Acute bacterial prostatitis and abscess formation

Abstract

BackgroundThe purpose of this study was to identify risk factors for abscess formation in acute bacterial prostatitis, and to compare treatment outcomes between abscess group and non-abscess group.MethodsThis is a multicenter, retrospective cohort study. All patients suspected of having an acute prostatic infection underwent computed tomography or transrectal ultrasonography to discriminate acute prostatic abscesses from acute prostatitis without abscess formation.ResultsA total of 31 prostate abscesses were reviewed among 142 patients with acute prostatitis. Univariate analysis revealed that symptom duration, diabetes mellitus and voiding disturbance were predisposing factors for abscess formation in acute prostatitis. However, diabetes mellitus was not related to prostate abscess in multivariate analysis. Patients with abscesses <20 mm in size did not undergo surgery and were cured without any complications. In contrast, patients with abscesses >20 mm who underwent transurethral resection had a shorter duration of antibiotic treatment than did those who did not have surgery. Regardless of surgical treatment, both the length of hospital stay and antibiotic treatment were longer in patients with prostatic abscesses than they were in those without abscesses. However, the incidence of septic shock was not different between the two groups. A wide spectrum of microorganisms was responsible for prostate abscesses. In contrast, Escherichia coli was the predominant organism responsible for acute prostatitis without abscess.ConclusionImaging studies should be considered when patients with acute prostatitis have delayed treatment and signs of voiding disturbance. Early diagnosis is beneficial because prostatic abscesses require prolonged treatment protocols, or even require surgical drainage. Surgical drainage procedures such as transurethral resection of the prostate were not necessary in all patients with prostate abscesses. However, surgical intervention may have potential merits that reduce the antibiotic exposure period and enhance voiding function in patients with prostatic abscess.

Community-Acquired Urinary Tract Infection byEscherichia coliin the Era of Antibiotic Resistance

“…Meanwhile, a major point in complicated UTIs is the concept of drainage of infected materials to reduce treatment periods and prevent infections from ascending to upper tract. Lee et al emphasized that drainage of prostatic abscesses would reduce the period of antibiotic administration [ 117 ]. A report of long-term bladder management in spinal cord injury showed that condom catheter use (passive drainage) increases the vulnerability of patients to severe infection rather than intermittent catheterization (active drainage) [ 118 ].…”

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

“…Therefore, especially in those cases of immunocompromised hosts, not only urologists but also other department physicians including intensive care units, cardiologists or infection ones work on. 1 Ackerman et al interestingly focused on imaging diagnosis and surgical interventions as in the post-antibiotic era. 2 These points might be mostly noted by and of interest to urologists.…”

“…PA is a localized collection of purulent fluid within the prostate, often as a complication of ABP . In 1842, W Allison first reported a fatal case of PA with spontaneous urethral rupture into the rectoprostatic fossa .…”

“…PA is a localized collection of purulent fluid within the prostate, often as a complication of ABP. 1 In 1842, W Allison first reported a fatal case of PA with spontaneous urethral rupture into the rectoprostatic fossa. 2 Similar reports from the 19th century emphasized the still-relevant difficulties in distinguishing abscess from ABP, and described associations with urinary obstruction, gonorrheal infection and immunodeficiency, although these were not recognized as such at the time.…”

Outcome analysis of transrectal ultrasonography guided aspiration versus transurethral resection of prostatic abscess: 10 years’ experience from a tertiary care hospital

“…However, it is not an uncommon finding in developing countries, especially in high-risk population groups, e.g. diabetics, chronic kidney disease (CKD), haemodialysis dependence, cirrhosis, and immune compromised patients [1] , [2] , [3] . Historically, mortality rates vary from 6% to 30% [4] .…”