Transurethral Drainage of Prostatic Abscess: Points of Technique

Abstract

BackgroundThe incidence of prostatic abscess (PA) has markedly declined with the widespread use of antibiotics and the decreasing incidence of urethral gonococcal infections.ObjectivesTo evaluate different treatment methods for prostatic abscess and to describe technical points that will improve the outcome of transurethral (TUR) drainage of prostatic abscess.Patients and MethodsWe performed a retrospective study of a series of 11 patients diagnosed with prostatic abscess, who were admitted and treated in Farwaniya Hospital, Kuwait, between February 2008 and November 2010. Drainage was indicated when antibiotic therapy did not cause clinical improvement and after prostatic abscess was confirmed by TRUS (Transrectal ultrasonography) and/or CT computed Tomographyscan. TUR drainage was indicated in 7 cases, ultrasound-guided transrectal drainage was performed in 2 cases, and ultrasound-guided perineal drainage was performed in 2 cases.ResultsAll patients that underwent TUR-drainage had successful outcomes, without the need of secondary treatment or further surgery.ConclusionsTUR drainage of a prostatic abscess increases the likelihood of a successful outcome and lowers the incidence of treatment failure or repeated surgery. Less invasive treatment, with perineal or transrectal aspiration, may be preferred as a primary treatment in relatively young patients with localized abscess cavities.

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

“…For patients with large, multiloculated infections, transurethral unroofing of PA might be more appropriate; up to one‐third of patients with PA will eventually require transurethral resection of the prostate . Other indications for transurethral unroofing with resection of the prostate include prostate sizes of ≥80 g, recurrent or residual abscesses (such as those following incomplete resolution after aspiration), associated BPH and persistent lower urinary tract symptoms . Under cystoscopic vision, after determining by imaging where the abscess cavity is located relative to the prostatic urethra, a wire loop or Collins knife is used to unroof the abscess cavity (Fig.…”

“…20,26 Other indications for transurethral unroofing with resection of the prostate include prostate sizes of ≥80 g, recurrent or residual abscesses (such as those following incomplete resolution after aspiration), associated BPH and persistent lower urinary tract symptoms. 25,26,83 Under cystoscopic vision, after determining by imaging where the abscess cavity is located relative to the prostatic urethra, a wire loop or Collins knife is used to unroof the abscess cavity ( Fig. 3; Video S1).…”

Rare case of a massive staphylococcal prostatic abscess presenting as an ischio‐rectal abscess

“…Perianal or ischio‐rectal abscesses can also occur in severe untreated prostatic abscesses when the prostatic abscess ruptures and purulent material spreads to adjacent pelvic tissues, as seen in our patient. These cases are exceedingly rare and to the authors’ knowledge, our case is the first reported case where the primary presenting complaint was the ischio‐rectal abscess. In one case series of 48 patients over a 15‐year period, only eight patients had spontaneous rupture through the prostatic capsule with only two patients developing perianal abscesses requiring open drainage.…”

Prostatic abscess: a rare complication of staghorn calculi

“…A review of 52 patients concluded that TUR drainage offers shorter hospitalisation than a transrectal needle-guided aspiration or antibiotic therapy alone 18. Another review conferred that TUR drainage of prostatic abscesses had better outcomes and do not necessarily warrant further procedures to treat the prostatic abscess, relative to ultrasound-guided transrectal and perineal drainage 19. However, performing a TUR drainage has its own complications, such as urethral strictures and urethral diverticulum as reported 20…”