Transurethral Resection of Prostate Abscess: Is It Different from Conventional Transurethral Resection for Benign Prostatic Hyperplasia?

Goyal, Neeraj Kumar; Goel, Apul; Sankhwar, Satyanarayan; Dalela, Divakar

doi:10.1155/2013/109505

Cited by 13 publications

(23 citation statements)

References 14 publications

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“…These patients, who are frequently older with coincident outlet obstruction, are at risk for PA from direct introduction of bacteria into the prostate. Along with multiple case reports, previous cross‐sectional studies have shown that 8–11% of patients presenting with PA had recently undergone prostate biopsies . In two such cases, PA was the result of infection with multidrug‐resistant Escherichia coli .…”

Section: Etiology and Natural Historymentioning

confidence: 91%

“…Along with multiple case reports, [21][22][23][24] previous cross-sectional studies have shown that 8-11% of patients presenting with PA had recently undergone prostate biopsies. 25,26 In two such cases, PA was the result of infection with multidrug-resistant Escherichia coli. 21,23 As patients undergoing transrectal prostate biopsy are frequently given antimicrobial prophylaxis, it is important to be mindful of the rising emergence of multidrug resistance in post-prostate biopsy infections.…”

Section: Etiology and Natural Historymentioning

confidence: 99%

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

2017

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We reviewed the pathogenesis, clinical presentation, treatment options and outcomes of prostatic abscess in the post-antibiotic era, focusing on how patient risk factors and the emergence of multidrug-resistant organisms influence management of the condition. A MEDLINE search for "prostate abscess" or "prostatic abscess" was carried out. Prostate abscess is no longer considered a consequence of untreated urinary infection; now, men with prostatic abscess are typically debilitated or immunologically compromised, with >50% of patients having diabetes. In younger men, prostatic abscess can be the initial presentation of such chronic conditions. In older men, prostatic abscess is increasingly a complication of benign prostatic hyperplasia or prostate biopsy. Diagnosis is based on a physical examination, leukocytosis, leukocyturia and transrectal ultrasound, with magnetic resonance imaging serving as the preferred confirmatory imaging modality. Treatment of prostatic abscess is changing as a result of the emergence of atypical and drug-resistant organisms, such as extended-spectrum blactamase-producing enterobacteriaceae and methicillin-resistant Staphylococcus aureus. As many as 75% of infections are resistant to first-generation antibiotics, necessitating aggressive therapy with broad-spectrum parenteral antibiotics, such as third-generation cephalosporins, aztreonam or antibiotic combinations. A total of 80% of patients require early surgical drainage, frequently through a transurethral approach. In the postantibiotic era, prostatic abscess is evolving from an uncommon complication of urinary infection to a consequence of immunodeficiency, growing antibiotic resistance and urological manipulation. This condition, primarily affecting patients with chronic medical conditions rendering them susceptible to atypical, drug-resistant organisms, requires prompt aggressive intervention with contemporary antibiotic therapy and surgical drainage.

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Section: Etiology and Natural Historymentioning

confidence: 91%

Section: Etiology and Natural Historymentioning

confidence: 99%

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

2017

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“…19 The management options include transrectal ultrasonography-guided aspiration, transurethral incision over the abscess, transurethral deroofing of the abscess cavity, or formal transurethral resection of prostate. 20 No management algorithms are currently available to guide physicians in the surgical drainage, and the decision is usually based on physician preference.…”

Section: Discussionmentioning

confidence: 99%

Klebsiella pneumonia-induced prostate abscess: How to work it up?

Kim

Yang

Kim

2014

CUAJ

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Cite as: Can Urol Assoc J 2014;8(11-12):e841-4. http://dx.doi.org/10.5489/cuaj.2155 Published online November 24, 2014. AbstractIntroduction: Klebsiella pneumonia (KP) is related to a metastatic phenomenon from the originally affected primary organ. About 28% of patients with pyogenic liver abscess arising from KP suffer from metastatic complications. This study was done to define the clinical features of KP-induced prostate abscess. Methods: A total of 14 patients were diagnosed with prostate abscess based on clinical, laboratory examination and abdominopelvic computed tomography (CT) scan from 2007 to 2013. Results: Among these 14 patients, KP was the dominant causative microorganism in 6 patients (42.9%), followed by Esherchia coli in 2, Pseudomonas aeroginosa in 1, methicillin-resistant Staphyolcoccus aureus in 1, and no growth in either the urine or blood culture in 4. Four (66.7%) of the 6 KP induced-prostate abscess had other concurrent abscess sites besides the prostate: liver in 3, kidney in 1, and perianal area with endogenous endophthalmitis that ended in loss of vision in 1 patient. Conclusions: We report on the clinical features of KP-induced prostate abscess based on a small number of patients, which is the main limitation of our study. We believe that if the causative organism of a prostate abscess was KP, more workup would be needed to rule out the presence of an abscess in other organs, especially in the liver. Abdominopelvic CT scan would be a proper imaging modality.

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“…1 ). Unlike holmium laser enucleation of the prostate (HoLEP), transurethral holmium laser deroofing of a prostatic abscess requires no further incision or resection between 10 o'clock and 2 o'clock, because the prostatic abscess is usually not located in the anterior zone of the fibromuscular stroma [ 6 ]. During this procedure, HoLEP was performed in patients with any residual obstructive adenoma [ 7 ].…”

Section: Methodsmentioning

confidence: 99%

“…Among the surgical interventions, such as open perineal drainage, transrectal ultrasound (TRUS)-guided needle aspiration, and transurethral resection of the prostatic abscess, transurethral drainage of the prostatic abscess is often performed in patients diagnosed with multiloculated abscesses, recurrent or residual abscesses, and associated bladder outlet obstruction [ 5 ]. Although many reports have focused on managing prostatic abscesses by use of conventional transurethral drainage, the use of a holmium laser to perform the transurethral approach has not yet been reported [ 4 , 5 , 6 ]. In this study, we describe the technical details of using a transurethral holmium laser for deroofing prostatic abscesses and we evaluate the effect of that procedure.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of holmium laser for transurethral deroofing of severe and multiloculated prostatic abscesses

Lee

Park

et al. 2015

Korean J Urol

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PurposeOur objective was to evaluate the use of a holmium laser for transurethral deroofing of a prostatic abscess in patients with severe and multiloculated prostatic abscesses.Materials and MethodsFrom January 2011 to April 2014, eight patients who were diagnosed with prostatic abscesses and who underwent transurethral holmium laser deroofing at Pusan National University Hospital were retrospectively reviewed.ResultsMultiloculated or multifocal abscess cavities were found on the preoperative computed tomography (CT) scan in all eight patients. All patients who underwent transurethral holmium laser deroofing of a prostatic abscess had successful outcomes, without the need for secondary surgery. Of the eight patients, seven underwent holmium laser enucleation of the prostate (HoLEP) for the removal of residual adenoma. Markedly reduced multiloculated abscess cavities were found in the follow-up CT in all patients. No prostatic abscess recurrence was found. Transient stress urinary incontinence was observed in three patients. The stress urinary incontinence subsided within 3 weeks in two patients and improved with conservative management within 2 months in the remaining patient.ConclusionsTransurethral holmium laser deroofing of prostatic abscesses ensures successful drainage of the entire abscess cavity. Because we resolved the predisposing conditions of prostatic abscess, such as bladder outlet obstruction and prostatic calcification, by simultaneously conducting HoLEP, there was no recurrence of the prostatic abscesses after surgery. We recommend our method in patients requiring transurethral drainage.

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Transurethral Resection of Prostate Abscess: Is It Different from Conventional Transurethral Resection for Benign Prostatic Hyperplasia?

Cited by 13 publications

References 14 publications

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

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

Klebsiella pneumonia-induced prostate abscess: How to work it up?

Evaluation of holmium laser for transurethral deroofing of severe and multiloculated prostatic abscesses

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