Bleeding in prostate adenoma treatment

Method of stopping bleeding in prostate adenomectomy

The invention relates to medicine, namely to surgery, and can be used to stop bleeding during prostate adenomectomy. Essence of the invention: during surgery, a thrombovar is injected in the form of a 0.3% solution in equal portions of 3 ml into the adenoma capsule in those places where the vessels of the prostate gland pass. The method allows you to effectively stop bleeding during adenomectomy.

The invention relates to urological medicine, in particular, to methods of hemostasis in prostate adenomectomy.

There are many methods of hemostasis used in prostate adenomectomy, each with its own advantages and disadvantages. Some methods recommend suturing the adenoma bed with catgut sutures, others apply temporary removable ligatures, and use tight tamponade of the bed. For this purpose, a Foley catheter is used.

Nevertheless, the search for optimal ways to stop bleeding remains relevant today.

There are various ways to stop bleeding, both with the use of various drugs, and with the use of ultrasound, glue, sterile air, as well as flashing blood vessels. (See auth. A 61 B 17/00, 1975 624606, class A 61 B 17/00, 1975 634737, class A 61 B 17/00, 1977 831114, class A 61 B 17/00, 1979 921148, class A 61 B 17/00, 1980 942720, class A 61 B 17/12, 1979 1143404, class A 61 B 17/00, 1982 1161093, class A 61 B 17/00, 1983; 1491464, class A 61 B 17/00, 1985) However, all the above methods are quite difficult to use and not effective enough.

The closest known method is the method of stopping bleeding using a hot isotonic sodium chloride solution.

However, it is not effective enough.

The new technical result of the proposed method consists in expanding the functionality of the known method in adenomectomy and is achieved by the fact that in the known method of stopping bleeding, including the treatment of the wound surface with isotonic sodium chloride solution, thrombovar is used as a drug in the form of a solution of 0.3- 10 mm, and the latter in equal doses of 3 ml is injected into the capsule of Prostate adenoma in those places where the vessels of the prostate gland pass.

Another result is that the thrombovar solution has a detergent effect on the vascular endothelium of the surrounding tissues, without causing their necrosis.

Example. Preliminary received 0.3rd thrombovar solution in 10 ml, for which the 3rd thrombovar solution was diluted with isotonic sodium chloride solution 0.9 to the desired concentration. Under the control of vision or by feeling the finger inserted through the wound in the bladder, we draw a long needle, the sharp end of which is inserted 0.5 cm into the prostate capsule at each of the 3 points where the vessels supplying the prostate gland pass. The introduced 0.3-th thrombovar solution infiltratively spreads through the tissues, affecting the vessels and surrounding tissues. The introduction of the solution can be carried out before or after adenectomy. In order to verify the positive effect of the proposed method, capsule pieces were taken from the injection site and examined pathologically. Conclusion: moderate lymphoid infiltration around the vessels, no necrosis. After 12 minutes, the bleeding decreases sharply, the urine is palely colored with blood, there are no clots in the urine.

Long-term results of the proposed method.

Over the year, 0.3 thrombovar solution was used in 45 patients. There were no deaths from bleeding. There is no sclerosis of the bladder neck in this group of patients. Pathological examination of the capsule taken from the thrombovar injection site showed that there was no necrosis.

The advantages of this method: 1. accessibility; 2. simplicity in execution; 3. low cost; 4. application for patients of any age; 5. high reliability; 6. the possibility of using both in early and late postoperative bleeding; 7. does not give complications; 8. due to the absence of clots in the postoperative period in the urine, a disease of the drainage system of the bladder is excluded; 9. The originality of the proposed method allows you to use it for other operations.

A method for stopping bleeding during prostate adenomectomy with the use of drugs, characterized in that a thrombovar is used in the form of a 0.3% solution, the latter being injected in equal doses of 3 ml into the adenoma capsule in those places where the vessels of the prostate gland pass .

Bleeding in prostate adenoma treatment

Surgery to remove prostate adenoma: possible consequences

Our readers have successfully used M-16 to improve potency. Seeing the popularity of this tool, we decided to bring it to your attention.Read more here-

Prostate adenoma (BPH) is a tumor formation of a benign nature, formed from an overgrown glandular epithelium or stromal part of an organ.

At this time, a small nodule (or nodules) appears, which, with time, increases, puts pressure on the urethra. This leads to dysfunction of urination.

The benign growth does not have metastases, which significantly distinguishes adenoma from prostate cancer. The main sign of the onset of a malignant process is the level of PSA (prostate specific antigen).

If the treatment of prostate adenoma with the help of medications did not give the expected results, a specialist - urologist prescribes treatment with the help of surgery. The main question for men at this stage of treatment is what are the consequences of the operation to remove prostate adenoma.

Prostate adenoma

In what cases is surgical intervention indicated?

Therapeutic measures for prostate adenoma are determined taking into account the severity of the pathological process and the symptoms that appear. Basically, it all depends on how disturbed the process of urination is.

Surgical intervention is required in the following cases:

• If the patient is not able to urinate on his own, one of the reasons for this is the condition when the urethra narrows due to the pressure of the neoplasm;
• Frequent urge to urinate;
• The constant development of infectious processes in the organs of the urinary system;
• Hematuria occurs;
• Spontaneous excretion of urine;
• Stones form in the bladder.

What types of interventions are used to remove BPH?

Removal of prostate adenoma is the elimination of pathologically overgrown glandular tissue. In severe cases, a prostatectomy is required, during which the prostate gland is completely removed.

Surgery to remove prostate adenoma

There are several types of surgical treatment:

• Open operations - excision of the adenoma is performed through a puncture in the bladder; this type of intervention includes transvesical adenomectomy, which is considered the most traumatic method, but allows you to completely get rid of the pathological tissue; is prescribed for complications of hyperplasia, for example, with intratrigonal growth of the formed nodes;
• Minimally invasive method - involves the excision of prostate adenoma without incision, using video endoscopic instruments through the urethra; this type includes TUR (transurethal resection) and holmium laser enucleation of the prostate.

Technique for performing transurethral resection of the prostate

TURP is most often used to eliminate the pathological process in the prostate. Treatment consists in removing the overgrown glandular epithelium using a special endoscopic device. Transurethral resection is prescribed to patients if it is necessary to maintain potency, at a younger age.

Before the operation, epidural anesthesia is used, so the patient does not feel pain, but remains conscious. Sometimes general anesthesia is required.

During the operation, a specialist inserts a medical instrument through the urethra - a resestoscope. After excision of the pathological tissue of the prostate, a special liquid is fed into the resestoscope to remove the removed part of the adenoma. The procedure lasts from 30 to 60 minutes, depending on the amount of tissue to be removed and on which part of the organ should be removed.

Transurea resection of the prostate

After the operation, a catheter is inserted into the urethra for several days to completely cleanse the bladder from elements of adenomatous tissue. During catheterization, the attending specialist monitors the patient's condition in the hospital.

After removal of prostate adenoma and discharge from the hospital, the patient needs about 7 - 10 days to return to his usual daily life, during which it is recommended to move more and do some physical exercises that help improve the functioning of the prostate gland.

What is holmium laser enucleation?

This method of surgical treatment consists in excising pathologically enlarged prostate tissue under the influence of a holmium laser. When adenomatous tissue is husked, the particles enter the bladder, and a special tool is used to extract them - an endomorcellator. The operation is performed with access through the urethra, using endoscopic equipment.

Laser enucleation resembles transvesical adenomectomy, but has fewer complications during and after surgery.Also, when conducting holmium laser enucleization, the catheter is kept for no more than one day, after which it is removed. The function of independent urination is restored on the second day after the operation.

Differences between laser enucleation and transurethral resection

How is transvesical adenomectomy performed?

Adenomectomy refers to an open type of surgery and is the removal of pathological prostate tissue in men through an incision in the abdominal cavity and in the bladder. Adenomectomy is prescribed for patients with an advanced degree of the disease, with large neoplasms, or with complications during the course of the disease.

During the procedure, the surgeon removes the affected areas of the prostate with his fingers, after which he inserts a catheter and drainage into the ureter for external excretion. After this operation, the patient is discharged from the hospital after 7 days.

Possible complications

After the operation to remove prostate adenoma, there is a risk of some consequences. Possible complications include:

• The entry of the solution used to wash the bladder into the patient's blood;
• Bleeding: occurs due to a puncture of a nearby large vessel, since it is quite difficult to see the vessels through the device; in some situations, blood loss is so significant that a transfusion of donor blood may be required;
• Impaired urination, which is manifested by urinary retention or inability to urinate: the cause of this condition may be concomitant pathologies of the bladder, the patient's advanced age, or some complications during surgery;
• Complication in the form of infection in the urinary tract during surgery;
• Injury to the organs of the genitourinary system.

How does the operation affect a man's sex life?

Reviews of patients who underwent surgery to remove prostate adenoma are unambiguous in that the consequences primarily affect sexual function. However, after some time, potency and erection resume.

Also, in some patients, after the onset of sexual activity (one and a half months after the operation), retrograde ejaculation is noted, which means that sperm is thrown into the bladder during the end of sexual intercourse. This condition affects the reproductive function, that is, there are problems with conception, while maintaining the possibility of a full sexual life.

Recommendations for recovery in the postoperative period

In order to help the body and the prostate gland restore normal functioning, as well as reduce possible negative consequences after surgery on prostate adenoma, you should follow some recommendations regarding the way of life.

First, you need to drink enough purified water, this will help flush the bladder and replenish the required amount of fluid. Also, special attention is paid to the dishes consumed, which should include fresh vegetables and fruits, meat, fish of low-fat varieties. Food is steamed or in the oven; fried foods should be excluded from the usual diet at first. It is not recommended to use salinity, smoked meats and canned food, it is required to reduce the amount of salt in dishes.

It is very important during the rehabilitation period to perform simple gymnastic exercises, walk more often in the fresh air, and move more. All this has a positive effect on the body, as a result, the prostate completely restores its functioning.

After the operation, you must stop smoking and drinking alcohol, try to avoid hypothermia, and do not lift weights.

Recovery after prostate adenoma surgery

Transurethral resection of prostate adenoma (the abbreviation TUR is often also used) is a minimally invasive method of dealing with a benign prostate tumor. With its help, complications are minimized. Efficiency, a positive impact on the quality of life of the operated patients and a short postoperative period have made this procedure (transurethral resection) the gold standard in the treatment of prostate adenoma.

When is this procedure recommended for men?

Surgery - transurethral resection of prostate adenoma, is usually recommended for those men in whom traditional methods have not achieved the desired results. Surgery is also required when there are complications. The main indications for its implementation are the following points:

• Frequent recurrence of infectious diseases of the urinary system.
• Retention of urine that persists for a long time and is not cured by medication, constantly causing complications.
• Regular appearance of blood in the urine (hematuria).
• The presence of stones in the bladder.
• If the blockage of the prostate has caused the patient to develop kidney failure.
• Anatomical features (bladder diverticulum) and functional disorders caused by prostate adenoma.

It is believed that among the candidates for transurethral resection are men whose conservative treatment of adenoma did not lead to recovery. These patients have severe and sometimes moderate symptoms of urinary tract disease, and treatment with 5-alpha-reductase inhibitors and alpha-blockers does not work.

How is a procedure better than an open operation?

The TUR operation (transurethral resection) of the prostate has a number of advantages over open surgery:

• Allows to preserve sexual function, which is especially important for young patients.
• May be used if prostate cancer is suspected.
• Successfully performed in the presence of concomitant diseases of the cardiovascular, endocrine, respiratory systems, obesity.
• If there are several diseases of the urinary and reproductive systems at the same time.
• TUR (transurethral resection) of the prostate gland is effective when adenoma occurs against the background of prostatitis, cystitis, bladder stones.
• Transurethral resection is effective if surgery has previously been performed on the bladder, abdominal wall, intestines, treatment of benign prostatic dysplasia.

Features of anesthesia

The TUR (transurethral resection) of the prostate is performed under local, spinal (another name is epidural) or general anesthesia. Its choice occurs during the patient's conversation with the doctor. Consider the types of anesthesia:

• General anesthesia is characterized by the patient being unconscious while the operation is being performed. The lungs at this time work with the help of artificial ventilation, body temperature, pressure and other vital parameters are controlled.
• Regional anesthesia is performed by injecting anesthetics into the area surrounding the spinal cord. When using it, the patient is conscious. This method is used more often, since complications are less likely to occur with it.

Each type of anesthesia has its own advantages and disadvantages. In addition, there are contraindications to their use. Therefore, you should not be silent about the presence of chronic diseases during a conversation with a doctor.

How to prepare properly?

In order for the TUR (transurethral resection) of the prostate to be successful, a patient examination is prescribed before it is carried out in order to assess the state of the body as a whole and the state of the prostate gland in particular. If there are no contraindications, a date for transurethral resection is scheduled.

On the day on which the TUR (transurethral resection) of the prostate is scheduled for adenoma, you should not eat or drink. Shown is a light dinner the night before. If necessary, take medications with a minimum amount of water. This is due to the peculiarities of the use of anesthesia. Violation of these requirements can lead to undesirable complications.

It is important to determine the prostate-specific antigen in the patient's blood, indicating the presence of prostate cancer, a coagulogram is performed.

Procedure, equipment used and rehabilitation

The operation of TURP is done using a special device - a resectoscope. The price of the device is affordable for most specialized clinics. It is used not only for surgical interventions in the prostate region.

A special loop moves in the lumen of the endoscope, which allows, with visual control, to accurately remove the prostate gland or part of it. The temperature required for operation is generated by electrical heating. The endoscope is inserted into the urethra. In parallel, the channel is irrigated with liquid.

Because the resectoscope does not damage body tissues, complications are also minimal. The postoperative period is very short. The next morning after the procedure, patients are allowed to get up.

A catheter remains in the canal after TUR (transurethral resection) of the prostate for some time. After urination returns to normal, it is removed, in rare cases the patient has a fever.

It is important during the recovery period after the procedure (transurethral resection of the prostate) to drink as much water as possible, to avoid constipation. It is forbidden to take products containing caffeine. After TUR on the prostate, the following complications may occur:

• Water intoxication of the organism. Appears with an excessive amount of irrigation fluid used for irrigation, after which general weakness appears, the temperature drops, you want to sleep.
• Bleeding.Occurs after an operation to remove an adenoma, if the procedure has been violated. Stopped by the use of hemostatic agents, endoscopic diathermocoagulation can be used.
• Retrograde ejaculation, or semen entering the bladder.

These complications occur very rarely and depend on the skill level of the surgeon.

A bit of history

Despite the fact that the first attempts to restore the normal excretion of urine in sick men were made by ancient doctors 2500 years ago, the methods that made possible TUR of prostate adenoma appeared in medical practice only after, at the end of the 19th century. Important discoveries were made during this period:

• Introduction of the Edison incandescent light bulb in 1879
• Development of a device for examining the bladder, called a cytoscope.
• The study of the properties of high-frequency currents, which can not only heat up tissues, but also destroy them by direct local action.

The beginning of the 20th century was marked by the first successful attempts by surgeons to use high-frequency currents for medical purposes. After that, it became possible to carry out in 1909 the first TUR operation for adenoma. Now it is successfully used in prostate adenoma, and in many other cases.

Our readers have successfully used M-16 to improve potency. Seeing the popularity of this tool, we decided to bring it to your attention. Read more here-

Blood in the urine in acute and chronic prostatitis: causes and treatment

Prostatitis is one of the most unpleasant diseases in men. Inflammation of the prostate negatively affects sexual life, leads to the appearance of unwanted symptoms. In difficult situations, additional signs of the disease are noted.

The appearance of bloody discharge during urination indicates the need for treatment.

Prostatitis symptoms

Inflammation of the prostate gland, prostatitis, has certain symptoms that occur in 99% of cases:

• frequent urge to urinate;
• increase in body temperature;
• pronounced pain syndrome.

Health deteriorates in the presence of adverse factors:

• lack of motor activity;
• chronic constipation;
• frequent hypothermia;
• non-compliance with the rules of a healthy sexual life (excessive frequency or lack of regularity);
• tense, conflict situations;
• non-compliance with the rules of a healthy diet;
• bad habits.

The prostate gland is an important organ in the male body. The prostate secretes special substances that affect the reproductive capacity of a man. The released secret also has special bactericidal properties.

Constant stagnation leads to a decrease in bactericidal properties and serious problems associated with reproduction.

Mechanism of clinical picture development

In what way does blood appear in the urine with prostatitis? Various factors lead to this unpleasant sign. At the same time, urine (a special type of diagnostics of the genitourinary system) determines the real causes and is required to control the condition of the prostate gland.

The prostate gland produces antimicrobial substances, affects the reproductive and urinary systems of men. Inflammation occurs during stagnant processes.

Blood clots appear under the influence of the following adverse factors:

• purulent processes occurring in the tissues of the prostate gland;
• trauma to the smallest vessels after incorrectly performed diagnostic measures;
• prostatic hyperplasia;
• oncology.

The patient notes the accompaniment of his condition with pain, impaired urination, high body temperature. Such signs are associated with constant irritation of the organ, which is forced to undergo inflammatory processes.

Prostatitis, accompanied by purulent processes, leads to complications in the patient's state of health. During special examinations in such situations, blood and purulent discharge are detected.

Frequent and difficult urge to urinate is the main symptom of prostatitis. The appearance of foci of the inflammatory process leads to damage to blood vessels. According to this scheme, blood clots appear. There is an increased risk of developing a secondary infection. Diagnosis and early treatment are required to prevent complications.

With prostate adenoma, the appearance of blood in the urine or semen is a symptom indicating the need for mandatory medical care. Deterioration of health leads to a constant filled bladder, pain syndrome, poor health.

With prostatitis and adenoma, the appearance of blood clots may be associated with minor injuries to intimate organs or vessels during a procedure such as catheterization.

The presence of unpleasant symptoms is allowed not only during the treatment process, but also some time after the surgical intervention.

Negative changes in the condition of the walls of the urinary canal with prolonged contact with the catheter causes profuse bleeding in male patients.

After catheterization, the vessels face an additional risk that can lead to the appearance of blood in the urine.

An undesirable sign is explained by numerous gaps in the organs responsible for proper urination.

Careful going to the toilets after catheterization is mandatory, so the doctor's recommendations should be followed.

Most often, blood appears at the beginning of urination, and by the end of the process it disappears. With a serious inflammation of the prostate gland, total damage to the vessels of the intimate organ, an undesirable symptom constantly makes itself felt, and it is noted even with the slightest trip to the toilet. Sometimes the blood creates large clots that block the urethra. Such manifestations are noted with fragility, sclerotic changes in blood vessels.

Additional risks are associated with the following changes in prostatitis:

• prostatic hyperplasia;
• urine accumulation leading to constant irritation and unpleasant signs of inflammation;
• development of infectious inflammation of a secondary nature.

Regular incomplete emptying of the bladder leads to the accumulation of urine, the formation of stones and sand. The resulting calculi pass through the inflamed intimate organ and urethra, damaging the walls, mucous membranes, and blood vessels. According to this principle, the appearance of blood is noted.

An increase in risk is noted with concomitant problems in men:

• varicose veins;
• a violation of the state in the blood (failures in coagulation);
• necrotic papillitis.

The appearance of blood clots in the urine or semen is a rare sign that facilitates the visit to a doctor for diagnosis, the start of timely treatment.

Potential Factors

Some factors that contribute to the appearance of unwanted symptoms are obvious.

Additional risks due to the weakening of men's health:

• excessive pressure on the abdominals;
• increased pressure in the renal pelvis, intensive work of the kidneys;
• taking medications that have an appropriate side effect (a temporary withdrawal of the drug is recommended to control changes in the state of health, the clinical picture);
• Urolithiasis;
• bladder or prostate cancer;
• Acute inflammation in the male body caused by mycobacteria.

The above potential factors indicate the need for increased monitoring of health status, a complete examination. Not only the inflammatory processes that occur with prostatitis become dangerous.

Varieties of symptoms

Hematuria can be macro and micro. What are the differences:

Regardless of the degree of the disorder, treatment becomes mandatory.

How to treat prostatitis?

When blood appears in the urine or semen in men, special treatment is recommended.

The treatment regimen is drawn up with an individual approach. The main tasks are to leave the scheme of formation of blood clots, improve urination. With massive blood loss, replenishment of blood loss is required, stabilization of the man's condition.

For treatment, medications are used that stop bleeding when going to the toilet in a small way and stop hemorrhagic phenomena:

The appearance of blood in the urine is a sign of prostatitis, so the treatment of the symptom will be complex. A man should take care of the treatment of an inflamed prostate gland, eliminating the risk of constant irritation of the bladder.

Retention of urination is eliminated by catheterization.

If the patient complains of severe pain, the doctor conducts a consultation. The primary complaint may be bleeding or pain. Further tactics of treatment depend on the response of the man. Pain occurs due to occlusion of the ureter by blood clots, so medication is required to relieve spasm. Urinary retention is eliminated by puncture. In each case, a diuretic is prescribed to improve urination.

Urinary incontinence requires good hygiene. A man should often wash the external genitalia, regularly change underwear. Otherwise, urinary incontinence creates good ground for the development of a secondary infection, the formation of serious complications.

The health of the prostate gland in men is the basis of not only a good sex life, but also a guarantee of comfort. Prostatitis often worsens the quality of life, which is confirmed by many patients.

In addition, the appearance of blood in chronic prostatitis indicates the need for ongoing treatment.

Prevention of prostatitis and its complications is the wisest decision.

Blood in the urine with prostate adenoma

Contents: Can there be blood in the urine with adenoma What is the danger of the duration of hematuria What can stop the blood Hematuria occurs as a symptom of hyperplasia or a complication after the operation. Sometimes, spotting is accompanied by purulent patches. Blood in the urine with prostate adenoma is detected by the patient himself while going to the toilet. In some cases, the presence of hematuria is recognized during a clinical detailed analysis.

Can there be blood in the urine with prostate adenoma

The main reason why urine with blood comes with prostate adenoma is the venous congestion that accompanies the disease. An enlarged prostate disrupts the normal circulation of fluids in the pelvic organs. Over time, the violations become so serious that red blood cells begin to enter the urine of men.

Blood in the urine with prostate adenoma may be the result of surgical intervention TURP, vaporization, ablation, etc.

The following hematuria catalysts are generally accepted:

• Adenomectomy - complete removal of the prostate gland, invasive surgery. The result is bleeding that lasts 2-3 days after surgery. Possible complications, when a month after surgery, the patient has repeated hematuria, accompanied by a rise in temperature.
• Enucleation - performed using laser therapy. In fact, the tumor is exfoliated from healthy tissue, without damage to adjacent areas. Hematuria is observed during the day.
• Embolization is a minimally invasive intervention, the essence of which is to block all the blood arteries that feed the gland. The effectiveness of the method is that even malignant neoplasms can be treated with embolization. As a rule, there is no bleeding after embolization, but slight hematuria is possible immediately after surgery.
• TUR is a surgical operation to excise damaged tissue. A small incision is made to insert the instruments. After partial or complete removal of the prostate by transurethral resection, heavy bleeding occurs within 2-3 days.
• Vaporization - during this method, damaged areas of tissue are evaporated with a narrow beam. Minimally invasive method. Bleeding is observed no more than 24-48 hours.
• Laparoscopy - the method is used to remove malignant neoplasms. After laparoscopy, hematuria is negligible. Possible complications.
• Puncture - bleeding after histology is observed in 45-55% of cases. To reduce hematuria, the patient is advised to refrain from blood thinners.

The presence of blood in the urine with prostate adenoma is possible without surgical intervention. Hematuria has a different intensity. From a small volume, which practically does not affect the color of urine, to large blood clots that can completely block the ureter.

How dangerous is the duration of hematuria

Blood in the urine appears in cases that directly indicate related pathological processes. Blood discharge, one of the first signs of a benign or malignant formation.

There is a direct relationship between prostate hyperplasia and blood in the urine. In any case, differential diagnosis will be required to understand what type of pathology will have to be dealt with.

If there is blood in the urine after a diagnostic or surgical procedure, an additional examination is performed.

Consequences of prolonged bleeding:

• Severe anemia - in severe cases, a blood transfusion is given.
• Occlusion of the urinary tract - blood clots in the urine compress the channel, which leads to a deterioration in the removal of fluid from the body. If resuscitation measures are not taken in time, general sepsis of the body is observed.
• Macrohematuria after surgery is normal. But, if the presence of red blood cells in the urine is observed 3-4 days after surgery, this indicates serious problems, non-healing of tissues, internal bleeding.

The need for additional diagnostics exists in every case of hematuria.

What can stop the blood

In order to remove the blood in the urine, a catalyst is installed that caused this. After contacting the urological center and conducting differential diagnostics, an individual course of therapy is developed.

Staining of urine with blood occurs in the second stage of BPH, the installation of a catheter, taking drugs that reduce pressure on the bladder and ducts can help.

Brown urine is observed in patients suffering from an infectious inflammatory process that requires antibiotics and a course of anti-infective drugs. An accurate diagnosis and effective therapy will be prescribed by the attending physician, after a complete examination.