Suspect in men with prostatitis and:
- High fevers
- Failure to improve on antibiotics
- Immunosuppressed or diabetic
Can sometimes feel a fluctuant area on DRE.
Diagnosed by imaging:
- Ultrasound (transabdominal/transrectal) – hypoechoic area
- CT with contrast – hypodense non enhancing lesion, may have enhancing rim – CT useful to define periprostatic extension (i.e. to ischiorectal fossa) and diagnosing emphysematous prostatitis
- MRI – hypointense in T1, hyperintense on T2
Usually caused by gram negative organisms – but also think pseudomonas, MRSA/staph, TB, Neisseria gonorrhoea, and candida in immunosuppressed. Melioidosis in endemic areas.
Treatment:
- Manage the patient acutely as per acute bacterial prostatitis with resuscitation and broad spectrum antibiotics
- Surgical management can be considered for larger abscesses or failure to improve on antibiotics
- Generally – abscess 1 cm or smaller can be managed with antibiotics
- Larger than 1 cm can be drained
- Transrectal needle aspiration
- Transperineal needle aspiration
- TURP – ideal for larger collections especially if within transition zone
- Deroof the abscess under antibiotic cover, consider “completion TURP” when well if ongoing bladder outlet obstruction symptoms