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Prostate Abscess

By

Gerald L. Andriole

, MD, Barnes-Jewish Hospital, Washington University School of Medicine

Last full review/revision Nov 2020| Content last modified Nov 2020
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Prostate abscesses are focal purulent collections that develop as complications of acute bacterial prostatitis.

The usual infecting organisms are aerobic gram-negative bacilli or, less frequently, Staphylococcus aureus.

Symptoms

Common symptoms include

  • Urinary frequency

  • Dysuria

  • Urinary retention

Perineal pain, evidence of acute epididymitis, hematuria, and a purulent urethral discharge are less common. Fever is sometimes present.

Rectal examination may disclose prostate tenderness and fluctuance, but prostate enlargement is often the only abnormality, and sometimes the gland feels normal.

Diagnosis

  • Prostate ultrasonography and possibly cystoscopy

Abscess is suspected in patients with persistent perineal pain and continued or recurrent urinary tract infections despite antimicrobial therapy. Such patients should undergo prostate ultrasonography and possibly cystoscopy.

Many abscesses, however, are discovered unexpectedly during prostate surgery or endoscopy; bulging of a lateral lobe into the prostatic urethra or rupture during instrumentation reveals the abscess. Although pyuria and bacteriuria are common, urine may be normal. Blood cultures are positive in some patients.

Treatment

  • Antibiotics

  • Drainage

Treatment involves appropriate antibiotics plus drainage by transurethral evacuation or transperineal aspiration and drainage. Pending culture results, empiric antibiotic therapy is begun with a fluoroquinolone (eg, ciprofloxacin).

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