PMC8289462_01
Ultrasound image of the scrotum. The right testicle is not changed. Paratesticular anechoic formation of 40x34 mm with irregular contours can be found in the tunics of the scrotum.
RRU-13-501-g0001.jpg
PMC8289462_01_RRU-13-501-g0001.jpg
f0001
The ultrasound of the scrotal organs has revealed the following: the testes were intact, an anechoic paratesticular formation of 40x34 mm in size was situated in the right half of the scrotum (Figure 1).
TRUS data: the prostate gland with a smooth contour, of heterogeneous echo structure, with hyperechoic areas in the paraurethral zone of about 12 mm (calcifications) and an acoustic path. The volume of the gland is 38 cm3.
RRU-13-501-g0002.jpg
PMC8289462_01_RRU-13-501-g0002.jpg
f0002
The gland's hypoechoic area was about 10 mm in the transient zone. The volume of the gland was 38 cm3 (Figure 2).
Ultrasound of the perineum: paraurethrally, below the pelvic diaphragm, a hypoechoic oblong area of 6.8x3.5 cm is observed.
RRU-13-501-g0003.jpg
PMC8289462_01_RRU-13-501-g0003.jpg
f0003
On the ultrasound, a hypoechoic area of 68x35 mm was noted paraurethrally below the pelvic diaphragm (Figure 3).
MRI of the pelvis: (A and B) paraurethral abscess spreading to the right half of the scrotum, to the cellular tissue of the left sciatic-rectal fossa, heterogeneity of the transient part of the prostate gland, and infiltration of paraprostatic tissue and mesorectal fascia.
RRU-13-501-g0004.jpg
PMC8289462_01_RRU-13-501-g0004.jpg
f0004
Based on the MRI analysis of the pelvic organs, a paraurethral abscess spreading to the right half of the scrotum and the tissue of the left sciatic-rectal fossa, heterogeneity of the transient part of the prostate gland, infiltration, and an affected area of the corpus cavernosum, paraprostatic tissue, and mesorectal fascia, and lymphadenopathy were observed (Figure 4A and B).
Stages of the operation: (A) opening the abscess by a median scrotal-perineal incision; (B) wound after evacuation of pus from the scrotum and paraurethral region, the urethra is intact; (C) opening the purulent cavity of the left sciatic-rectal fossa on the left; (D) drainage of the paraurethral region and scrotal wound.
RRU-13-501-g0005.jpg
PMC8289462_01_RRU-13-501-g0005.jpg
f0005
On an emergency basis, three hours after the hospitalization, the patient underwent surgical treatment: a purulent cavity was opened by a midline scrotal-perineal incision (Figure 5A) and about 120 mL of yellow material was evacuated. The urethra and corpus cavernosum were infiltrated and in one area, a purulent lesion of the cavernous body of about 1 cm was revealed, which was then opened (Figure 5B). A separate incision opened a cellular space of the pelvis in the left sciatic-rectal fossa (Figure 5C), where about 50 mL of pus was also evacuated. A cystostomy was installed after (Figure 5D).
Urethrogram on the 14th day after surgery. Contrast agent leaks into the perineum and pelvic cellular tissue.
RRU-13-501-g0006.jpg
PMC8289462_01_RRU-13-501-g0006.jpg
f0006
Retrograde urethrocystography revealed leakage of contrast agent in the bulbous urethra (Figure 6), which confirmed the presence of a fistula between the urethra and Cowper's glands but excluded syringocele.