Prostate abscess

Prostate abscess
CT scan showing an abscess of the prostate (red arrow) resulting in urinary retention (blue arrow)
Specialty	Urology
Complications	Sepsis[1]
Causes	Acute prostatitis, chronic bacterial prostatitis[1]
Risk factors	Diabetes, foley catheter, prostate biopsy, kidney failure, cirrhosis, poor immune function[1]
Differential diagnosis	Acute prostatitis, urethritis,[1]
Treatment	Incision and drainage, antibiotics, benign prostatic hyperplasia[2][1]
Prognosis	Risk of death 1% to 16%[1]
Frequency	Rare (developed world), relatively common (developing world)[1]

A prostate abscess is a collection of pus within the prostate gland.^[1] Symptoms may include pelvic pain, fever, blood in the urine, and pain with urination.^[1] Low back pain may also be present.^[1] Complications may include urinary retention and sepsis.^[1]

They generally occurs as a complication of acute prostatitis and less commonly chronic bacterial prostatitis.^[1] Risk factors include foley catheter, prostate biopsy, diabetes, kidney failure, cirrhosis, and poor immune function.^[1] While various types of bacteria may be involved, E. coli is most common.^[1] The diagnosis should be suspected in someone who has acute prostatitis that is not improving and can be confirmed by medical imaging.^[1]

Treatment of a prostate abscess often involves incision and drainage and antibiotics.^[2][1] The risk of death is between 1% and 16%.^[1] Well relatively uncommon in the developed world due to the appropriate treatment of acute prostatitis, prostate abscesses are more common in the developed world.^[1] They make up about 0.5% of urologic disease.^[1] Older people are more commonly affected.^[1]

Signs and symptoms

Symptoms often include pelvic pain, fever, and pain with urination.^[1] Complications may include sepsis and urinary retention.^[1]

Cause

Prostate abscess generally occurs as a complication of acute prostatitis.^[1] Risk factors include foley catheter, prostate biopsy, diabetes, kidney failure, cirrhosis, and poor immune function.^[1] While various types of bacteria may be involved, E. coli is most common.^[1]

Diagnosis

CT scan showing an abscess of the prostate (red arrow) resulting in urinary retention (blue arrow)

The diagnosis should be suspected in someone who has acute prostatitis that is not improving and can be confirmed by medical imaging.^[1] The preferred method of imaging is generally ultrasound of the prostate via the rectum.^[1] CT scan of the abdomen and pelvis may be less painful.^[1] MRI may also be useful in certain cases.^[1]

Treatment

Treatment generally involves surgical incision and drainage.^[2] This may be done via the urethra, rectum, abdomen, or skin of the groin.^[2] Antibiotics without surgery may be initially tried for abscesses smaller than 1 cm in diameter.^[1]

References