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Prostate Abscess

By

Gerald L. Andriole

, MD, Barnes-Jewish Hospital, Washington University School of Medicine

Last full review/revision Nov 2020| Content last modified Nov 2020
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Prostate abscesses are collections of pus that develop as the result of acute bacterial prostatitis.

  • Prostate abscesses are caused by bacteria.

  • Common symptoms include frequent urination, pain while urinating, difficulty with urination, or retaining urine.

  • Men with symptoms that suggest a possible prostate abscess undergo ultrasonography and possibly cystoscopy to confirm the diagnosis.

  • Antibiotic therapy and drainage of pus from the abscess are the treatments of choice.

The prostate is a gland in men that lies just under the bladder and surrounds the urethra. The gland, along with the nearby seminal vesicles, produces much of the fluid that makes up a man's ejaculate (semen).

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Symptoms

Common symptoms include

  • More frequent urination

  • Painful or difficult urination

  • Difficulty emptying the bladder (urinary retention)

Other, less common symptoms include pain in the area between the scrotum and anus, scrotal pain due to epididymitis (inflammation of the coiled tube that contains and carries sperm), blood in the urine, and a pus-containing discharge from the urethra. Fever is sometimes present.

Rectal examination done by a physician may be painful. The prostate is usually enlarged.

Diagnosis

  • Prostate ultrasonography

  • Possibly cystoscopy

Doctors often suspect prostate abscess in men with persistent pain in the area between the scrotum and anus (perineum). Continued or recurrent urinary tract infections (UTIs) despite treatment are also cause for suspicion. Men with these symptoms should undergo prostate ultrasonography and possibly cystoscopy.

Many abscesses, however, are discovered unexpectedly during prostate surgery or endoscopy of the urinary tract (cystoscopy). Although it is common to find pus and bacteria in the urine in men with a prostate abscess, some men may not have any pus or bacteria.

Treatment

  • Antibiotics

  • Drainage of pus

Treatment involves antibiotics (for example, trimethoprim/sulfamethoxazole) and drainage of pus from the abscess. To drain pus, the doctor may use one of two methods. In one, the doctor threads an instrument up the urethra and then punctures and drains the abscess. In the other, the doctor uses a hollow needle inserted in the area between the scrotum and anus (perineal area) to aspirate (suck up) the pus through the needle.

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