Clinical Management and Treatment Outcomes of Prostatic Abscess in a Tertiary Care Center

Clinical Management and Treatment Outcomes of Prostatic Abscess in a Tertiary Care Center | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Management and Treatment Outcomes of Prostatic Abscess in a Tertiary Care Center Xuan Thai Ngo, Hoai Phan Nguyen, Hoai Tam Ly, Minh Sam Thai, Quy Thuan Chau, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4739578/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Prostatic abscess (PA) is an uncommon but serious urological emergency with a high mortality rate if not properly treated. It can lead to severe complications, including urosepsis and death. Diagnosing and treating PA remains challenging due to limited comparative studies on treatment modalities. Objective This study aims to characterize the clinical features and evaluate the treatment outcomes of prostatic abscesses treated at our center. Methods This retrospective study describes a case series of patients hospitalized with PA at our hospital from January 2017 to April 2020. Results Seventy-six cases of PA were confirmed using transrectal ultrasonography (TRUS), MRI, or CT scan. The mean age was 51.58 years (range 24 to 85). The most common predisposing factors were diabetes mellitus, urinary tract infections, and immunodeficiency. Presenting symptoms included lower urinary tract symptoms (67%), fever and chills (47%), and perineal pain (32%). Digital rectal examination revealed a severely tender prostate with areas of fluctuation in two-thirds of cases. Single abscess cavities were found in 36.84% of cases, while 63.16% had multiple cavities. Bacteria were isolated from urine, pus, and blood in 31.34%, 58.2%, and 19.6% of cases, respectively, with E. coli and Burkholderia pseudomallei being predominant pathogens. Mycobacterium tuberculosis was found in the pus of 4 out of 45 cases. Management included conservative treatment in 5 cases (6.58%) and surgical interventions in most cases: open cystostomy with abscess drainage (50%), TRUS-guided aspiration (15.79%), and transurethral resection deroofing (23.68%). Successful treatment was achieved in 93% of cases. Conclusion Prostatic abscess is a serious infection with high mortality. Early diagnosis, appropriate antibiotic therapy, and surgical intervention are crucial for successful treatment. Empirical antibiotic decisions should adhere to the guidelines of each medical facility. Prostate abscess TRUS TUR deroofing Figures Figure 1 Figure 2 Figure 3 Introduction Prostatic abscess (PA) is rare and commonly a complication of acute bacterial prostatitis (ABP), thought to occur through reflux of infected urine contents into prostatic ducts 7 . The mortality ranges from 3–16% 2,3 . The incidence of PA peaks in the fifth and sixth decades, but can affect males of all ages 1 . PA was estimated to affect 0.2–0.5% of males, comprising 0.5–2.5% of all prostatic disease 1 – 3 . E. coli is the most common pathogen seen in more than 70% of PA. The incidence of PA is rising in older patients with primarily voiding dysfunction as a result of forms of bladder outlet obstruction, or urinary tract infection and especially in men with immune deficiency disorders such as diabetes, chronic renal failure, cirrhosis, cancer and HIV/AIDS 1,3,4 . Misdiagnosis and delayed treatment of PA can lead to severe sepsis, multiple organ dysfunction syndrome, and even death. Treatment strategies involve drainage and antibiotics, with the choice of surgical intervention based on the size and number of abscess cavities. While several methods for surgical drainage exist, ultrasound-guided aspiration or transurethral deroofing are preferred over open drainage in the era of minimally invasive surgeries 3 , 5 , 6 Due to the lack of management guidelines and limited research, diagnosing and treating prostatic abscess (PA) remains challenging for clinicians. Our study aims to provide practitioners with additional data on the clinical characteristics, pathogens, and outcomes of various interventions in PA patients. Material and methods This retrospective case series study describes patients hospitalized with prostatic abscess (PA) at our center from January 2017 to June 2022. This study was approved by our Institutional Review Board. PA was diagnosed based on physical examination, digital rectal examination, and confirmed by radiological methods including transrectal ultrasound (TRUS), CT scan, or MRI. Once PA was confirmed, all patients were promptly started on broad-spectrum intravenous antibiotics, which were later adjusted based on antibiogram results. The decision to perform surgical drainage was based on the diameter and number of abscess cavities as well as the patient's general condition. Surgical interventions included transrectal ultrasound-guided aspiration, transurethral deroofing, transurethral resection of the prostate, and open drainage. Outcomes were assessed based on the improvement of clinical symptoms and a reduction of at least 50% in the volume of the abscess cavity as evaluated by TRUS. Variables collected in the database included patient demographics, clinical signs and symptoms, imaging findings, surgical morbidity, postoperative morbidity, and intervention outcomes. For variables with a non-normal distribution, data were presented as median and interquartile range (IQR). Means and medians were reported for continuous variables, while proportions and frequencies were reported for categorical variables. Means were compared using the Student’s t-test. For variables with a non-normal distribution, the Mann-Whitney U test was used to compare two groups. Proportions were compared using Chi-squared tests with continuity correction or Fisher’s exact test when appropriate. All analyses were performed using R software version 4.2.0 (R Foundation for Statistical Computing, Vienna, Austria). Results A total of 76 patients with prostatic abscess (PA) were referred to our clinic over more than five years, with a mean age of 51.58 years. Predisposing conditions were detected in two-thirds of the patients, with diabetes mellitus being the most common (nearly 50% of cases), followed by bladder voiding disturbances (15.79% of cases). Nearly all patients exhibited leukocytosis, with a mean white blood cell (WBC) count of 15.21 ± 11.22 G/L. The mean serum PSA level at hospitalization was 5.46 ± 27.74 ng/dL (range 0.04–100). Subjective and objective signs are detailed in Table 1 . Table 1 Signs and Symptoms of prostatic abscess in our study Physical Examination N = 76 % Subjective Signs Dysuria 64 84,2 Frequency 61 80,3 Fever 47 61,84 Perineal pain 30 39,47 Urinary retention 32 42,1% Objective Signs Prostatic pain 49 64,47 Prostatic fluctuation 47 61,84 Complications of PA occurred in 7 out of 76 patients (9.21%), including sepsis in six cases, spontaneous fistulation into the rectum in one case, and into the perineum in another case. PA was diagnosed using abdominal ultrasound in 53 out of 76 cases (69.74%), transrectal ultrasound (TRUS) in 18 out of 76 cases (23.68%), CT scan in 58 out of 76 cases (76.32%), and MRI in 2 out of 76 cases (2.63%). Imaging characteristics revealed multiple abscess cavities in 63.16% of patients, with the largest diameter being greater than 1 cm in 94.74% of cases. Pathogens were isolated from urine specimens in 31.34% of cases, from abscess fluid in 58.2%, and from blood in 19.6%. Gram-negative bacteria were predominant (87% of cases), while gram-positive bacteria accounted for 13% of cases. Detailed information on isolated pathogens is provided in Table 2 . Upon confirmation of PA, all patients were prescribed intravenous antibiotics, predominantly carbapenems (63% of cases). Combined antibiotic therapy (two or three types) was used in 35 out of 76 cases (46.05%). Antibiotic susceptibility of isolated pathogens is shown in Fig. 1 for gram-negative bacteria and Fig. 2 for gram-positive bacteria. In this series, 5 out of 76 cases (6.58%) recovered with conservative treatment, while the remaining 93.42% underwent surgical drainage. Patients who received conservative treatment had abscess cavities less than 1 cm in diameter and mild symptoms. Various surgical methods are described in Table 3 . A total of 71 out of 76 cases (93.42%) recovered and were discharged from the hospital. Three cases (3.95%) required a second surgical drainage, and two patients (2.63%) died. The mean length of hospital stay was 10.8 ± 14.4 days (range 2–45 days). Table 2. Isolated pathogens in urine, abscess fluid and blood. Table 3 Treatment methods of PA in our study Treatment N % Conservative treatment 5 6,58% Open drainage + cystostomy 38 50% Transurethral deroofing 12 15,79% Transurethral resection of prostate 3 23% Ultrasound guided aspiration transrectal approach 18 23,68% Total 76 100 Discussion Prostatic abscess (PA) presents with non-specific symptoms similar to acute bacterial prostatitis (ABP), including lower urinary tract symptoms such as dysuria, urgency, frequency, and sensation of incomplete voiding, along with suprapubic or perineal pain. Occasionally, patients may exhibit hematuria or pus discharge from the urethra. Urinary retention can occur in up to one-third of patients if the abscess is large enough to obstruct outflow. One-third of patients present with systemic symptoms such as fever, malaise, or sepsis. On physical examination, over 95% of patients experience prostate pain on digital rectal examination (DRE). Although fluctuance on DRE is considered pathognomonic for PA, its incidence varies widely in the literature (16–88%) 3 , 5 , 8 . In our study, we found prostatic pain and fluctuance in nearly two-thirds of patients. In the post-antibiotic era, PA has shifted from primarily affecting young sexually active men to those who are debilitated and immunocompromised. While gonorrheal infections were once the most common cause, Gram-negative bacteria such as E. coli now account for over 70% of cases 1 , 4 . This infection typically results from the reflux of infected urine into prostatic ducts. Hematogenous spread from infections in other organs, such as the lungs, digestive tract, skin, or kidneys, can also cause PA, with Staphylococcus aureus being the most common pathogen via this route. Less common pathogens include Mycobacterium tuberculosis and Burkholderia pseudomallei (causing melioidosis) 1 , 2 , 6 . Melioidosis involves multiple organs, including the prostate gland. Treatment often requires both broad-spectrum antibiotics and abscess drainage. In our study, all 13 cases underwent abscess drainage, with a successful outcome in 12 out of 13 cases. The incidence of prostatic tuberculosis in our study (8.57%) is higher than in other reports (5.9%) due to the endemic nature of tuberculosis in Vietnam. Treatment of prostatic tuberculosis requires both anti-tuberculosis drugs and drainage due to the difficulty of drug penetration into the prostatic and blood-prostate barriers. Among our six cases, five were treated with drainage and one with medication alone due to the small size of the lesion. Various imaging modalities, including TRUS, CT scan, and MRI, can accurately diagnose PA. TRUS is the most common and cost-effective method for initial diagnosis, therapeutic intervention, and monitoring recovery 2 , 3 , 5 . Recent studies indicate that CT scan and MRI do not offer significant advantages over TRUS except in early abscess formation or when the abscess extends beyond the prostate gland 3 , 5 . Early diagnosis of PA is crucial for immediate treatment. Currently, there are no standardized guidelines for diagnosing and treating PA. Most published data consists of case reports and reviews, with only a few case series. Treatment typically involves broad-spectrum antibiotics, abscess drainage, urinary diversion in cases of obstruction, and supportive care 2 , 8 , 9 . Some experts recommend using antibiotics alone in stable patients with small (< 1 cm), monofocal abscesses 1 , 2 , 10 . If an abscess does not respond to antibiotics within two weeks, surgical drainage is warranted. In our series, 63.16% of PA cases had multiple cavities, and 94.74% had abscesses larger than 1 cm in diameter. Conservative treatment was successful in 5 out of 76 cases with small abscesses, consistent with other recommendations 1 , 3 . In our series, 63.16% of PA cases had multiple cavities, and 94.74% had abscesses larger than 1 cm in diameter. Conservative treatment was successful in 5 out of 76 cases with small abscesses, consistent with other recommendations. Upon PA confirmation, we immediately prescribed antibiotics, with carbapenems and combined antibiotic therapy used in 60% and 46.05% of cases, respectively. The choice of antibiotics was based on antibiotic stewardship, local resistance patterns, and susceptibility testing. Most authors recommend surgical drainage for PA with multiple cavities, abscesses larger than 1 cm, recurrent PA, sepsis, associated lower urinary tract obstruction, or failure of conservative treatment 3 , 7 , 10 . Several drainage methods, including ultrasound-guided aspiration, transurethral deroofing, and open drainage, have been reported to be effective and feasible. Ultrasound-guided aspiration is preferred for its minimally invasive nature, low morbidity, and repeatability in case of incomplete drainage 5 , 8 , 11 . Transurethral deroofing may be more appropriate for large, multiloculated abscesses, recurrent infections, or those associated with benign prostatic hypertrophy (BPH). This method has been linked to shorter hospital stays compared to needle aspiration 1 , 5 , 6 . In our study, we performed ultrasound-guided transrectal aspiration and transurethral deroofing in nearly 50% of cases, with no complications or recurrences. Open drainage was performed in over 50% of cases, yielding good outcomes. Our results showed that surgical drainage was effective in over 90% of cases, consistent with other studies reporting success rates of 60 to 90%. We had two deaths due to sepsis and multi-organ failure, and three cases required re-drainage with no complications. Although the low incidence of PA limits the establishment of a standardized treatment algorithm, our treatment approaches yielded good results. The choice of treatment method depends on patient condition, abscess size and location, extension to surrounding structures, and available resources. Our treatment algorithm for PA at our center is presented in Fig. 3 . Conclusion Prostatic abscess (PA) is a severe lower urinary tract infection that presents a diagnostic challenge for clinicians. An ideal treatment algorithm has yet to be established. Early diagnosis should be made through a combination of clinical examination and transrectal ultrasound (TRUS). Once PA is confirmed, broad-spectrum antibiotics should be administered promptly. Conservative treatment may be considered for selected cases with small (< 1 cm) and monofocal abscess formations. However, the majority of patients will require drainage procedures. Abbreviations PA- Prostatic abscess, TRUS-Transrectal ultrasonography, ABP- Acute bacterial prostatitis, MRI-Magnetic Resonance Imaging, CT- Computed Tomography, DRE- Digital Rectal exam, BPH-Benign prostatic hyperplasia. Declarations Ethics declarations Conflict of interest The authors declare that they have no conflict of interest. Research involving human participants All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The research was performed with institutional review board approval. Informed consent The research involved retrospective data analysis of a prospective database. Data analysis was performed on the identified patient data, and consent was waived. Funding support This study receives no funding support. Availability of supporting data The data that support the findings of this study are available from the corresponding author upon reasonable request. Acknowledgements Not applicable. References Ackerman AL, Parameshwar PS, Anger JT. Diagnosis and treatment of patients with prostatic abscess in the post-antibiotic era. International Journal of Urology . 2018;25(2):103-110. doi:https://doi.org/10.1111/iju.13451 Abdelmoteleb H, Rashed F, Hawary A. Management of prostate abscess in the absence of guidelines. International braz j urol : official journal of the Brazilian Society of Urology . Sep-Oct 2017;43(5):835-840. doi:10.1590/s1677-5538.ibju.2016.0472 Ludwig M, Schroeder-Printzen I, Schiefer HG, Weidner W. Diagnosis and therapeutic management of 18 patients with prostatic abscess. Urology . 1999/02/01/ 1999;53(2):340-345. doi:https://doi.org/10.1016/S0090-4295(98)00503-2 Khudhur H, Brunckhorst O, Muir G, Jalil R, Khan A, Ahmed K. Prostatic abscess: A systematic review of current diagnostic methods, treatment modalities and outcomes. Turkish journal of urology . May 27 2020;46(4):262-73. doi:10.5152/tud.2020.19273 El-Shazly M, El-Enzy N, El-Enzy K, Yordanov E, Hathout B, Allam A. Transurethral drainage of prostatic abscess: points of technique. Nephro-urology monthly . Spring 2012;4(2):458-61. doi:10.5812/numonthly.3690 Jang K, Lee DH, Lee SH, Chung BH. Treatment of prostatic abscess: case collection and comparison of treatment methods. Korean journal of urology . Dec 2012;53(12):860-4. doi:10.4111/kju.2012.53.12.860 Lee DS, Choe HS, Kim HY, et al. Acute bacterial prostatitis and abscess formation. BMC urology . Jul 7 2016;16(1):38. doi:10.1186/s12894-016-0153-7 Granados EA, Riley G, Salvador J, Vicente J. Prostatic Abscess: Diagnosis and Treatment. The Journal of Urology . 1992/07/01/ 1992;148(1):80-82. doi:https://doi.org/10.1016/S0022-5347(17)36516-3 Doble A, Carter SSC. Ultrasonographic Findings in Prostatitis. Urologic Clinics of North America . 1989/11/01/ 1989;16(4):763-772. doi:https://doi.org/10.1016/S0094-0143(21)01810-3 Alnadhari I, Sampige VRP, Abdeljaleel O, et al. Presentation, diagnosis, management, and outcomes of prostatic abscess: comparison of three treatment modalities. Therapeutic advances in urology . Jan-Dec 2020;12:1756287220930627. doi:10.1177/1756287220930627 Elshal AM, Abdelhalim A, Barakat TS, Shaaban AA, Nabeeh A, Ibrahiem el H. Prostatic abscess: Objective assessment of the treatment approach in the absence of guidelines. Arab journal of urology . Dec 2014;12(4):262-8. doi:10.1016/j.aju.2014.09.002 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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The mortality ranges from 3\u0026ndash;16%\u003csup\u003e2,3\u003c/sup\u003e. The incidence of PA peaks in the fifth and sixth decades, but can affect males of all ages\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. PA was estimated to affect 0.2\u0026ndash;0.5% of males, comprising 0.5\u0026ndash;2.5% of all prostatic disease\u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. \u003cem\u003eE. coli\u003c/em\u003e is the most common pathogen seen in more than 70% of PA. The incidence of PA is rising in older patients with primarily voiding dysfunction as a result of forms of bladder outlet obstruction, or urinary tract infection and especially in men with immune deficiency disorders such as diabetes, chronic renal failure, cirrhosis, cancer and HIV/AIDS\u003csup\u003e1,3,4\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMisdiagnosis and delayed treatment of PA can lead to severe sepsis, multiple organ dysfunction syndrome, and even death. Treatment strategies involve drainage and antibiotics, with the choice of surgical intervention based on the size and number of abscess cavities. While several methods for surgical drainage exist, ultrasound-guided aspiration or transurethral deroofing are preferred over open drainage in the era of minimally invasive surgeries\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDue to the lack of management guidelines and limited research, diagnosing and treating prostatic abscess (PA) remains challenging for clinicians. Our study aims to provide practitioners with additional data on the clinical characteristics, pathogens, and outcomes of various interventions in PA patients.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eThis retrospective case series study describes patients hospitalized with prostatic abscess (PA) at our center from January 2017 to June 2022. This study was approved by our Institutional Review Board. PA was diagnosed based on physical examination, digital rectal examination, and confirmed by radiological methods including transrectal ultrasound (TRUS), CT scan, or MRI. Once PA was confirmed, all patients were promptly started on broad-spectrum intravenous antibiotics, which were later adjusted based on antibiogram results. The decision to perform surgical drainage was based on the diameter and number of abscess cavities as well as the patient's general condition. Surgical interventions included transrectal ultrasound-guided aspiration, transurethral deroofing, transurethral resection of the prostate, and open drainage. Outcomes were assessed based on the improvement of clinical symptoms and a reduction of at least 50% in the volume of the abscess cavity as evaluated by TRUS.\u003c/p\u003e \u003cp\u003eVariables collected in the database included patient demographics, clinical signs and symptoms, imaging findings, surgical morbidity, postoperative morbidity, and intervention outcomes. For variables with a non-normal distribution, data were presented as median and interquartile range (IQR). Means and medians were reported for continuous variables, while proportions and frequencies were reported for categorical variables. Means were compared using the Student\u0026rsquo;s t-test. For variables with a non-normal distribution, the Mann-Whitney U test was used to compare two groups. Proportions were compared using Chi-squared tests with continuity correction or Fisher\u0026rsquo;s exact test when appropriate. All analyses were performed using R software version 4.2.0 (R Foundation for Statistical Computing, Vienna, Austria).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 76 patients with prostatic abscess (PA) were referred to our clinic over more than five years, with a mean age of 51.58 years. Predisposing conditions were detected in two-thirds of the patients, with diabetes mellitus being the most common (nearly 50% of cases), followed by bladder voiding disturbances (15.79% of cases). Nearly all patients exhibited leukocytosis, with a mean white blood cell (WBC) count of 15.21\u0026thinsp;\u0026plusmn;\u0026thinsp;11.22 G/L. The mean serum PSA level at hospitalization was 5.46\u0026thinsp;\u0026plusmn;\u0026thinsp;27.74 ng/dL (range 0.04\u0026ndash;100). Subjective and objective signs are detailed in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSigns and Symptoms of prostatic abscess in our study\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePhysical Examination\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;76\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubjective Signs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDysuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e84,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e80,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e61,84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerineal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e39,47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrinary retention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e42,1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eObjective Signs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProstatic pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e64,47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProstatic fluctuation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e61,84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eComplications of PA occurred in 7 out of 76 patients (9.21%), including sepsis in six cases, spontaneous fistulation into the rectum in one case, and into the perineum in another case. PA was diagnosed using abdominal ultrasound in 53 out of 76 cases (69.74%), transrectal ultrasound (TRUS) in 18 out of 76 cases (23.68%), CT scan in 58 out of 76 cases (76.32%), and MRI in 2 out of 76 cases (2.63%).\u003c/p\u003e\n\u003cp\u003eImaging characteristics revealed multiple abscess cavities in 63.16% of patients, with the largest diameter being greater than 1 cm in 94.74% of cases. Pathogens were isolated from urine specimens in 31.34% of cases, from abscess fluid in 58.2%, and from blood in 19.6%. Gram-negative bacteria were predominant (87% of cases), while gram-positive bacteria accounted for 13% of cases. Detailed information on isolated pathogens is provided in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eUpon confirmation of PA, all patients were prescribed intravenous antibiotics, predominantly carbapenems (63% of cases). Combined antibiotic therapy (two or three types) was used in 35 out of 76 cases (46.05%). Antibiotic susceptibility of isolated pathogens is shown in Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e for gram-negative bacteria and Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e for gram-positive bacteria.\u003c/p\u003e\n\u003cp\u003eIn this series, 5 out of 76 cases (6.58%) recovered with conservative treatment, while the remaining 93.42% underwent surgical drainage. Patients who received conservative treatment had abscess cavities less than 1 cm in diameter and mild symptoms. Various surgical methods are described in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. A total of 71 out of 76 cases (93.42%) recovered and were discharged from the hospital. Three cases (3.95%) required a second surgical drainage, and two patients (2.63%) died. The mean length of hospital stay was 10.8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.4 days (range 2\u0026ndash;45 days).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Isolated pathogens in urine, abscess fluid and blood.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1723230806.png\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eTreatment methods of PA in our study\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTreatment\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConservative treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6,58%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOpen drainage\u0026thinsp;+\u0026thinsp;cystostomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTransurethral deroofing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15,79%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTransurethral resection of prostate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUltrasound guided aspiration transrectal approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23,68%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eProstatic abscess (PA) presents with non-specific symptoms similar to acute bacterial prostatitis (ABP), including lower urinary tract symptoms such as dysuria, urgency, frequency, and sensation of incomplete voiding, along with suprapubic or perineal pain. Occasionally, patients may exhibit hematuria or pus discharge from the urethra. Urinary retention can occur in up to one-third of patients if the abscess is large enough to obstruct outflow. One-third of patients present with systemic symptoms such as fever, malaise, or sepsis. On physical examination, over 95% of patients experience prostate pain on digital rectal examination (DRE). Although fluctuance on DRE is considered pathognomonic for PA, its incidence varies widely in the literature (16\u0026ndash;88%) \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. In our study, we found prostatic pain and fluctuance in nearly two-thirds of patients.\u003c/p\u003e \u003cp\u003eIn the post-antibiotic era, PA has shifted from primarily affecting young sexually active men to those who are debilitated and immunocompromised. While gonorrheal infections were once the most common cause, Gram-negative bacteria such as E. coli now account for over 70% of cases \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. This infection typically results from the reflux of infected urine into prostatic ducts. Hematogenous spread from infections in other organs, such as the lungs, digestive tract, skin, or kidneys, can also cause PA, with Staphylococcus aureus being the most common pathogen via this route. Less common pathogens include Mycobacterium tuberculosis and Burkholderia pseudomallei (causing melioidosis) \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMelioidosis involves multiple organs, including the prostate gland. Treatment often requires both broad-spectrum antibiotics and abscess drainage. In our study, all 13 cases underwent abscess drainage, with a successful outcome in 12 out of 13 cases. The incidence of prostatic tuberculosis in our study (8.57%) is higher than in other reports (5.9%) due to the endemic nature of tuberculosis in Vietnam. Treatment of prostatic tuberculosis requires both anti-tuberculosis drugs and drainage due to the difficulty of drug penetration into the prostatic and blood-prostate barriers. Among our six cases, five were treated with drainage and one with medication alone due to the small size of the lesion.\u003c/p\u003e \u003cp\u003eVarious imaging modalities, including TRUS, CT scan, and MRI, can accurately diagnose PA. TRUS is the most common and cost-effective method for initial diagnosis, therapeutic intervention, and monitoring recovery \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Recent studies indicate that CT scan and MRI do not offer significant advantages over TRUS except in early abscess formation or when the abscess extends beyond the prostate gland \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEarly diagnosis of PA is crucial for immediate treatment. Currently, there are no standardized guidelines for diagnosing and treating PA. Most published data consists of case reports and reviews, with only a few case series. Treatment typically involves broad-spectrum antibiotics, abscess drainage, urinary diversion in cases of obstruction, and supportive care \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Some experts recommend using antibiotics alone in stable patients with small (\u0026lt;\u0026thinsp;1 cm), monofocal abscesses \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. If an abscess does not respond to antibiotics within two weeks, surgical drainage is warranted. In our series, 63.16% of PA cases had multiple cavities, and 94.74% had abscesses larger than 1 cm in diameter. Conservative treatment was successful in 5 out of 76 cases with small abscesses, consistent with other recommendations \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. In our series, 63.16% of PA cases had multiple cavities, and 94.74% had abscesses larger than 1 cm in diameter. Conservative treatment was successful in 5 out of 76 cases with small abscesses, consistent with other recommendations. Upon PA confirmation, we immediately prescribed antibiotics, with carbapenems and combined antibiotic therapy used in 60% and 46.05% of cases, respectively. The choice of antibiotics was based on antibiotic stewardship, local resistance patterns, and susceptibility testing.\u003c/p\u003e \u003cp\u003eMost authors recommend surgical drainage for PA with multiple cavities, abscesses larger than 1 cm, recurrent PA, sepsis, associated lower urinary tract obstruction, or failure of conservative treatment \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Several drainage methods, including ultrasound-guided aspiration, transurethral deroofing, and open drainage, have been reported to be effective and feasible. Ultrasound-guided aspiration is preferred for its minimally invasive nature, low morbidity, and repeatability in case of incomplete drainage \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Transurethral deroofing may be more appropriate for large, multiloculated abscesses, recurrent infections, or those associated with benign prostatic hypertrophy (BPH). This method has been linked to shorter hospital stays compared to needle aspiration \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. In our study, we performed ultrasound-guided transrectal aspiration and transurethral deroofing in nearly 50% of cases, with no complications or recurrences. Open drainage was performed in over 50% of cases, yielding good outcomes. Our results showed that surgical drainage was effective in over 90% of cases, consistent with other studies reporting success rates of 60 to 90%. We had two deaths due to sepsis and multi-organ failure, and three cases required re-drainage with no complications.\u003c/p\u003e \u003cp\u003eAlthough the low incidence of PA limits the establishment of a standardized treatment algorithm, our treatment approaches yielded good results. The choice of treatment method depends on patient condition, abscess size and location, extension to surrounding structures, and available resources. Our treatment algorithm for PA at our center is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eProstatic abscess (PA) is a severe lower urinary tract infection that presents a diagnostic challenge for clinicians. An ideal treatment algorithm has yet to be established. Early diagnosis should be made through a combination of clinical examination and transrectal ultrasound (TRUS). Once PA is confirmed, broad-spectrum antibiotics should be administered promptly. Conservative treatment may be considered for selected cases with small (\u0026lt;\u0026thinsp;1 cm) and monofocal abscess formations. However, the majority of patients will require drainage procedures.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePA- Prostatic abscess, TRUS-Transrectal ultrasonography, ABP-\u0026nbsp;Acute bacterial prostatitis, MRI-Magnetic Resonance Imaging, CT-\u0026nbsp;Computed Tomography, DRE- Digital Rectal exam, BPH-Benign prostatic hyperplasia.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch involving human participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The research was performed with institutional review board approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research involved retrospective data analysis of a prospective database. Data analysis was performed on the identified patient data, and consent was waived.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding support\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study receives no funding support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of supporting data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References ","content":"\u003col\u003e\n\u003cli\u003eAckerman AL, Parameshwar PS, Anger JT. Diagnosis and treatment of patients with prostatic abscess in the post-antibiotic era. \u003cem\u003eInternational Journal of Urology\u003c/em\u003e. 2018;25(2):103-110. doi:https://doi.org/10.1111/iju.13451\u003c/li\u003e\n\u003cli\u003eAbdelmoteleb H, Rashed F, Hawary A. Management of prostate abscess in the absence of guidelines. \u003cem\u003eInternational braz j urol : official journal of the Brazilian Society of Urology\u003c/em\u003e. Sep-Oct 2017;43(5):835-840. doi:10.1590/s1677-5538.ibju.2016.0472\u003c/li\u003e\n\u003cli\u003eLudwig M, Schroeder-Printzen I, Schiefer HG, Weidner W. Diagnosis and therapeutic management of 18 patients with prostatic abscess. \u003cem\u003eUrology\u003c/em\u003e. 1999/02/01/ 1999;53(2):340-345. doi:https://doi.org/10.1016/S0090-4295(98)00503-2\u003c/li\u003e\n\u003cli\u003eKhudhur H, Brunckhorst O, Muir G, Jalil R, Khan A, Ahmed K. Prostatic abscess: A systematic review of current diagnostic methods, treatment modalities and outcomes. \u003cem\u003eTurkish journal of urology\u003c/em\u003e. May 27 2020;46(4):262-73. doi:10.5152/tud.2020.19273\u003c/li\u003e\n\u003cli\u003eEl-Shazly M, El-Enzy N, El-Enzy K, Yordanov E, Hathout B, Allam A. Transurethral drainage of prostatic abscess: points of technique. \u003cem\u003eNephro-urology monthly\u003c/em\u003e. Spring 2012;4(2):458-61. doi:10.5812/numonthly.3690\u003c/li\u003e\n\u003cli\u003eJang K, Lee DH, Lee SH, Chung BH. Treatment of prostatic abscess: case collection and comparison of treatment methods. \u003cem\u003eKorean journal of urology\u003c/em\u003e. Dec 2012;53(12):860-4. doi:10.4111/kju.2012.53.12.860\u003c/li\u003e\n\u003cli\u003eLee DS, Choe HS, Kim HY, et al. Acute bacterial prostatitis and abscess formation. \u003cem\u003eBMC urology\u003c/em\u003e. Jul 7 2016;16(1):38. doi:10.1186/s12894-016-0153-7\u003c/li\u003e\n\u003cli\u003eGranados EA, Riley G, Salvador J, Vicente J. Prostatic Abscess: Diagnosis and Treatment. \u003cem\u003eThe Journal of Urology\u003c/em\u003e. 1992/07/01/ 1992;148(1):80-82. doi:https://doi.org/10.1016/S0022-5347(17)36516-3\u003c/li\u003e\n\u003cli\u003eDoble A, Carter SSC. Ultrasonographic Findings in Prostatitis. \u003cem\u003eUrologic Clinics of North America\u003c/em\u003e. 1989/11/01/ 1989;16(4):763-772. doi:https://doi.org/10.1016/S0094-0143(21)01810-3\u003c/li\u003e\n\u003cli\u003eAlnadhari I, Sampige VRP, Abdeljaleel O, et al. Presentation, diagnosis, management, and outcomes of prostatic abscess: comparison of three treatment modalities. \u003cem\u003eTherapeutic advances in urology\u003c/em\u003e. Jan-Dec 2020;12:1756287220930627. doi:10.1177/1756287220930627\u003c/li\u003e\n\u003cli\u003eElshal AM, Abdelhalim A, Barakat TS, Shaaban AA, Nabeeh A, Ibrahiem el H. Prostatic abscess: Objective assessment of the treatment approach in the absence of guidelines. \u003cem\u003eArab journal of urology\u003c/em\u003e. Dec 2014;12(4):262-8. doi:10.1016/j.aju.2014.09.002\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Prostate abscess, TRUS, TUR deroofing","lastPublishedDoi":"10.21203/rs.3.rs-4739578/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4739578/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eProstatic abscess (PA) is an uncommon but serious urological emergency with a high mortality rate if not properly treated. It can lead to severe complications, including urosepsis and death. Diagnosing and treating PA remains challenging due to limited comparative studies on treatment modalities.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aims to characterize the clinical features and evaluate the treatment outcomes of prostatic abscesses treated at our center.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective study describes a case series of patients hospitalized with PA at our hospital from January 2017 to April 2020.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSeventy-six cases of PA were confirmed using transrectal ultrasonography (TRUS), MRI, or CT scan. The mean age was 51.58 years (range 24 to 85). The most common predisposing factors were diabetes mellitus, urinary tract infections, and immunodeficiency. Presenting symptoms included lower urinary tract symptoms (67%), fever and chills (47%), and perineal pain (32%). Digital rectal examination revealed a severely tender prostate with areas of fluctuation in two-thirds of cases. Single abscess cavities were found in 36.84% of cases, while 63.16% had multiple cavities. Bacteria were isolated from urine, pus, and blood in 31.34%, 58.2%, and 19.6% of cases, respectively, with E. coli and Burkholderia pseudomallei being predominant pathogens. Mycobacterium tuberculosis was found in the pus of 4 out of 45 cases. Management included conservative treatment in 5 cases (6.58%) and surgical interventions in most cases: open cystostomy with abscess drainage (50%), TRUS-guided aspiration (15.79%), and transurethral resection deroofing (23.68%). Successful treatment was achieved in 93% of cases.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eProstatic abscess is a serious infection with high mortality. Early diagnosis, appropriate antibiotic therapy, and surgical intervention are crucial for successful treatment. Empirical antibiotic decisions should adhere to the guidelines of each medical facility.\u003c/p\u003e","manuscriptTitle":"Clinical Management and Treatment Outcomes of Prostatic Abscess in a Tertiary Care Center","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-17 00:58:47","doi":"10.21203/rs.3.rs-4739578/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0a3ee6a6-e671-41ae-b98e-ca52aba36034","owner":[],"postedDate":"August 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-16T16:18:19+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-17 00:58:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4739578","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4739578","identity":"rs-4739578","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}