Elsevier

Urology

Volume 53, Issue 3, March 1999, Pages 548-552
Urology

Adult Urology
Ultrasound-guided needle aspiration in prostatic abscess

https://doi.org/10.1016/S0090-4295(98)00570-6Get rights and content

Abstract

Objectives. To review the clinical presentation of prostatic abscess and to assess the usefulness of ultrasound-guided needle aspiration as a treatment option for this condition.

Methods. Between October 1984 and November 1997, prostatic abscess was diagnosed in 31 patients. The average age was 60 years (range 29 to 79). Prostate ultrasound was performed using either a hypogastric or transrectal approach. Initial therapy included ultrasound-guided needle aspiration in 24 (77.4%), transurethral resection of prostate (TURP) in 5 (16.1%), or conservative management with antibiotic therapy. During follow-up, ultrasound examinations and urine cultures were performed on an outpatient basis.

Results. Past medical history most often included previous urinary infection (15 patients, 48%) and bladder outlet obstruction (13 patients, 42%). Sixty-one percent of patients presented with irritative voiding symptoms at the time of diagnosis. Ultrasound-guided needle aspiration resolved 83.3% of cases; 2 patients needed a second procedure. Three patients required TURP for drainage and 2 to remove an obstruction after abscess resolution.

Conclusions. A high degree of suspicion is needed to diagnose prostatic abscess clinically. Transrectal ultrasound is necessary for the differential diagnosis. Transrectal ultrasound-guided needle aspiration is a technically simple and effective therapeutic procedure with no morbidity and, in case of failure, may be repeated or a drainage TURP may be undertaken.

Section snippets

Material and methods

Between October 1984 and November 1997, prostatic abscess was diagnosed in 31 patients. The average age was 60 years (range 29 to 79). Abscess was diagnosed either at the emergency care unit or as an incidental finding in a control ultrasound examination. After obtaining the patient’s history and making a physical examination, blood analysis, urine culture, and prostate ultrasound were performed. For diagnostic purposes, a 5-mHz real time convex probe was used for the hypogastric approach and a

Results

It is of note that 9 patients (29%) were diabetic and 15 (48%) had a previous history of urinary tract infection (orchitis, cystitis, prostatitis). Thirteen patients (42%) had bladder outlet obstruction (4 were carrying an indwelling bladder catheter, 4 had had acute urine retention, 3 had been diagnosed with urethral stenosis, and in 2, uroflowmetry data were consistent with bladder outlet obstruction according to Siroky’s nomogram). Six patients had neither had a significant urologic disease

Comment

Prostatic abscess is a rare condition, with an incidence of about 0.5% of all prostatic diseases.4 Its incidence has decreased remarkably since the introduction of broad-spectrum antibiotics.1 This decrease is associated with a change in the frequencies of causal microorganisms.5 A study by Sargent and Irwin6 from 1931 showed that Neisseria gonorrhoaea was responsible for 75% of prostatic abscesses, followed in frequency by Staphylococcus aureus.7 At present, major pathogenic microorganisms are

Conclusions

Because of the difficulty involved in clinically distinguishing between acute prostatitis and prostatic abscess, a high degree of suspicion is needed to diagnose the latter. However, making the distinction is important, since the treatment varies depending on the diagnosis. The performance of transrectal ultrasound is thus indicated in those patients with a suspicious digital rectal examination or in those who do not respond to intravenous antibiotic therapy within 48 hours. This procedure does

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