Prostatic Abscess: Case Report and Review of Literature

Background: Prostatic abscess is rare and quite often its diagnosis is delayed in view of the fact that it mimics symptoms of a number of lower urinary tract diseases hence a high index of suspicion is required in its diagnosis. Aims: To report a case of prostatic abscess To review the literature on prostatic abscess Case Report: A 45-years-old man was admitted as emergency in view of his worsening lower urinary tract symptoms. He had been taking antibiotics for 3 months with a presumed diagnosis of persistent / recurrent urinary tract infection. He was diagnosed on admission as having insipient retention of urine due to prostatitis. He was catheterised and received Gentamycin injection as well as oral antibiotics and analgesia but despite this his symptoms worsened. He had trans-rectal ultrasound scan of prostate which confirmed prostatic abscess and 10 mls of pus aspirated through the guidance of trans-rectal ultrasound scan and entonox to control pain. His prostatic abscess recurred and he underwent further aspiration of his recurrent abscess under general anaesthesia and trans-rectal ultrasound scan guidance. He also subsequently underwent trans-urethral resection of prostate to de-roof the abscess cavity in order to avoid subsequent recurrence of abscess and to allow any residual pus to drain into the urethra to be voided out within the urine o r a s u r e t h r a l d i s c h a r g e . R e p e a t trans-rectal-ultrasound scan revealed complete resolution of the abscess. His urine and pus from the abscess grew E coli and he was also treated by means of appropriate antibiotics based upon the sensitivity pattern. He also took tamsulosin medication to improve the flow of his urine. Conclusions: The experience gained in the management of this patient and from reviewing the literature would point to the following concluding statements. * Prostatic abscess usually presents with non specific symptoms that mimic other lower urinary tract diseases. * If a patient despite being on antibiotics for some time continues to be symptomatic then prostatic abscess should be suspected. * In some cases digital rectal examination may reveal fluctuation in the prostate but quite often there is only tenderness over the prostate in that case imaging by means of (a) trans-rectal ultrasound scan, (b) CT scan or (c) MRI scan would confirm the diagnosis * Differential diagnoses of prostatic abscess include: prostatic cysts; neoplasm * Treatment of prostatic abscess should include: (a) appropriate antibiotic treatment which should ultimately be based upon the sensitivity pattern of the causative organism and (b) drainage of the abscess * Some of the approaches to drainage of prostatic abscesses that have been used include (a) trans-rectal ultrasound guided aspiration; (b) digital-guided puncture / drainage by perineal route; (c) Trans urethral resection of prostate (TURP) to lay open the abscess cavity; (d) open perineal drainage. * Recurrence of prostatic abscess could occur pursuant to the initial treatment therefore follow-up trans-rectal ultrasound scan or CT scan or MRI scan is required to confirm complete resolution of the abscess. Increasingly trans-rectal ultrasound is being used for this purpose.