Emphysematous cystitis following a transrectal needle guided biopsy of the prostate

Abstract

BackgroundEmphysematous cystitis (EC) is a comparatively rare urinary tract infection characterized by air within the bladder wall and lumen and is usually associated with immunosuppression or poorly controlled diabetes mellitus.Case presentationWe report a case of EC in a 70-year-old man who recently underwent transrectal ultrasound needle-guided prostate biopsy, after which he underwent pylorogastrectomy. He did not have any history of diabetes mellitus or any immunosuppressive disease. The patient developed severe sepsis, requiring intravenous antibiotics and urinary catheterization. Despite therapy, the patient developed disseminated intravascular coagulopathy and acute respiratory distress syndrome. Therefore, he was admitted to the intensive care unit, antibiotic coverage was broadened, and danaparoid sodium and sivelestat sodium hydrate was administered. After 20 days, the patient’s condition improved, and on the 28th day, the patient was discharged to home in a good condition without any sequelae.ConclusionPrompt diagnosis and treatment are warranted to prevent potential morbidity of and mortality in cases of EC.

Risk factors for infectious complications following transrectal ultrasound-guided prostate biopsy

“…Infectious symptoms were observed within 1 week of prostate biopsy in 99 patients. Patients who developed fever 20 (≥38.3°C) after prostate biopsy were hospitalized and treated with third-generation cephalosporins or quinolones. The eight patients who developed sepsis were treated with carbapenem and teicoplanin.…”

“…The definition of febrile urinary tract infections was as follows: fever (≥38.3°C), leukocytes in urine sediment, and tenderness of the prostate during digital rectal examination. 19 , 20 Fever was defined as body temperature ≥38.3°C, and infectious complications were defined as body temperature ≥38.3°C accompanied by urinary tract infection symptoms. 19 , 20 Urinary tract infection symptoms were defined as the presence of chilliness, frequency, urgency, and dysuria.…”

“… 19 , 20 Fever was defined as body temperature ≥38.3°C, and infectious complications were defined as body temperature ≥38.3°C accompanied by urinary tract infection symptoms. 19 , 20 Urinary tract infection symptoms were defined as the presence of chilliness, frequency, urgency, and dysuria. Sepsis was defined as the presence of clinically or microbiologically documented infection in conjunction with systemic inflammatory response syndrome.…”

“…Sepsis was defined as the presence of clinically or microbiologically documented infection in conjunction with systemic inflammatory response syndrome. 11 , 19 , 20 …”

A case of alcohol-related emphysematous cystitis

“…Rarely EC can occur after prostate biopsy, renal transplant, hysterectomy, colectomy, hemodialysis, rectum resection, chemotherapy [8]. EC symptoms and signs are similar to classical cystitis without emphysema which includes irritative voiding symptoms, abdominal pain, hematuria, fever, nausea, vomiting, pneumaturia, painful urination, urinary retention, and urosepsis [4,8].…”