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. Urinary frequency, dysuria, and urinary retention are common. 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.
Abscess is suspected in patients with persistent perineal pain and continued or recurrent UTIs 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 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).
Last full review/revision March 2014 by Gerald L. Andriole, MD
updates.last-modified March 2014