Factors Deciding Conservative or Intervention Treatment for Prostate Abscess: A Retrospective Case-Control Study

Chang, Yi‐Huei; Pan, Szu-Ying; Lin, Chia Yu; Huang, Chi‐Ping; Chung, Chi Jung; Chen, Yung‐Hsiang; Chen, Wen‐Chi

doi:10.3390/jpm13030484

Cited by 4 publications

(2 citation statements)

References 29 publications

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“…The decision to opt for surgical intervention were large abscesses (>2.2 cm); large prostates (>48 g); or a white cell count >17. All patients had complete resolution of abscess and symptoms; however, the intervention group generally had a longer hospital stay, possibly related to the severity of disease 24 …”

Section: Discussionmentioning

confidence: 98%

“…All patients had complete resolution of abscess and symptoms; however, the intervention group generally had a longer hospital stay, possibly related to the severity of disease. 24 The most studied method for treating PA is TURP. TURP is effective with complete resolution in nearly all cases, with the lowest recurrence rate among all drainage techniques.…”

Section: Nomentioning

confidence: 99%

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Transperineal drainage of prostate abscesses: A minimally invasive, low‐risk management strategy that yields satisfactory results

Scholtz,

Hooshyari,

Vermeulen

et al. 2023

BJUI Compass

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ObjectivesIn this narrative review, we aim to present two cases of transperineal drainage of prostate abscesses with a good clinical outcome. Furthermore, we reviewed the literature on this treatment approach and aim to propose a minimally invasive protocol for managing this rare condition.Patients and MethodsOur patients are 33‐ and 61‐year‐old males who both underwent uncomplicated transperineal drainage of prostate abscess with the use of a Precision Point device with rapid clinical improvement and complete resolution of the abscess within the follow‐up period. We used PubMed to conduct a literature search and included and evaluated 16 relevant case reports and case series in which the authors utilized transperineal drainage techniques for prostatic abscesses.ResultsOur first patient was young and very unwell with sepsis and a pulmonary embolism. He had a complex abscess extending through the prostate to the left pelvic side wall. Trans‐gluteal drainage of the pelvic side‐wall collection was required in addition to transperineal drainage of the prostate abscess. After drainage and a prolonged course of antibiotics, he achieved resolution of the abscess by 7 weeks with ejaculatory function intact. Our second patient who was very keen on the preservation of ejaculatory function had multiple small abscesses and underwent transperineal drainage. He had significant interval improvement of his abscess burden at the 4‐week follow‐up and complete resolution at the 6‐month follow‐up. The total number of cases in the literature on our review is 22, with considerable variability in how the authors managed the prostate abscesses that underwent transperineal drainage, including variability in their follow‐up time frame, choice of imaging modality, duration of antibiotic treatment, drain placement, and use of irrigation solutions (including antibiotics) into the abscess cavity. Furthermore, the sizes of the prostate abscesses were not consistently reported. Given the small sample size and variability in management from different authors, it was not possible to draw any statistical analysis.ConclusionTransperineal prostate abscess drainage combined with prolonged antibiotic therapy provides a less invasive alternative to treating prostate abscesses for those who which to preserve ejaculatory function and avoid the other adverse events of transurethral de‐roofing. In itself, it can achieve complete resolution of abscess. It provides the benefit of drainage under real‐time imaging; for percutaneous drain placement; prevents urethral injury; retrograde ejaculation; and can be done under local anaesthetic which is preferable for the unstable patient. The utility of the procedure may be limited by the complexity of the abscess or whether it has extended beyond the prostate. The patient should always be informed that further drainage via percutaneous methods or transurethral methods may be necessary if their clinical condition does not improve. We recommend this procedure be offered as an alternative to transurethral methods in younger patients and those who would like to preserve ejaculatory function. Furthermore, we highly encourage a prolonged course of antibiotic therapy and interval follow‐up with clinical review of symptoms and imaging to confirm resolution.

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Section: Discussionmentioning

confidence: 98%

Section: Nomentioning

confidence: 99%

Transperineal drainage of prostate abscesses: A minimally invasive, low‐risk management strategy that yields satisfactory results

Scholtz,

Hooshyari,

Vermeulen

et al. 2023

BJUI Compass

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Predicting the need for additional intervention in prostate abscess treatment: Insights from a multicenter study and proposal of a Prostate Abscess Complexity Score

Pallares-Mendez,

Armillas-Canseco,

Martinez

et al. 2024

Urological Science

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Purpose: To evaluate prostate abscess outcomes and identify predictors for additional intervention. Additionally, assess a complexity score for clinical decision-making. Materials and methods: This is a retrospective, multicenter study including 62 consecutively admitted prostate abscess patients. Primary treatment involved antibiotics or a combination with transrectal ultrasound-guided aspiration (TRUS-GA) or transurethral resection of the prostate with abscess deroofing. Outcomes were assessed by comparing resolution with primary treatment to additional intervention. Additional intervention involved escalation to TRUS-GA, repeat TRUS-GA, or transurethral resection of the prostate with abscess deroofing. The sample was further categorized by Prostate Abscess Complexity Score (PACS) into complex and noncomplex. Risk factors, clinical features, abscess characteristics, and reintervention predictors were analyzed using logistic regression and receiver operating characteristic analysis. Results: Sixty-two patients were included, 47 (75.8%) responded well to primary treatment, while 15 (24.2%) needed additional intervention. Risk factors for additional intervention included multifocal abscess (P = 0.005), septa (P = 0.023), bilateral involvement (P = 0.008), abscess diameter ≥3 cm (P = 0.040), and volume ≥20 cc (P ≤ 0.001). The PACS, considering abscess focality, septa, laterality, polarity, abscess diameter, and volume, showed 73% sensitivity and 74% specificity in predicting additional intervention (P = 0.001) with a threshold of ≥6 points to classify as complex. Among complex cases, 80% required additional intervention, compared to 34% in noncomplex cases (P = 0.002). Conclusion: This study highlights personalized treatment for prostate abscess. Identified risk factors (multifocal abscess, septa, bilateral involvement, large abscess diameter, and increased volume) provide insights into predicting the need for additional interventions. The proposed PACS offers a valuable tool for clinical decision-making when ≥6 points are encountered.

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A rare case report of severe prostate abscess treated with artificial intelligence-assisted mpMRI-TRUS real-time-guided puncture drainage

Wu,

Wang,

et al. 2024

SAGE Open Medical Case Reports

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A prostate abscess is a rare complication of prostatitis, typically observed in patients with conditions such as immunodeficiency, diabetes, urinary tract abnormalities, and chronic indwelling catheters. We present a 60-year-old patient, admitted to the hospital presenting progressively with dysuria for more than 1 year, accompanied by frequent urination, urgent pain, and urinary retention, intermittent fever for 20 days. A multi-parametric magnetic resonance imaging (mpMRI) scan of the abdomen/pelvis showed a prostatic abscess. Initially, meropenem treatment was not effective. Subsequently, the patient underwent an artificial intelligence-assisted mpMRI-TRUS (transrectal ultrasonography) real-time-guided puncture drainage. The results of purulent drainage cultures were positive for K. pneumonia, sensitive to bacillosporin. Thus, the combination treatment of sensitive antibiotics and transperineal drainage was conducted. The patient was followed up for 6 months, the outcome was satisfactory. Timely and appropriate treatments (such as the combination of sensitive antibiotics and artificial intelligence-assisted mpMRI-TRUS real-time-guided transperineal puncture drainage) are crucial for both patient survival and the prevention of complications.

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Factors Deciding Conservative or Intervention Treatment for Prostate Abscess: A Retrospective Case-Control Study

Cited by 4 publications

References 29 publications

Transperineal drainage of prostate abscesses: A minimally invasive, low‐risk management strategy that yields satisfactory results

Transperineal drainage of prostate abscesses: A minimally invasive, low‐risk management strategy that yields satisfactory results

Predicting the need for additional intervention in prostate abscess treatment: Insights from a multicenter study and proposal of a Prostate Abscess Complexity Score

A rare case report of severe prostate abscess treated with artificial intelligence-assisted mpMRI-TRUS real-time-guided puncture drainage

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