Treatment outcomes and clinical experience of prostatic abscess
10.3760/cma.j.cn112330-20240702-00307
- VernacularTitle:前列腺脓肿治疗效果分析及经验总结
- Author:
Yushi ZHANG
1
;
Enhao ZHANG
1
;
Xiaogang LI
1
Author Information
1. 延边大学附属医院泌尿外科，吉林 133000
- Publication Type:Journal Article
- Keywords:
Prostatic abscess;
Therapeutic approach;
Aspiration;
Operation;
Prognosis;
Diabetes
- From:
Chinese Journal of Urology
2025;46(3):198-204
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the treatment efficacy of prostatic abscess and summarize clinical experience.Methods:A retrospective analysis was conducted on clinical data from 23 patients diagnosed with prostatic abscess at Yanbian University Hospital between December 2019 and April 2024. The mean age was (57.72±16.09) years, and BMI was (22.63±2.80) kg/m 2. Comorbidities included diabetes mellitus in 15 cases (65.2%), cardiovascular/cerebrovascular diseases in 12 cases, and hepatitis with cirrhosis in 2 cases. Medical histories comprised benign prostatic hyperplasia in 3 cases (13.0%), prostatitis in 3 cases (13.0%), and recent catheterization in 7 cases. Clinical manifestations included lower urinary tract symptoms in 19 cases and varying degrees of fever in 14 cases. All patients underwent urinary bacterial culture upon admission, with positive results in 8 cases (34.8%): Klebsiella pneumoniae (4 cases), Escherichia coli (2 cases), Staphylococcus aureus (1 case), and Pseudomonas aeruginosa (1 case). All patients received urinary tract ultrasound, while 10 underwent full abdominal CT and 20 underwent prostate MRI. Prostatic abscess was confirmed in 20 cases, while 3 suspected cases were intraoperatively confirmed. In the 23 cases, the maximum abscess cavity diameter ranged from 11 to 70 mm; multiple abscesses (≥2) were observed in 12 cases (52.2%), with pelvic and scrotal involvement noted in 4 cases. All patients received systemic antibiotic therapy, with 4 cases managed conservatively due to favorable baseline status, significant response to antibiotics, and low abscess complexity; 4 cases with favorable baseline status, good response to anti-infective therapy, and younger age, along with at least one large abscess cavity (33-70 mm in diameter), underwent ultrasound-guided transperineal drainage after confirmation of abscess localization strictly within the prostatic region and established purulent material; and 15 cases with poorly controlled infections and complex abscesses (multiloculated/multiple abscesses/extensive involvement/diameter ≥30 mm/volume ≥20 cm 2), abscess cavity (11-40 mm in diameter), underwent transurethral incision and drainage. Results:The follow-up period ranged from 3 months to 1 year, with a mean duration of 10.8 months. No residual or recurrent abscesses were observed in the transurethral incision and drainage group, while 2 cases in the ultrasound-guided drainage group and 1 case in the conservative management group showed persistent abscesses, all of whom were diabetic patients. A comparative analysis stratified by diabetes status revealed significantly higher levels of white blood cell count [16.7 (11.8, 17.4) ×10 9/L vs. 11.9 (7.1, 14.5) ×10 9/L, P = 0.045] and procalcitonin [1.40 (0.8, 3.2) ng/ml vs. 0.3(0, 2.0) ng/ml, P = 0.042] at admission in the diabetic group compared to the non-diabetic group. Conclusions:If the patient has a favorable baseline status and demonstrates a stable clinical response to antibiotic therapy, either ultrasound-guided drainage or conservative management may be selected based on abscess characteristics such as size and location. However, for patients with complex abscesses, particularly those showing suboptimal response to antibiotics, transurethral incision and drainage is recommended. This study also identified diabetes mellitus as a potential significant factor influencing both the severity at disease onset and the prognosis of prostatic abscess.
