Prostatic abscess with infected aneurysms and spondylodiscitis after transrectal ultrasound-guided prostate biopsy: a case report and literature review

Abstract

Background Transrectal ultrasonography (TRUS)-guided prostate biopsy is the conventional method of diagnosing prostate cancer. TRUS-guided prostate biopsy can occasionally be associated with severe complications. Here, we report the first case of a prostate abscess with aneurysms and spondylodiscitis as a complication of TRUS-guided prostate biopsy, and we review the relevant literature. Case presentation A 78-year-old man presented with back pain, sepsis, and prostate abscesses. Twenty days after TRUS-guided prostate biopsy, he was found to have a 20-mm diameter abdominal aortic aneurysm that expanded to 28.2 mm in the space of a week, despite antibiotic therapy. Therefore, he underwent transurethral resection of the prostate to control prostatic abscesses. Although his aneurysm decreased to 23 mm in size after surgery, he continued to experience back pain. He was diagnosed as having pyogenic spondylitis and this was managed using a lumbar corset. Sixty-four days after the prostate biopsy, the aneurysm had re-expanded to 30 mm; therefore, we performed endovascular aneurysm repair (EVAR) using a microcore stent graft 82 days after the biopsy. Four days after the EVAR, the patient developed acute cholecystitis, and he underwent endoscopic retrograde biliary drainage. One hundred and sixty days after the prostate biopsy, all the complications had improved, and he was discharged. A literature review identified a further six cases of spondylodiscitis that had occurred after transrectal ultrasound-guided prostate biopsy. Conclusions We have reported the first case of a complication of TRUS-guided prostate biopsy that involved prostatic abscesses, aneurysms, and spondylodiscitis. Although such complications are uncommon, clinicians should be aware of the potential for such severe complications of this procedure to develop.

Giant Prostate Abscess: A Case Report and Literature Review

“…Prostate abscesses are more frequently observed in individuals with poor blood glucose control and compromised immunity. Additional risk factors encompass bladder outlet obstruction, neurogenic bladder dysfunction, postbiopsy prostate surgery, and potential voiding dysfunction ( Brede & Shoskes, 2011 ; Nomura et al, 2021 ; Tiwari et al, 2011 ). Although this patient does not belong to the diabetic and immunocompromised group, he has a history of prostatic hyperplasia, a condition often associated with dysuria, weak urinary flow, frequent urination, and urgency.…”

“…Left untreated, prostate abscess can progress to urogenic sepsis and septic shock, potentially resulting in a fatal outcome (Ackerman et al, 2018). Individuals with poor glycemic control, compromised immunity, bladder outlet obstruction, neurogenic bladder dysfunction, postbiopsy prostate surgery, or underlying voiding dysfunction face an increased risk of developing prostate abscess (Brede & Shoskes, 2011;Nomura et al, 2021;Tiwari et al, 2011).…”

“…Left untreated, prostate abscess can progress to urogenic sepsis and septic shock, potentially resulting in a fatal outcome ( Ackerman et al, 2018 ). Individuals with poor glycemic control, compromised immunity, bladder outlet obstruction, neurogenic bladder dysfunction, postbiopsy prostate surgery, or underlying voiding dysfunction face an increased risk of developing prostate abscess ( Brede & Shoskes, 2011 ; Nomura et al, 2021 ; Tiwari et al, 2011 ). Contemporary studies have highlighted gram-negative bacteria as the predominant pathogens responsible for prostate abscesses, with Escherichia coli accounting for over 70% of cases, followed by Klebsiella, Pseudomonas, Proteus, Enterobacter, Serrella , and Enterococcus .…”

Factors Deciding Conservative or Intervention Treatment for Prostate Abscess: A Retrospective Case-Control Study

“…The interventional treatment group for patients with PA consisted of 5 patients who received transurethral prostate drainage (TPD) and 20 patients who underwent transurethral resection of the prostate (TURP) [ 18 , 19 ]. The size of the abscess and the size of the prostate were important factors in determining the appropriate treatment approach.…”

Prostatic Abscess Combined With Spleen Abscess Due to Multi-Drug-Resistant Gram-Negative Bacilli: A Case Report and Literature Review

“…Overall, the annual incidence of prostatic abscess can be 0.5% of all urological disorders, and the mortality rate is between 1% and 16% ( Ha et al, 2008 ). The severe infection of the prostate is frequently caused by the reflux of infected urinary contents into prostatic ducts, especially in patients with diabetes, immunosuppressive state, chronic prostatitis, epididymitis, gonorrhea, or undertaking prostate biopsy, and so on ( Caulier et al., 2009 ; Dell’atti, 2013 ; Nomura et al, 2021 ; Tay et al, 2021 ). Gram-negative Enterobacteriaceae causing urinary tract infections is the dominant pathogenic bacteria, while Gram-positive bacteria had also been reported as the cause of prostate abscesses in uncontrolled diabetes patients ( McCormick et al, 2021 ; Merchant et al, 2016 ).…”