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Background: The objective of our study was to perform retrospective analysis of management of prostatic abscess in a tertiary care hospital in northeast India.Methods: This was a single tertiary care hospital based retrospective analysis of management of 24 patients diagnosed with prostatic abscess, between January 2015 and January 2020. Diagnosis of prostatic abscess was confirmed by trans-rectal ultrasonography (TRUS) and/or computed tomography (CT) scan/magnetic resonance imaging (MRI) prostate. Various treatment modalities used in our study were conservative, transurethral resection of prostatic abscess (TURP), TRUS-guided trans-rectal drainage/aspiration, trans-urethral drainage (TUD) + trans-urethral incision (TUI).Results: On analysing 24 patients diagnosed with prostatic abscess, mean age was 46.12 years (range, 17 to 73 years), the mean prostate-specific antigen (PSA) was 17.3 ng/ml (range, 2 to 40.0 ng/ml), mean prostatic abscess volume was 33 cubic mm (range, 10 to 75 gm). All patients were hospitalised, on admission all patients were started on intravenous antibiotics (3rd-generation cephalosporin along with an amino-glycoside) or antibiotics as per urine culture report. Diabetes mellitus was most common associated co-morbidity present in almost 50% of patients. Patients presented with dysuria (75%), urinary retention (29%) fever (25%) and perineal pain. Cases were managed by surgical approach after failure of conservative management.Conclusions: Early surgical intervention for prostatic abscess reduces morbidity and mortality associated with it. TRUS guided drainage can be performed under local anaesthesia, are better suited for small localised abscess but associated with increase hospital stay. Trans-urethral drainage are better suited for elderly patient with large prostate volume.
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Prostatic abscess is a rare entity with an incidence of 0.5%–2.5% in all prostate diseases and usually occurs in the 5th and 6th decades of life with immunocompromised status. Prostatic abscess might be a process of evolution from acute prostatitis. Klebsiella pneumoniae is the leading microorganism in the diabetic patients of prostatic abscess in Taiwan. A 60-year-old diabetic man, with a one-week history of acute bacterial prostatitis was reported in this study, presenting to the emergency department with sudden altered mental status. The abdominal computed tomographic scan demonstrated lobulated prostatic abscess and multiple septic pulmonary emboli with lung abscesses. Analysis of cerebrospinal fluid showed white blood cells of 10 771 counts/mm
ABSTRACT
Prostatic abscess is a rare entity with an incidence of 0.5%-2.5% in all prostate diseases and usually occurs in the 5th and 6th decades of life with immunocompromised status. Prostatic abscess might be a process of evolution from acute prostatitis. Klebsiella pneumoniae is the leading microorganism in the diabetic patients of prostatic abscess in Taiwan. A 60-year-old diabetic man, with a one-week history of acute bacterial prostatitis was reported in this study, presenting to the emergency department with sudden altered mental status. The abdominal computed tomographic scan demonstrated lobulated prostatic abscess and multiple septic pulmonary emboli with lung abscesses. Analysis of cerebrospinal fluid showed white blood cells of 10771 counts/mm with segmented neutrophils of 99%. Cultures of blood, cerebrospinal fluid and sputum yielded Klebsiella pneumoniae. We concluded that computed tomographic scan can make a definite diagnosis of prostatic abscess associated with complications and management with empiric antibiotics and adequate drainage is suggested.
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Objective To analyze the diagnosis and treatment of prostatic abscess,thus to improve the level of the treatment of prostatic abscess.Methods The clinical manifestations, imaging examination and treatment of prostatic abscess patients were analyzed.11 cases were taken by transrectal puncture drainage,transurethral electric cutting and application of sensitive antibiotic conservative treatment.Results 1 case was cured after medicine conser-vative treatment.The rest 10 patients,7 cases underwent ultrasound guided by transrectal puncture drainage,3 cases of transurethral electric cutting prostatic abscess to top decompression.Review showed that 8 cases of abscess obviously decreased or disappeared,2 cases had no significant change,again the puncture drainage after cured.Follow-up of 3-12 months,no recurrence observed.Conclusion Prostatic abscess is uncommon clinical abscess according to size, location and the result of bacterial culture +drug susceptibility, and combining the patients'physical condition to choose a suitable treatment method.
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SUMMARY Intravesical bacillus Calmette-Guérin ( BCG) was a common treatment for non-muscle inva-sive urothelial carcinoma of the bladder. The complication of prostatic abscess was rare. We reported a case of tuberculous prostatic abscess after BCG therapy. A 65-year-old man was diagnosed as bladder cancer and accepted transurethral resection of bladder tumor ( TURBT) treatment. He received a 6-week induction course without any infection complication. Following the second BCG maintenance instillation, he complained of fever and dysuria. Transrectal ultrasound ( TRUS) demonstrated a well-defined complex mass in the right lobe of his prostate. The diagnosis of tuberculous prostatic abscess was considered after excluding other bacterial infection. The patient was treated with an anti-tuberculous regimen of isoniazid, rifampicin, and ethambutol. The symptoms were relieved after 4 weeks of anti-tuberculous therapy. Be-cause of the good response to the medicine, no further aspiration or drainage of prostatic abscess was car-ried out. The anti-tuberculous therapy had to be stopped for serious drug induced liver injury after 6 weeks of anti-tuberculous therapy. Eight weeks later of stopping anti-tuberculous therapy, the follow-up TRUS showed the disappearance of the prostatic abscess and the test of his liver function was normal. Considering the virulence of BCG is weaker than that of common tuberclebacillus, the shorter course of anti-tuberculous therapy maybe an alternative choice, and surgical drainage is not always necessary.
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Objective To investigate the conventional MRI and DWI features of prostatic abscess.Methods 8 patients with path-ologically and clinically proved prostatic abscess who were performed MRI examination in our institution were enrolled in this study. Among them,2 patients underwent CT examination and 7 patients were performed DWI examination (b = 0 and 1 000 s/mm2 ). Their CT,conventional MRI and DWI features were retrospectively analyzed.The ADC value between prostatic abscess and normal prostate tissues were compared by using paired t test.Statistical significance was inferred at P <0.05.Results 2 patients with 3 fo-cal abscesses,2 patients with 2 focal abscesses,and 4 patients with only one focal abscess.4 abscesses perforated the prostate cap-sule and involved the fat gap in front of the rectum.Prostatic abscess showed low hypointensity on T1 WI,hyperintensity on T2 WI and DWI.2 focal abscesses with low signal areas consistent both on T1 WI and T2 WI of gas.The mean ADCs of prostatic abscess were (0.854±0.223)×10 -3 mm2/s ,which were significantly lower than those of prostate tissues (1.41 6±0.1 68 )×10 -3 mm2/s (P <0.05).Conclusion Prostatic abscess has characteristic feature on MRI,and shows restricted diffusion on DWI.MRI can clearly display their size,number and invasive condition of the circumambient organs.Thus should be considered as an optimal method in the diagnosis of prostatic abscess.
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Abscess, is a condition that often occurs in the anorectal region. Anorectal abscesses are more frequently seen in men than women (2:1 or 3:1) and often seen in 3th-5th decades. Prostatic abscess, which is a rare condition today, has been thought that originated from prostatitis. A 50 year old male patient, was admitted to our urology clinic with the complaints of urinary frequency and dysuria for last two months. There is no prominent feature other than diabetes in the patient's history and asymmetric growth found on the left lobe in rectal examination of the prostate. The patients presenting with clinically anorectal abscess should be assessed properly with history, physical examination, laboratory, and imaging findings and also rarely underlying causes of inflammation of adjacent organs such as the prostate abscess should be kept in mind.
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Melioidosis is an infectious disease caused by the Gram-negative bacillus, Burkholderia pseudomallei. It is endemic in Southeast Asia and northern Australia, where B. pseudomallei is a soil saprophyte and invades the host through inoculation, inhalation or ingestion. It infects mostly adults with predisposing conditions, mainly diabetes mellitus. The lung is the most commonly affected organ, presenting with either cough or fever resulting from a primary spread. Also, seeding and abscess formation can arise in any organ. However, prostatic abscess due to melioidosis is uncommon. We report a case of pneumonia, and prostate and scrotal abscesses due to Burkholderia pseudomallei, in a 48-year-old man with diabetes mellitus who had a history of working in Malaysia. This is the first report of genitourinary infection of melioidosis in Korea.
Subject(s)
Adult , Humans , Middle Aged , Abscess , Asia, Southeastern , Australia , Bacillus , Burkholderia , Burkholderia pseudomallei , Communicable Diseases , Cough , Diabetes Mellitus , Eating , Fever , Inhalation , Korea , Lung , Malaysia , Melioidosis , Pneumonia , Prostate , Seeds , SoilABSTRACT
PURPOSE: Prostatic abscess is a very rare disease whose incidence has been reported to be approximately 0.2% in patients with urologic symptoms. Besides, it cannot be diagnosed by interview and physical examination, for which imaging studies must also be performed. In the current study, we examined the clinical usefulness of imaging studies in making a diagnosis of prostatic abscess and the effect of a fine needle aspiration based on trans-rectal ultrasonography on the treatment outcomes. MATERIALS AND METHODS: In ten patients who were diagnosed with prostatic abscess and then treated during a period ranging from January of 1995 to June of 2008 (mean age: 61.8 years, range: 40-89 years), a past history, clinical symptoms, physical examination findings, laboratory findings, trans-rectal ultrasonography findings, computed tomography findings, treatment modalities and complications were retrospectively analyzed. RESULTS: All patients complained fever and voiding dysfunction as chief complaint. On trans-rectal ultrasonography and computed tomography scans, all the ten patients had abnormal findings. In five patients, there were nonhomogenous hypo-echoic lesions on trans-rectal ultrasonography. All the patients had cystic abscess lesions detected on computed tomography scans. In four patients, in whom the diameter of lesions was greater than 1cm on computed tomography scans, a fine needle aspiration was performed on trans-rectal ultrasonography and antibiotic treatment was performed. In six patients, in whom the diameter of lesions was smaller than 1 cm on computed tomography scans, antibiotic treatment was performed. There were statistically significant differences in the length of hospital stay and the size of prostate gland between the group where a fine needle aspiration was performed using trans-rectal ultrasonography and the group where antibiotic treatment was performed (p0.05). Length of antibiotic therapy was shorter in antibiotic therapy only group, but there was no statistically significant difference (P>0.05). CONCLUSIONS: A computed tomography is a useful diagnostic modality for prostatic abscess. Besides, a fine needle aspiration based on trans-rectal ultrasonography is one of the minimally invasive treatment regimens for prostatic abscess, whose good treatment outcomes have been well documented. Furthermore, there were no severe complications in our series.
Subject(s)
Humans , Abscess , Biopsy, Fine-Needle , Fever , Incidence , Length of Stay , Physical Examination , Prostate , Rare Diseases , Retrospective StudiesABSTRACT
The genito-urinary tract is a common site of involvement in extra-pulmonary tuberculosis. However, an isolated tubercular abscess in the prostate with no evidence of disease elsewhere in the urinary tract is extremely uncommon unless the patient is immuno-compromised. We report an extremely rare instance of an isolated prostatic abscess presenting solely as pyrexia of unknown origin in a young male with no evidence of immuno-suppression.
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PURPOSE: Since the 1940s, the incidence of prostatic abscess appears to have declined and the type of infecting organism has changed. So we evaluated the change on clinical characteristics of prostatic abscess in recent years. MATERIALS AND METHODS: From 1991 to 1997, we treated 12 patients with prostatic abscess. Mean patient age was 52.2years(range 22 to 69). An analysis was made of history, presenting symptoms, digital rectal examination(DRE) and usefulness of transrectal sonography(TRUS). Diagnostic work-up included analysis of midstream urine for leucocytes and common pathogens. Treatment included antibiotic therapy with or without percutaneous cystostomy, or together with surgical drainage. RESULTS: Medical history revealed predisposing diseases in 7 cases : diabetes mellitus(2 patients), previously treated gonococcal urethritis(2 patients), percutaneous cystostomy due to urethral rupture(1 patient), BPH(1 patient) and chronic hepatic disorder(1 patient). The characteristics of the initial DRE revealed increased prostatic size in 11 patients, tenderness and heating sense in 9 patients, fluctuation in 6 patients. In 12 patients, diagnosis was based on TRUS. In 2 patients with mimicking prostate cancer, pelvic MRI was done and prostatic abscess was confirmed. All patients demonstrated leucocytes in their midstream urine. Causative pathogens in midstream urine were found in 8 patients: Staphylococcus aureus(4 patients), Escherichia coli(3 patients), Proteus vulgaris(1 patient) and Candida albicans(1 patient). In one patient, mixed infection was found. All patients received antibiotic treatment. In one patient, transrectal aspiration was performed by sono-guided puncture, one patient underwent transurethral incision of the prostate(TUIP) and two patients underwent TURP. In eight patients, antibiotic treatment alone was administered and led to cure. CONCLUSIONS: An analysis of 12 patients with prostatic abscess was presented. Diabetes was not so common in predisposing factor of prostatic abscess as compared with previous literatures. S. aureus and E. coli were the main causative organisms. Besides C. albicans, nosocomial organism, was observed in 1 patient. We have found TRUS to be helpful in the diagnosis and follow-up of this disease. In addition, pelvic MRI is considered as a noninvasive technique helpful in differentiation with prostatic cancer. Definitive treatment is complete surgical drainage, but there is no difference in results of treatment between patients with antibiotics only and those with mixed surgical drainage and antibiotic coverage.
Subject(s)
Humans , Abscess , Anti-Bacterial Agents , Candida , Causality , Coinfection , Cystostomy , Diagnosis , Drainage , Escherichia , Follow-Up Studies , Heating , Hot Temperature , Incidence , Magnetic Resonance Imaging , Prostatic Neoplasms , Proteus , Punctures , Staphylococcus , Transurethral Resection of ProstateABSTRACT
Metastatic infections were rare complications of Klebsiella p neumoniae liver abscess and bacteremia. However, over the past 15 years, they have become prevalent infectious complications in diabetic patients in Taiwan. A 72-year old man was admitted to Kyung-Hee University Hospital with fever, chill, dysuria, and frequency. On rectal examination the prostate gland was tender. Abdominal sonogram showed liver abscess. On hospital day 3, orbital pain, eyelid edema, conjunctival chemosis, hypopyon, and absence of light perception were noted in the right eye. K. pneumoniae was isolated from blood culture. The antimicrobial susceptibility test showed susceptibility to all antibiotics, except ampicillin. He was treated with ceftriaxone and astromicin intravenously for 3 weeks and follow up-transrectal sonogram revealed formation of prostatic abcess. We report a case of K. p neumoniae liver abscess complicated with bacteremia, endophthalmitis, and prostatic abscess.
Subject(s)
Aged , Humans , Abscess , Ampicillin , Anti-Bacterial Agents , Bacteremia , Ceftriaxone , Dysuria , Edema , Endophthalmitis , Eyelids , Fever , Klebsiella pneumoniae , Klebsiella , Liver Abscess , Liver , Orbit , Pneumonia , Prostate , TaiwanABSTRACT
We report a case of prostatic abscess in a 46-year old man with chronic myelocytic leukemia. Preoperative transrectal ultrasonography and computerized tomography confirmed the diagnosis of prostatic abscess, which was treated with pus drainage via transurethral resection of prostate and broad-spectrum antibiotics.
Subject(s)
Humans , Middle Aged , Abscess , Anti-Bacterial Agents , Diagnosis , Drainage , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Suppuration , Transurethral Resection of Prostate , UltrasonographyABSTRACT
Abscess of prostate has become a rare disease due to development of modern antibiotics and decreasing incidence of gonococcal infection. Recently the pathogen of prostatic abscess is almostly E. coli, the others are pseudomonas, staphylococcus, obligate anaerobic bacteria. Staphylococcus aureus infected rostatic abscess arises from other inflammatory focus as a complication of a skin infection by hematogenous route most commonly. We encountered two cases of Staphylococcus aureus infected prostatic abscess in diabetes mellitus patients. There had been no primary inflammatory focus in both cases moreover no fever in the first case. He did not complain of specific symptoms of prostatic abscess such as fever, dysuria, pyuria and perineal pain. The other one complained of fever and acute urinary retention. In both cases, prostatic abscess was suspected by transrectal ultrasonography and confirmed by percutaneous needle aspiration. The patients were treated with pathogen sensitive antibiotics combined with transurethral resection drainage of prostate.
Subject(s)
Humans , Abscess , Anti-Bacterial Agents , Bacteria, Anaerobic , Diabetes Mellitus , Drainage , Dysuria , Fever , Incidence , Needles , Prostate , Pseudomonas , Pyuria , Rare Diseases , Skin , Staphylococcus , Staphylococcus aureus , Ultrasonography , Urinary RetentionABSTRACT
Although fungal infections involving the genitourinary system are increasing in case, those involving the prostate are uncommon and fungal prostatic abscesses are especially rare. There are a few sporadic reports in the literature of fungal prostatic abscess. We thought that a high index of suspicion for fungal prostatic infection must be maintained especially in high risk patients. We report a case of candidal prostatic abscess in a 37-year old man with diabetes. The diagnosis and management are discussed, and the literature is reviewed.
Subject(s)
Adult , Humans , Abscess , Candida albicans , Diagnosis , Prostate , Urogenital SystemABSTRACT
Prostatic abscess is seen infrequently. Furthermore small abscess or microabscess accompanied with BPH or chronic prostatitis is likely to be overlooked and very difficult to diagnose with history and physical examination due to obscurity of its clinical symptoms. We have experienced frequent pus discharge from resected area of prostate during transurethral resection in patients with BPH and/or chronic prostatitis. And through clinical observation of 32 patients with BPH and 7 patients with chronic prostatitis whom we had treated by transurethral resection of prostate following results were obtained. 1. Prostatic abscess was found in 26 cases of 39 patients with BPH and/or chronic prostatitis during transurethral resection of prostate. 2. Transvesical and transrectal ultrasonography of prostate may increase the chances to diagnose small abscess with sensitivity of 46%. 3. Urinary tract infection and concomitant prostatic calculi with lower urinary tract obstruction were important predisposing factors in formation of prostatic abscess. 4. Diabetes mellitus was accompanied in 5 cases of 26 patients of prostatic abscess. 5. Definite drainage with transurethral resection of the gland and the use of broad spectrum antibiotics brought good results.