochrome + formula on July result within normal limits. Pancolonoscopy + retrograde ileoscopy on August 2008 with the following results: “grade 1 hemorrhoids. In the distal rectum, on the back wall, presence of sessile polyp of 5 mm, removed with forceps. Mucus surface of regular appearance in the colon and in the terminal ileum”. As the patient complained of the same symptoms with burning sensations during the miction, frequent mictions, especially during the morning, soreness in perineal region after a few minutes in seated position, on August 2008, a further urological visit was performed with a diagnosis of “prostatodynia” and following therapy: Ciproxin 250 mg 1 tablet daily for 7 days a month for 2 months + serenoa repens tablets and urine test repetition and possible cistoscopy.