Spermatic cord abscess with concurrent prostatic abscess involving the seminal vesicle

Transperineal drainage of prostate abscesses: A minimally invasive, low-risk management strategy that yields satisfactory results

Objectives

In this narrative review, we aim to present two cases of transperineal drainage of prostate abscesses with a good clinical outcome. Furthermore, we reviewed the literature on this treatment approach and aim to propose a minimally invasive protocol for managing this rare condition.

Patients and Methods

Our patients are 33- and 61-year-old males who both underwent uncomplicated transperineal drainage of prostate abscess with the use of a Precision Point device with rapid clinical improvement and complete resolution of the abscess within the follow-up period. We used PubMed to conduct a literature search and included and evaluated 16 relevant case reports and case series in which the authors utilized transperineal drainage techniques for prostatic abscesses.

Results

Our first patient was young and very unwell with sepsis and a pulmonary embolism. He had a complex abscess extending through the prostate to the left pelvic side wall. Trans-gluteal drainage of the pelvic side-wall collection was required in addition to transperineal drainage of the prostate abscess. After drainage and a prolonged course of antibiotics, he achieved resolution of the abscess by 7 weeks with ejaculatory function intact. Our second patient who was very keen on the preservation of ejaculatory function had multiple small abscesses and underwent transperineal drainage. He had significant interval improvement of his abscess burden at the 4-week follow-up and complete resolution at the 6-month follow-up. The total number of cases in the literature on our review is 22, with considerable variability in how the authors managed the prostate abscesses that underwent transperineal drainage, including variability in their follow-up time frame, choice of imaging modality, duration of antibiotic treatment, drain placement, and use of irrigation solutions (including antibiotics) into the abscess cavity. Furthermore, the sizes of the prostate abscesses were not consistently reported. Given the small sample size and variability in management from different authors, it was not possible to draw any statistical analysis.

Conclusion

Transperineal prostate abscess drainage combined with prolonged antibiotic therapy provides a less invasive alternative to treating prostate abscesses for those who which to preserve ejaculatory function and avoid the other adverse events of transurethral de-roofing. In itself, it can achieve complete resolution of abscess. It provides the benefit of drainage under real-time imaging; for percutaneous drain placement; prevents urethral injury; retrograde ejaculation; and can be done under local anaesthetic which is preferable for the unstable patient. The utility of the procedure may be limited by the complexity of the abscess or whether it has extended beyond the prostate. The patient should always be informed that further drainage via percutaneous methods or transurethral methods may be necessary if their clinical condition does not improve. We recommend this procedure be offered as an alternative to transurethral methods in younger patients and those who would like to preserve ejaculatory function. Furthermore, we highly encourage a prolonged course of antibiotic therapy and interval follow-up with clinical review of symptoms and imaging to confirm resolution.

Acute diffuse peritonitis secondary to a seminal vesicle abscess: A case report

BACKGROUND

Seminal vesicle abscess (SVA) is the manifestation of a relatively rare urinary system infection. In response to urinary system inflammation, an abscess forms in special locations. However, acute diffuse peritonitis (ADP) induced by SVA is unusual.

CASE SUMMARY

We report a case of a left SVA in a male patient complicated with pelvic abscess, ADP, multiple organ dysfunction syndrome, infectious shock, bacteremia, and acute appendiceal extraserous suppurative inflammation as a result of a long-term indwelling urinary catheter. The patient received a course of morinidazole + cefminol antibiotics but showed no obvious relief, so the perineal SVA underwent puncture drainage and abdominal abscess drainage + appendectomy was performed. The operations were successful. After the operation, anti-infection, anti-shock, and nutritional support treatments were continued and various laboratory indicators were regularly reviewed. The patient was discharged from the hospital after recovery. This disease is a challenge for the clinician because of the unusual spreading path of the abscess. Moreover, appropriate intervention and adequate drainage of abdominal and pelvic lesions are necessary, especially when the primary focus cannot be determined.

CONCLUSION

The etiology of ADP varies, but acute peritonitis secondary to SVA is very rare. In this patient, the left SVA not only affected the adjacent prostate and bladder but also spread retrogradely through the vas deferens, forming a pelvic abscess in the loose tissues of the extraperitoneal fascia layer. Inflammation involving the peritoneal layer led to ascites and pus accumulation in the abdominal cavity, and appendix involvement led to extraserous suppurative inflammation. In clinical practice, surgeons need to consider the results of various laboratory tests and imaging examinations to make comprehensive judgments involving the diagnosis and treatment plan.

Spermatic cord abscess: Case report and imaging findings

Spermatic cord abscess is a rare condition usually associated with other genitourinary infections. We present a case of a 49-year-old male with past medical history of uncontrolled diabetes mellitus. He presented with right groin swelling and pain for a week. Ultrasound showed a tubular hyperemic structure extending into the scrotal sac. Computed tomography showed concurrent perinephric abscess and right spermatic cord abscess. The spermatic cord abscess was managed surgically by incision and drainage. To our knowledge, this is the first case report of a patient with spermatic cord abscess and concurrent perinephric abscess. We highlight the clinical importance of familiarity with such a rare condition and the role of imaging in establishing the correct diagnosis while excluding close differentials.

Diagnosis and treatment of community-associated methicillin-resistant Staphylococcus aureus prostatic abscess involving the seminal vesicle: A case report

Prostatic abscess involving the seminal vesicle is a rare disease due to the widespread use of broad-spectrum antibiotics in patients with lower urinary tract symptoms. With the elevated risk of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), a great emphasis on its pathogenicity in prostatic abscesses is required. To the best of our knowledge, this is the first study to describe the use of ultrasound perfusion imaging and traditional computed tomography to diagnose a patient with CA-MRSA prostate abscess involving the seminal vesicle. In the present case, the patient was successfully treated via adjuvant antibiotics and transrectal ultrasonography (TRUS)-guided prostate needle aspiration. Prostatic abscess involving the seminal vesicle is an uncommon disease with a potential risk of mortality if the appropriate treatment is not provided, and thus deserves particular attention. Ultrasound perfusion imaging plays an important role in the diagnosis of prostatic abscess involving the seminal vesicle. In the present case, early treatment with adjuvant antibiotics and TRUS-guided needle aspiration of the prostatic abscess resulted in a shorter hospital stay, and lower risk of local recurrence and mortality.

Spermatic cord abscess: a rare complication of epididymo-orchitis, the diagnosis and management

We present a case of a 54-year-old man who had a history of poorly controlled diabetes and end-stage renal failure on haemodialysis. He presented with an acute left groin swelling that was diagnosed to be a rare occurrence of spermatic cord abscess. Two months prior to this, he had had an episode of bacterial epididymo-orchitis that was treated with oral antibiotics. An urgent CT of the abdomen and pelvis was performed to rule out incarcerated inguinal hernia. The spermatic cord abscess was initially managed with appropriate intravenous antibiotics and ultrasound-guided percutaneous drainage. When the pus eventually accumulated in the scrotum, an open incision and drainage of the scrotum was also performed. He achieved complete resolution after 2 months.