Transrectal Ultrasound-Guided Needle Aspiration of a Prostatic Abscess

Objectives: Prostatic abscess (PA) is an infrequent condition in the modern antibiotic era. The everyday use of transrectal ultrasound (TRUS) during diagnostic work-up and the widespread recurrence to prostatic biopsies may lead to an increase of PA diagnosis. In this short report we analyze the patients characteristics and the management of seven recent cases of PA diagnosed in our institution. Materials and Methods: The records of 7 patients admitted to our Center for LUTS associated to septic fever or acute urinary retention, was prospectively collected. Suspect of PA was done on digital rectal examination (DRE) and confirmed by TRUS performed after urinary system ultrasound (UUS) evaluation. Patients were admitted to hospital only in case of septic signs. A sovrapubic (SPC) or urethral catheter (UC) was placed depending on symptoms. A TRUS-guided aspiration of PA was performed with patient in lithotomic position, using a 18 gauge two-part needle, side/end fire needle access. Patient was discharged with antibiotic therapy and followed up until complete resolution of the PA and symptoms. Results: Mean age was 62 years (range 24-82). Two patients were diabetics and one was affected by the immunodeficiency acquired syndrome (HIV). In one case, PA was detected after a persistent fever post TRUS guided prostate biopsy. Average prostate volume was 69 ml (range 19-118 ml). DRE was able to diagnose PA only in 2 cases (29%), UUS evaluation in 1 case (14%). All cases were confirmed by TRUS as hypo-anechoic areas with or without internal echoes in all patients. Mean PA dimension was 3.64 cm (range 1.5-8). SPC was placed in 3 cases (43%), UC in 3 patients (43%). Only 1 patient refused catheterization. Side fire needle aspiration was performed in all cases and in combination with end fire access in case of particular location of abscess cavities. Second look was needed in 2 cases (29%). Antibiotics were administered in all cases. The aspirated pus showed a positive culture for Escherichia coli (43%), Klebsiella pneumoniae (29%), Pseudomonas aeruginosa (14%) and Enterococcus faecalis (14%). PA resolution time mean was 9 days (range 3-24). Conclusions: TRUS evaluation in case of persistent LUTS associated with fever or acute urinary retention is determinant in the diagnosis of PA. Office or institutional management with TRUS needle aspiration is a good option in these cases.

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MP-08.09 Minimally-Invasive Management of Prostatic Abscess: Transrectal Ultrasound Guided Aspiration of Prostatic Abscess Under Local Anesthesia: Ganga Ram Needle

Urology ◽

10.1016/j.urology.2011.07.186 ◽

2011 ◽

Vol 78 (3) ◽

pp. S88

Author(s):

S. Khanna ◽

s. Mittal

Keyword(s):

Minimally Invasive ◽

Local Anesthesia ◽

Transrectal Ultrasound ◽

Ultrasound Guided ◽

Prostatic Abscess ◽

Invasive Management

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Presentation, diagnosis, management, and outcomes of prostatic abscess: comparison of three treatment modalities

Therapeutic Advances in Urology ◽

10.1177/1756287220930627 ◽

2020 ◽

Vol 12 ◽

pp. 175628722093062

Author(s):

Ibrahim Alnadhari ◽

Venkata Ramana Pai Sampige ◽

Osama Abdeljaleel ◽

Walid El Ansari ◽

Omar Ali ◽

...

Keyword(s):

Conservative Treatment ◽

Hospital Stay ◽

Clinical Laboratory ◽

Transrectal Ultrasound ◽

Needle Aspiration ◽

Treatment Modalities ◽

Prostatic Abscess ◽

Urinary Tract Symptoms ◽

Management Modality

Purpose: The lack of available guidelines for the management of prostatic abscess (PA) results in inconsistencies in its management. The most commonly used management modalities were conservative treatment with parenteral antibiotics alone, transrectal ultrasound-guided (TRUS) needle aspiration, or transurethral deroofing (TUD). The current study is a retrospective study and examines prostatic abscess cases treated by either one or more of the different modalities. We assess and compare presentation, diagnosis, management, and outcomes of prostatic abscess and we compare the outcomes of the three management modalities. Methods: We retrieved the records of all patients ( n = 23) admitted to the Urology department at Al Wakra hospital with the computed tomography (CT) diagnosis of prostatic abscess from January 2013 to March 2018. Data collected included demographic, clinical, laboratory, and imaging findings, as well as management modality, duration of hospital stay, duration of follow up, outcome, and recurrence. Results: A total of nine (39.1%) patients had conservative treatment only; eight (34.8%) had TUD, and six (26.1%) had TRUS needle aspiration. The mean age was 52.7 years. Lower urinary tract symptoms and fever were the most common presentations (95.7% and 82.6%, respectively). CT scan of the abdomen and pelvis with contrast was undertaken for all patients and it showed that multiple abscesses were observed in 14 (60.9%) cases. The overall mean hospital stay was 8.45 days (range 2–21 days). We observed no recurrences for patients treated conservatively or those who undertook TUD, but three patient (50%) recurrences were noted in TRUS aspiration patients. There was no mortality across the sample. Conclusion: Early diagnosis of prostatic abscess and prompt management may have decreased the morbidity and mortality. Conservative management can succeed in subcentimeter abscesses but TUD is the definite therapy for large and multiloculated abscess. TRUS aspiration does have a role in treatment, but it has higher recurrence and longer hospital stay.

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