Clinical Characteristics of Prostatic Abscess / 대한비뇨기과학회지

ABSTRACT

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.