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

Alnadhari, Ibrahim; Sampige, Venkata Ramana Pai; Abdeljaleel, Osama; Ansari, Walid El; Ali, Omar; Salah, Morshed Ali; Shamsodini, Ahmad

doi:10.1177/1756287220930627

Cited by 10 publications

(4 citation statements)

References 15 publications

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“…In this study, both the conservative and intervention groups had similar basic characteristics, with median ages of 57.1 and 59.6 years, respectively, consistent with the typical age range for PA occurrence. The average hospital stay for the intervention group was significantly longer than that of the conservative group (18.5 vs. 11.6 days), which is in line with previous research by Alnadhari et al [ 20 ]. The longer stay in the intervention group may be attributed to more advanced disease and severe symptoms requiring a longer recovery time, as all patients received medical treatment followed by intervention treatment with TURP or TPD.…”

Section: Discussionsupporting

confidence: 91%

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

Chang

Pan

Lin

et al. 2023

JPM

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Prostate abscess (PA) can lead to severe urosepsis and septic shock if not treated promptly. However, early diagnosis can be hindered by the declining incidence of PA, especially in developing countries and high-risk patients. Despite the prevalence of PA, there is currently a lack of well-established contemporary guidelines or treatment algorithms. This study aimed to review the etiology, pathophysiology, diagnosis, and treatment options for PA, as well as analyze the characteristics, background profiles of patients, and clinical course. Ultimately, the goal was to develop a personalized treatment strategy for patients with PA. This retrospective study examined 44 patients diagnosed with PA at a tertiary medical center between 2010 and 2020. The patients were divided into two groups based on their treatment: conservative treatment or intervention (transurethral resection of the prostate [TURP] or transurethral prostate drainage [TPD]). The study evaluated various factors, including patients’ background profiles, comorbidities, laboratory data, and PA size and volume. Complications of the interventions were also analyzed. No significant differences were found in basic data between the conservative treatment group (19 patients) and intervention group (25 patients; 20 for TURP, 5 for TPD). However, it was observed that single abscesses, size <2.2 cm, and prostate volume <48 cm3, may be suitable for conservative treatment. Patients with diabetes mellitus and human immunodeficiency virus should be monitored for thrombotic events. In addition, there was a significant difference in white blood count between the two groups (12.1 ± 7.0 vs. 17.6 ± 9.7 × 109/L, p < 0.05). A subgroup analysis of the intervention group showed no significant difference in the risk of complications between TPD and TURP. Patients with poorly controlled diabetes mellitus and immunodeficiency are at a high risk of PA but are not indicated for surgical treatment. The PA profile, including number, size, volume, and percentage to prostate volume, should be considered when deciding on surgical intervention for patients with PA. Patients with higher leukocytosis may require surgical treatment. Overall, these findings can help guide the development of a personalized treatment strategy for patients with PA.

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Section: Discussionsupporting

confidence: 91%

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

Chang

Pan

Lin

et al. 2023

JPM

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“…As seen in the cases in this study, prostate abscess is a severe urological disease that can lead to septic shock or death even with appropriate treatment after diagnosis. Therefore, when a prostate abscess is clinically suspected, abdominal CT or transrectal ultrasound should be performed at an early stage to quickly diagnose and select an appropriate antibiotic [1,5,7,12]. In addition, transurethral abscess surgery can prevent prostate abscess recurrence and/or chronic complications in the urinary system in patients with unstable vital signs or prostate abscess size ≥2 cm [10,16] (Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…Conservative management is only recommended for prostate abscess ＜1-2 cm, and appropriate antibiotics are administered based on complex urinary tract infections. Very few studies have analyzed the prognosis and treatment outcomes for prostate abscess ＞2 cm [1,[11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Treatment Modality of Prostatic Abscess according to Size: A Retrospective Study

Lee

Jang

Seong

et al. 2022

Urogenit Tract Infect

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Purpose: This study aimed to determine the treatment modality for prostatic abscesses according to size. Materials and Methods: Twenty-five patients diagnosed with prostatic abscesses were retrospectively reviewed. All patients were treated with intravenous empirical and appropriate antibiotics according to culture results. They were grouped according to the size of the prostate abscess based on computed tomography results (group A, with prostate abscess ≤2 cm, n=10; group B, with prostate abscess size >2 cm, n=15), and their treatment modality and outcomes were compared. Results: The prostatic abscess sizes were 1.31±0.37 and 3.49±1.06 cm for groups A and B, respectively. Prostate-specific antigen, prostatic volume, and comorbidity were not significantly different (p>0.05), whereas pelvic pain was significantly different (p=0.028). There was no difference in the microorganisms isolated from urine and blood culture, empirical antibiotics, and broad-spectrum antibiotics between the two groups (p>0.05). More patients in group B underwent transurethral abscess deroofing than those in group A (p=0.040). Patients in group B had a more extended hospitalization period and intravenous antibiotics duration than those in group A (p=0.024 and p=0.013, respectively). Group B had more cases of septic shock, intensive care unit admission, and mortality events than group A (p=0.024, p=0.001, and p=0.061, respectively). However, prostatic abscess recurrence and urological chronic complication did not significantly differ (p>0.05). Conclusions: Appropriate use of antibiotics is crucial. This study shows that the treatment of patients with prostatic abscess >2 cm is more difficult, but transurethral abscess deroofing can lower mortality, prostatic abscess recurrence, and urological chronic complications.

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“…Existing literature suggests that smaller abscesses (diameter <2 cm) respond favorably to medical management, whereas larger abscesses (diameter >2 cm) often benefit from surgical unroofing, transurethral prostate resection, or similar drainage procedures. Such interventions have demonstrated the potential to reduce antibiotic dosage, shorten hospital stays, and improve urinary dysfunction ( Alnadhari et al, 2020 ; Brede & Shoskes, 2011 ; Chou et al, 2004 ). Drawing on previous treatment experience and considering the patient's unique circumstances and preferences, a standardized treatment was administered to a patient with a giant prostate abscess.…”

Section: Introductionmentioning

confidence: 99%

Giant Prostate Abscess: A Case Report and Literature Review

Liang,

Cao,

Qin

et al. 2023

Am J Mens Health

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Prostate abscess, a rare condition often associated with prostate bacterial infections, often occurs in immunosuppressive individuals and manifests as fever and lower urinary tract symptoms. Clinical practice lacks standardized diagnostic and treatment protocols for prostate abscesses, resulting in predominantly empirical approaches with uncertain outcomes. This study presents a case of a giant prostate abscess, diagnosed in a patient exhibiting fever, lower urinary tract symptoms (including dysuria, urinary frequency, urgency, and weakness), and anal pain. The diagnosis was confirmed through prostate magnetic resonance imaging and transrectal color ultrasound examinations. Treatment included targeted anti-infective therapy (based on the urine culture results), urine flow diversion (suprapubic bladder puncture stomy), ultrasound-guided perineal puncture drainage of the prostatic abscess, intermittent abscess cavity irrigation, and urethral electroprostatectomy. The patient experienced a complete recovery and significantly improved quality of life. This successful case underscores several key points: (1) the importance of targeted anti-infective therapy based on etiological findings in prostate abscess treatment; (2) early urine flow diversion, precise puncture drainage, and intermittent abscess cavity irrigation may be one of crucial elements in abscess management; (3) the potential significance of transurethral prostate resection following abscess resolution in preventing recurrence. It is hoped that this case report offers new valuable insights for diagnosing and treating prostate abscesses. Slightly different from previous treatment experience, we extra used early urine diversion, intermittent abscess cavity irrigation, and etiological electroprostatectomy, which might also hold promise as potential therapies.

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

Cited by 10 publications

References 15 publications

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

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

Treatment Modality of Prostatic Abscess according to Size: A Retrospective Study

Giant Prostate Abscess: A Case Report and Literature Review

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