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

Abstract

PurposeProstatic 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 MethodsThe 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.ResultsAt 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.ConclusionsPatients with prostatic abscess treated by transurethral resection of the prostate had a significantly shorter hospitalization length compared with needle aspiration.

Imaging Enterobacteriaceae infection in vivo with 18 F-fluorodeoxysorbitol positron emission tomography

“…18 F-FDS produced a strong signal with minimal background noise, allowing for the detection of as few as 6.2 ± 0.2 log 10 CFU of E. coli as enumerated from the infected tissues after imaging. This is a promising threshold because clinically relevant bacterial infections have high bacterial burdens [8.3 log 10 CFU/ml (20)] and can be as large as several centimeters in diameter with volumes of tens to hundreds of milliliters (21, 22). Therefore, the 18 F-FDS limit of detection suggests that a positive signal would provide an early indication of infection in the host, although the sensitivity and specificity of this technique in the clinical setting remain to be determined.…”

Diagnosis and treatment of patients with prostatic abscess in the post‐antibiotic era

“…Seven out of nine patients with PA underwent surgical intervention several other large case studies similarly report a majority of patients requiring surgical management for PA . For many providers, transrectal ultrasound‐guided aspiration of the abscess is the first‐line of therapy .…”

Community-Acquired Methicillin-ResistantStaphylococcus aureusProstatic Abscess Presenting as Acute Urinary Retention: A Case Report and Review of the Literature

“…In that respect one can conclude that TURP-treated patients had a more favorable outcome. On the other hand, patients treated with needle aspiration resulted in a longer hospitalization and high recurrence [20]. Our patient was successfully treated with antibiotics and the TURP approach.…”