[Prostatic abscess--diagnosis and treatment]

Abstract

Prostatic abscess is an uncommon condition, often difficult to discern clinically from acute prostatitis. It results from focal accumulation of pus within the prostate gland. Historically, the common infecting organisms were Neisseria gonorrheae, Staphylococcus aureus and Mycobacterium tuberculosis. However, more recently, gram negative bacteria, such as Escherichia coli, are causative species. Prostatic abscess mainly affects diabetic and immunosuppressed patients. In the past, transurethral drainage was the first choice for therapy. Today, percutaneous transperineal or transrectal drainage under transrectal sonography is the first choice for therapy because of the low risk of complication. This is a case history of 47-year old male patient who was admitted due to prostatic abscess. On admission he complained of severe dysuria and high fever lasting 10 days after antibiotic treatment for urinary tract infection. On rectal examination the prostate was enlarged and very tender. Both the CT-scan and transrectal ultrasound revealed well defined fluid collection areas compatible with an abscess in the right lobe of the prostate. Under general anesthesia and transrectal ultrasound guidance the abscess was aspirated transperineally. A 12-F drain was left for 6 days with complete remission in clinical and CT findings. Once an abscess of the prostate is diagnosed, anaerobic antimicrobial therapy should be added and transrectal or percutaneous transperineal aspiration and drainage is required. The authors consider the percutaneuos transperineal drainage to be the most effective and safest solution.