Prostatic abscess

Abstract

Chitty (1957), reporting on prostatic abscess from the Bristol Department of Urology, suggested that the treatment of choice was transurethral resection of the entire gland. Over the 10 years since this initial report our experience has amply confirmed this view and a further series of 67 patients is now analysed. It would appear that there is no absolute means of establishing the diagnosis, either from the history or the clinical findings, and that even when the diagnosis is suspected it may only be confirmed by resection of the gland. The abscesses are not infrequently multiple and thus a simple saucerization of one cavity may leave further significant foci undiscovered. A full transurethral prostatectomy is therefore the treatment of choice. This policy of radical treatment by the transurethral route has been followed by minimal postoperative complications or recurrence.IN 1957 Chitty reported to the BRITISH JOURNAL OF SURGERY 6 years' experience of prostatic abscess in the Urological Department in Bristol. His series consisted of 27 cases averaging rather more than 4 a year, and from these he outlined the mode of presentation and the various forms of treatment which had been employed. He also reviewed the literature and discussed various theories as to the aetiology of the condition. He concluded that conservative treatment carried the danger of either recurrent abscess or the establishment of chronic prostatitis. This appeared to be because drainage was incomplete and Chitty therefore advocated transurethral resection (TUR) of the prostate gland as the treatment of choice. This has since been the policy of this Department of Urology, and it was felt that our experience of this condition should now be reviewed. In particular, the results of this more radical form of treatment are reassessed with full follow-up.

Sonographic demonstration of prostatic abscess.

“…and S. allms. 7 \Ve were unable to find a case report of Citrobacter dir;er.m , \' as the causative agent in the literature.…”

“…1 Systemic symptoms also show significant overlap, 2 and it has been noted that even when the diagnosis of abscess is suspected, it may only be confirmed by surgical resection of the gland. 3 Differentiation of these two entities is important from a therapeutic standpoint, as the treatment for acute bacterial prostatitis is antibiotic therapy,~ while an abscess requires surgical intervention. 5 The unique ability of transrectal ultrasonographic prostatic imaging to diagnose the presence of an abscess, and thus affect the choice of treatment, is discussed in the following case report.…”

Prostatic Malacoplakia Associated with Prostatic Abscess: Diagnosis and Treatment

“…Transurethral drainage is the most favored approach [13]. We recommend full resection of the gland either for complete relief of bladder outlet obstruction and also for histological examination.…”

Prostatitis

“…Since the beginning of the antibiotic era, prostatic abscess formation has been rare because of declining gonococcal urethritis and associated stricture disease (Brawer 1992;Brawer and Stamey 1987;Dajani and O'Flynn 1968;Mariani et aI. 1983;Trapnell and Roberts 1970). Although microabscesses often develop early in the course of ABP, the appropriate use of modern antimicrobial agents generally eliminates the infection and prevents abscess formation .…”