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

AUTHORS

Timur Kuru 1 , * , Boris Hadaschik 1

1 Department of Urology, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany

How to Cite: Kuru T, Hadaschik B. Treatment of Prostatic Abscess: Role of Transrectal Ultrasound Guided Needle Aspiration, Nephro-Urol Mon. 2012 ; 4(2):485-486. doi: 10.5812/numonthly.2665.

ARTICLE INFORMATION

Nephro-Urology Monthly: 4 (2); 485-486
Published Online: March 1, 2012
Article Type: Letter
Received: October 9, 2011
Revised: October 13, 2011
Accepted: October 24, 2011
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Keywords

Ultrasound Perinum Transrectal Prostate

Copyright © 2012, Nephrology and Urology Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

Dear Editor,

The report by Yadav et al. concerned 12 patients with abscesses within the prostate which were treated with transrectal ultrasound (TRUS) guided needle aspiration (1). Of these 12 patients, 4 had residual abscesses detected in a follow-up TRUS after 1 week and 3 needed further intervention. All patients were treated with antibiotics for 4 weeks.

The treatment of acute prostatitis has frequently been described (2-5). There is wide consensus, that abscesses of the prostate which are visible in a TRUS should be evacuated (4). If the abscess is located in the transition zone of the prostate or concomitant benign prostatic hyperplasia is present, a transurethral resection of the prostatic tissue can also be performed (2). Abscess drainage can be accomplished using either aspiration alone or by temporary drainage placement. This decision should be based on the patient’s general condition, age, comorbidities and abscess volume. If such an intervention is needed, we would recommend the transperineal approach either for needle aspiration or drainage placement. This type of technique has been described previously (6).

The advantage of the perineal approach is in preserving the integrity of the rectal wall and Denonvillier’s fascia to avoid further periprostatic or systemic spread of bacteria during the intervention, which could lead to general sepsis.

Regarding the residual abscess rate of 33% (4/12) intermittent drainage instead of pure aspiration may have been a more appropriate treatment approach. However, this decision has to be made with consideration of all the patient’s clinical aspects at the time of admittance. Regardless of the intervention a 4-week antibiotic treatment according to the microbiology results is common standard practice.

Footnotes

References

  • 1.

    Yadav AS, Singh SK, Pawar DS, Sharma S, Aggarwal T, Kumari A. Treatment of prostatic abscess: role of transrectal ultrasound guided needle aspiration. Nephro-Urol Mon. 2011; 3(4) : 264 -7

  • 2.

    Nickel JC. Campbell-Walsh Urology. 2007;

  • 3.

    Brede CM, Shoskes DA. The etiology and management of acute prostatitis. Nat Rev Urol. 2011; 8(4) : 207 -12 [DOI][PubMed]

  • 4.

    Kravchick S, Cytron S, Agulansky L, Ben-Dor D. Acute prostatitis in middle-aged men: a prospective study. BJU Int. 2004; 93(1) : 93 -6 [DOI][PubMed]

  • 5.

    Sharp VJ, Takacs EB, Powell CR. Prostatitis: diagnosis and treatment. Am Fam Physician. 2010; 82(4) : 397 -406

  • 6.

    Mason BM, Hakimi AA, Clerkin KJ, Silva JV. Successful percutaneous transperineal drainage of a large prostatic abscess. Urology. 2010; 76(6) : 1369 -70 [DOI][PubMed]

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