Treatment of Prostatic Abscess: Role of Transrectal Ultrasound Guided Needle Aspiration

Background: Prostatic abscess is an uncommon condition and is most often associated with prostatitis. The incidence of prostatic abscess has declined markedly with the widespread use of antibiotics and decreasing incidence of gonococcal urethritis. The management of prostatic abscess consists of antibiotic therapy and aspiration/drainage by transperineal, transrectal and transurethral route.
Objectives: The purpose of the study was to present and discuss the clinical presentation, etiologies, diagnosis and treatment outcome of prostatic abscess at our institute in last 8 years.
Patients and Methods: A retrospective study was carried out on 12 patients diagnosed with prostatic abscess during 2002-2010 at our institute. Age of patients ranged from 17-76 years. The data analyses regarding age, presenting complaint, digital rectal examination, diagnostic imaging, bacteriological profile, treatment modalities and outcome. The collected data was compared with the available latest literature.
Results: 10 patients presented with lower urinary tract symptoms, 5 patients were diabetics, 3 patients presented with retention urine and 3 had fever. Two patients had pyrexia of unknown etiology without any LUTS. Urine culture was sterile in 7 patients. On digital rectal examination fluctuation was present in only 5 patients. Pus culture showed Escherichia coli in 5 patients, Staphylococcus aureus in 3 patients, Pseudomonas aeruginosa and Klebsiella sp. in one patient each. 9 patients were cured by TRUS guided aspiration; only 2 patients underwent transurethral drainage and 1 with concomitant BPH underwent TURP. One patient had retrograde ejaculation after TUR deroofing of abscess.
Conclusions: TRUS guided aspiration of prostatic abscess may be the first line treatment of prostatic abscess. TRUS is also helpful in the diagnosis of prostatic abscess and follow up of patients who are treated conservatively. Other modalities should be reserved for failed treatment.