Korean J Urol.  2012 Dec;53(12):860-864. 10.4111/kju.2012.53.12.860.

Treatment of Prostatic Abscess: Case Collection and Comparison of Treatment Methods

• Jang K
• Lee DH
• Lee SH
• Chung BH

• KMID: 1988732
• DOI: http://doi.org/10.4111/kju.2012.53.12.860

Abstract

PURPOSE
Prostatic abscess is an uncommon urologic disease but has a high mortality rate if not treated properly. Furthermore, diagnosis and proper treatment of prostatic abscesses remains a challenge for physicians. Therefore, we compared data on conservative treatments, transurethral resection of prostatic abscess, and transrectal ultrasound (TRUS)-guided needle aspiration in 52 cases over a 10-year period.
MATERIALS AND METHODS
The records of 52 patients diagnosed with prostatic abscess by computed tomography at Gangnam Severance Hospital between January 2000 and September 2010 were retrospectively reviewed. All patients were discharged when their leukocytosis had normalized and they had been free of fever for 2 days. Multivariate regression analysis was done to determine independent risk factors for the length of hospitalization.
RESULTS
At the time of diagnosis, the average age of the 52 patients was 61.3 years (range, 33 to 81 years), the average volume of the prostate was 56.3 ml (range, 21 to 223 ml), the average prostate-specific antigen was 18.54 ng/ml (range, 2.0 to 57.0 ng/ml), and the average abscess size was 3.8 cm (range, 2.1 to 5.5 cm). All patients were treated with parenteral antibiotics during their hospital stay with intravenous antibiotics (fluoroquinolone monotherapy or 3rd-generation cephalosporin in combination with an aminoglycoside). Of 52 patients, 22 had diabetes mellitus (42.3%), 19 had hypertension (36.5%), and 7 (13.5%) had paraplegia due to spinal cord injury. The most common symptoms were fever (47, 90.4%), perineal discomfort (43, 82.7%), dysuria (40, 76.9%), and urinary retention (29, 55.8%). Prostatic abscesses were treated by conservative treatment (11 cases), transurethral resection of prostatic abscess (23 cases), and TRUS-guided needle aspiration (18 cases). The average hospitalization stay was 17.5 days (range, 6 to 39 days); that of conservative treatment patients was 19.1 days (range, 9 to 39 days). Patients treated by transurethral resection of prostatic abscess and TRUS-guided needle aspiration stayed 10.2 days (range, 6 to 15 days) and 23.25 days (range, 18 to 34 days), respectively. Of the 18 cases who underwent needle aspiration, prostatic abscesses recurred in 4 cases (22.2%) within 1 month after patient discharge. The 2 patients subjected to conservative treatment died due to sepsis. We found no independent factors that affected the average hospitalization period.
CONCLUSIONS
Patients with prostatic abscess treated by transurethral resection of the prostate had a significantly shorter hospitalization length compared with needle aspiration.

Keyword

Abscess; Prostate; Transurethral resection of prostate

MeSH Terms

Abscess
Anti-Bacterial Agents
Diabetes Mellitus
Dysuria
Fever
Hospitalization
Humans
Hypertension
Length of Stay
Leukocytosis
Needles
Paraplegia
Patient Discharge
Prostate
Prostate-Specific Antigen
Retrospective Studies
Risk Factors
Sepsis
Spinal Cord Injuries
Transurethral Resection of Prostate
Urinary Retention
Urologic Diseases
Anti-Bacterial Agents
Prostate-Specific Antigen

Reference

1. Oliveira P, Andrade JA, Porto HC, Filho JE, Vinhaes AF. Diagnosis and treatment of prostatic abscess. Int Braz J Urol. 2003. 29:30–34.

2. Barozzi L, Pavlica P, Menchi I, De Matteis M, Canepari M. Prostatic abscess: diagnosis and treatment. AJR Am J Roentgenol. 1998. 170:753–757.

3. Aravantinos E, Kalogeras N, Zygoulakis N, Kakkas G, Anagnostou T, Melekos M. Ultrasound-guided transrectal placement of a drainage tube as therapeutic management of patients with prostatic abscess. J Endourol. 2008. 22:1751–1754.

4. Becker LE, Harrin WR. Prostatic abscess: a diagnostic and therapeutic approach. J Urol. 1964. 91:582–585.

5. Chitty K. Prostatic abscess. Br J Surg. 1957. 44:599–602.

6. Dajani AM, O'Flynn JD. Prostatic abscess: a report of 25 cases. Br J Urol. 1968. 40:736–739.

7. Kinahan TJ, Goldenberg SL, Ajzen SA, Cooperberg PL, English RA. Transurethral resection of prostatic abscess under sonographic guidance. Urology. 1991. 37:475–477.

8. Collado A, Palou J, Garcia-Penit J, Salvador J, de la Torre P, Vicente J. Ultrasound-guided needle aspiration in prostatic abscess. Urology. 1999. 53:548–552.

9. Gan E. Transrectal ultrasound-guided needle aspiration for prostatic abscesses: an alternative to transurethral drainage? Tech Urol. 2000. 6:178–184.

10. Lim JW, Ko YT, Lee DH, Park SJ, Oh JH, Yoon Y, et al. Treatment of prostatic abscess: value of transrectal ultrasonographically guided needle aspiration. J Ultrasound Med. 2000. 19:609–617.

11. Weinberger M, Cytron S, Servadio C, Block C, Rosenfeld JB, Pitlik SD. Prostatic abscess in the antibiotic era. Rev Infect Dis. 1988. 10:239–249.

12. Tiwari P, Pal DK, Tripathi A, Kumar S, Vijay M, Goel A, et al. Prostatic abscess: diagnosis and management in the modern antibiotic era. Saudi J Kidney Dis Transpl. 2011. 22:298–301.

13. Granados EA, Caffaratti J, Farina L, Hocsman H. Prostatic abscess drainage: clinical-sonography correlation. Urol Int. 1992. 48:358–361.

14. Bhagat SK, Kekre NS, Gopalakrishnan G, Balaji V, Mathews MS. Changing profile of prostatic abscess. Int Braz J Urol. 2008. 34:164–170.

15. Meares EM Jr. Prostatic abscess. J Urol. 1986. 136:1281–1282.

16. Trauzzi SJ, Kay CJ, Kaufman DG, Lowe FC. Management of prostatic abscess in patients with human immunodeficiency syndrome. Urology. 1994. 43:629–633.

17. Singh P, Yadav MK, Singh SK, Lal A, Khandelwal N. Case series: diffusion weighted MRI appearance in prostatic abscess. Indian J Radiol Imaging. 2011. 21:46–48.

18. Thornhill BA, Morehouse HT, Coleman P, Hoffman-Tretin JC. Prostatic abscess: CT and sonographic findings. AJR Am J Roentgenol. 1987. 148:899–900.

19. Ludwig M, Schroeder-Printzen I, Schiefer HG, Weidner W. Diagnosis and therapeutic management of 18 patients with prostatic abscess. Urology. 1999. 53:340–345.