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

The harmful effects of overlooking acute bacterial prostatitis

Prostatitis is a major urological disease affecting 25%-50% of men over their lifetime. However, prostatitis is often overlooked in nonurologic departments due to its sometimes indeterminate symptoms. In this review, we describe how to recognize and treat acute bacterial prostatitis, which manifests as a clinical problem in other departments as well as urology, to help prevent this disease from being overlooked. There are several possible negative effects of not recognizing acute bacterial prostatitis (ABP). First, initial treatment can fail. In the hyperacute phase, common antibiotics are often effective, but in rare cases, such antibiotics may not be effective. In addition, once ABP progresses to form a prostate abscess, potentially avoidable surgical interventions are often needed. A second issue is the transition to chronic prostatitis. If chronic bacterial prostatitis progresses, treatment requires long-term antibiotic administration and the response rate is not high. Some patients may have to deal with urinary tract infections for the rest of their lives. Finally, there is the problem of overlooking the underlying disease. ABP is rare in healthy adult men without underlying disease, including sexually transmitted diseases as well as benign prostatic hyperplasia, urinary stones, and malignant tumors, and may not be obvious. When examining patients with fever of unknown origin, it is necessary to exclude not only infectious diseases but also collagen diseases and malignant tumors. If there are any doubts, we recommend a rectal exam and consultation with a urologist.

Prostatic Abscess Combined With Spleen Abscess Due to Multi-Drug-Resistant Gram-Negative Bacilli: A Case Report and Literature Review

The prostatic abscess is a rare complication of a bacterial infection of the prostate. Since the early use of potent antibiotics to treat urinary tract infections, the incidence of the prostatic abscess has declined significantly. In keeping with that, prostatic abscess combined with abscesses in the spleen or other distant organs become an extremely rare but fatal clinical condition. Here, we present a case of prostate and spleen abscess due to multi-drug-resistant gram-negative bacilli without obvious risk factors. The patient initially complained of high-grade fever and dysuria. After screening the source of infection by computed tomography (CT) scans, prostate and spleen abscesses were diagnosed. In addition, extended-spectrum beta-lactamase positive Escherichia coli was detected both in urine and blood culture. The patient was successfully treated by a transurethral resection of the prostate followed by splenic puncture and drainage, as well as intravenous administration of meropenem. Although the prostate abscess combined with spleen abscess was rare, the possibility of dissemination in remote tissues should be taken into consideration before the surgical treatment of prostatic abscesses. The concurrent drainage of multiple abscesses followed by intensive and sensitive antibiotics was safe and effective for indicated patients.

Transurethral Drainage of Prostatic Abscess Using 120 W Holmium Laser Technology

Introduction: Prostatic abscess is an infrequent but serious pathology that could be treated by ultrasound-guided puncture, transurethral resection, or open surgery. Case Report: We present a case of a 72-year-old male with a 3x5 cm prostatic abscess in the right lobe showed in abdominal computed tomography (CT). In the blood test, he presented coagulopathy. Urgent transurethral drainage by holmium laser was decided to be performed. It started with incision and opening of the right prostatic lobe with an energy of 1.2 J and a frequency of 20 Hz with a total power of 24 W. A 550-micron fiber was used for this technique. Coagulation of the area was performed with a power of 20 W. The postoperative course was uneventful. Conclusion: The holmium laser appears to be an effective alternative in the treatment of this pathology in patients with coagulation disorders by providing adequate hemostatic control.

Prostatic abscess: clinical features, management, and outcomes of a "Stealth" infection: retrospective case series and review of the literature

Prostatic abscess (PA) is uncommon and may be difficult to distinguish from acute prostatitis which often leads to delayed or missed diagnoses. Although gram-negative bacilli are the traditional etiology of PA, Staphylococcus aureus is an emerging cause. The goals of this study were to characterize the current clinical features, microbiology, management, and outcomes of PA at a US academic center. A retrospective review of adult patients hospitalized with an ICD-9/10 diagnosis of PA between January 2013 and July 2018 was conducted. Inclusion criteria included age ≥18 years, a compatible genitourinary (GU) infection syndrome, and imaging consistent with PA. Relevant data were extracted and analyzed by univariate analysis as appropriate. Twenty-two patients with PA were identified with median age 57 years. Five patients (23%) were immunosuppressed and 11 (50%) had diabetes. No patient had prior PA but 3 had past prostatitis. Only 1 patient had recent GU instrumentation and none had indwelling urinary catheters. The most common presenting symptoms were fever (59%), dysuria (45%), and urinary retention (32%). Only 7 out of 18 (39%) patients had prostate tenderness on exam and none had fluctuance. As demonstrated by computed tomography, PAs were multifocal in 8 (36%) patients and 16 (73%) had PAs >2 cm in diameter. The median abscess size was 3.2 cm. S. aureus was isolated in 60% of positive urine cultures and 78% of positive blood cultures; 46% were methicillin-resistant. Nine patients (41%) received antibiotics alone whereas 13 (59%) required antibiotics plus drainage. The median duration of antimicrobial therapy was 34.5 days. Four week mortality was 9%. When comparing S. aureus PA to other causes, S. aureus patients tended to have higher fevers, more often had diabetes, and received longer durations of antibiotic therapy (median 35 days vs 31 days, P = 0.04) but age, abscess size, and mortality did not differ. PA is relatively uncommon and often clinically unsuspected. Imaging may be critical to accurate diagnosis. Optimal management usually requires antibiotics and sometimes drainage depending on abscess size. We found a significant proportion of cases due to S. aureus which might be relevant when deciding empiric antimicrobial therapy.

Prostate tuberculosis complicated by huge prostatic abscess: A rare case report from Nepal

INTRODUCTION

Prostatic tuberculosis is one of the rarest findings in clinical practice and associated prostatic abscess is even scarce, described in literatures. We present a rare case of prostatic tuberculosis complicated by huge prostatic abscess.

PRESENTATION OF A CASE

A 68-year-old male with no any comorbidity presented with history of increased frequency of micturition along with poor flow, urgency and nocturia for 17 days. He was under medical treatment for benign enlargement of prostate for 2 years. Per rectal examination revealed a boggy cystic swelling anteriorly with enlarged prostate with mild tenderness. Ultrasonography abdomen and pelvis showed massive enlargement of prostate with central avascular necrotic area with moving internal echoes. Contrast enhanced computed tomography (CECT) showed 230 g of prostate with central liquefaction of approximately 101 mm3. Transurethral loop drainage along with resection of prostate was done. Histopathology revealed granulomatous prostatitis highly suggestive of prostatic tuberculosis. Prostatic abscess culture was negative. Patient is currently under category 1 anti-tubercular therapy.

DISCUSSION

Prostatic tuberculosis is a rare clinical finding which is commonly seen in patients with disseminated tuberculosis with immunocompromised status. Prostatic abscess in setting of granulomatous tuberculosis of prostate is even rarer. Transrectal ultrasonography is the investigation of choice for diagnosis of abscess if available. Treatment includes drainage of abscess preferably transurethral, and antitubercular therapy.

CONCLUSION

Trans-urethral loop drainage is a safe treatment modality for patients presenting with prostatic abscess followed by anti-tubercular therapy if histopathology findings are suggestive of granulomatous lesions.

Prostatic abscess: A systematic review of current diagnostic methods, treatment modalities and outcomes

OBJECTIVE

Prostatic abscesses (PAs) are an uncommon urologic presentation with widely varying approaches in their diagnoses and management. This study, therefore, aims to systematically review the literature of PAs to identify common clinical presentations, evaluate currently utilized diagnostic and treatment modalities, and assess their outcomes.

MATERIAL AND METHODS

A systematic review of the literature was performed using the MEDLINE and EMBASE databases, from January 1968 to June 2019. Outcome measures extracted from identified articles included age, the underlying disease, identified pathogens, diagnostic tool utilized, treatment used, and various subsequent clinical outcomes.

RESULTS

The literature search yielded 683 articles, with a final twelve included in the review, representing a total of 210 patients. Transrectal ultrasonography (TRUS) was the most commonly used imaging tool used to identify PAs in all twelve studies. The PAs were treated with conservative antibiotic treatment in seven studies. Transurethral resection of the prostatic abscess (TURP) was utilized in eight studies with an average abscess size of 3.87 cm (3.0-4.0 cm) and with an average hospital stay of 10.22 days in those undergoing TURP. Transperineal aspiration was seen in five studies and offered a less invasive treatment modality. Finally, TRUS-guided needle aspiration was seen in seven studies with an average hospital stay of 23.25 days. This was the longest of any identified modalities with an additional high rate of abscess recurrence.

CONCLUSION

Diagnosis and treatment practices of PAs remain widely varied in the literature due to a lack of clear guidelines. Based on the current evidence, we provide recommendations of treatment based on abscess size, patient age, and clinical condition. While smaller abscesses may be suited to antibiotic or TRUS-guided aspiration, transurethral approaches should be considered for larger and more complex abscesses. However, the current evidence remains poor with further research required to determine the optimum treatment modalities for patients.

Prostate abscess: A comprehensive review of the literature

Prostate abscess (PA) is a rare but serious infection of the prostate gland. Traditionally a complication of urethral gonococcal infection, the majority of PAs are now seen in the older or immunosuppressed populations, in men with existing prostatic disease, or those who have undergone recent instrumentation of the lower urinary tract. Aetiological organisms are diverse, often with non-specific presentations posing a diagnostic challenge. Multiple management options have been described, however no consensus exists on what is the best practice. This comprehensive review examines the literature surrounding this condition in detail, with a focus on diagnostic and surgical treatment options. Recommendations for practice are made where appropriate. This article aims to edge towards a national guideline for the management of PA and inspire more research in the field.

Level of evidence - 3a

Prostatic abscess of Klebsiella pneumonia complicating septic pulmonary emboli and meningitis: A case report and brief review

Prostatic abscess is a rare entity with an incidence of 0.5%-2.5% in all prostate diseases and usually occurs in the 5th and 6th decades of life with immunocompromised status. Prostatic abscess might be a process of evolution from acute prostatitis. Klebsiella pneumoniae is the leading microorganism in the diabetic patients of prostatic abscess in Taiwan. A 60-year-old diabetic man, with a one-week history of acute bacterial prostatitis was reported in this study, presenting to the emergency department with sudden altered mental status. The abdominal computed tomographic scan demonstrated lobulated prostatic abscess and multiple septic pulmonary emboli with lung abscesses. Analysis of cerebrospinal fluid showed white blood cells of 10771 counts/mm³ with segmented neutrophils of 99%. Cultures of blood, cerebrospinal fluid and sputum yielded Klebsiella pneumoniae. We concluded that computed tomographic scan can make a definite diagnosis of prostatic abscess associated with complications and management with empiric antibiotics and adequate drainage is suggested.