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. 2014 Dec;12(4):262-8.
doi: 10.1016/j.aju.2014.09.002. Epub 2014 Oct 19.

Prostatic abscess: Objective assessment of the treatment approach in the absence of guidelines

Ahmed M Elshal  1 , Ahmed Abdelhalim  1 , Tamer S Barakat  1 , Atallah A Shaaban  1 , Adel Nabeeh  1 , El-Housseiny Ibrahiem  1
Affiliations

Prostatic abscess: Objective assessment of the treatment approach in the absence of guidelines

Ahmed M Elshal et al. Arab J Urol. 2014 Dec.

Abstract

Objective: To assess the outcome of the drainage procedure used for treating a prostatic abscess, and to propose a treatment algorithm to reduce the morbidity and the need for re-treatment. Patients and methods We retrospectively reviewed patients who were admitted and received an interventional treatment for a prostatic abscess. All baseline relevant variables were reviewed. Details of the intervention, laboratory data, duration of hospital stay, follow-up data and re-admissions were recorded.

Results: A prostatic abscess was diagnosed in 42 patients; 30 were treated by transurethral deroofing and 12 by transrectal needle aspiration. The median (range) size of the abscess was 4.5 (2-23) mL and 2.7 (1.5-7.1) mL in the deroofing and aspiration groups, respectively (P = 0.2). In half of the cases multiple abscesses were evident on imaging before the intervention. The median (range) hospital stay after deroofing and aspiration was 2 (1-11) and 1 (1-19) days, respectively (P = 0.04). Perioperative complications occurred only in the deroofing group, in which two patients developed septic shock requiring intensive care (Clavien 4) and one developed epididymo-orchitis (Clavien 2). There were two late complications in the deroofing group, in which one patient developed a urethral stricture that required endoscopic urethrotomy (Clavien 3a) and one developed a urethral diverticulum and urinary incontinence that required diverticulectomy and a bulbo-urethral sling procedure (Clavien 3b). A urethro-rectal fistula developed after aspiration in one patient. Re-treatment for the abscess was indicated in two (7%) patients in the deroofing group, which was treated by aspiration.

Conclusion: Transrectal needle aspiration for a prostatic abscess, when done for properly selected cases, could minimise the morbidity of the drainage procedure.

Keywords: Abscess; Aspiration; Deroofing; MIS, minimally invasive surgery; Prostate; Transrectal.

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Figures

Figure 1
Figure 1
(a) MRI, Sagittal (i) and axial (ii) views after administration of intravenous contrast medium show enlarged right side of the prostate. The abscess appears multilocular with enhancing wall. (iii) A cystoscopic view of the abscess bulge at time of deroofing. (iv) A cystoscopic view of the abscess cavity during deroofing. (b) TRUS images showing hypoechoic areas with thick well-defined walls (abscesses) (c) (i) TRUS image (sagittal) showing a solitary posterior abscess in a giant prostate (>200 mL) 1c (ii) TRUS image (sagittal) after transrectal aspiration of the abscess in giant prostate (> 200 mL). (iii) TRUS image (sagittal) for the same case, 3 months after a subsequent laser procedure (holmium laser enucleation of the prostate).
Figure 2
Figure 2
A retrograde urethrogram showing a urethral diverticulum.
Figure 3
Figure 3
An algorithm for the treatment of prostatic abscess.
See this image and copyright information in PMC

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