The usual infecting organisms are aerobic gram-negative bacilli or, less frequently, Staphylococcus aureus.
Symptoms of Prostate Abscess
Common symptoms include
Perineal pain, evidence of acute epididymitis Epididymitis Epididymitis is inflammation of the epididymis, occasionally accompanied by inflammation of the testis (epididymo-orchitis). Scrotal pain and swelling usually occur unilaterally. Diagnosis is... read more , 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.
Diagnosis of Prostate Abscess
Prostate ultrasonography and possibly cystoscopy
Abscess is suspected in patients with persistent perineal pain and continued or recurrent urinary tract infections Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys (pyelonephritis), and lower tract infections, which involve the bladder (cystitis), urethra... read more despite antimicrobial therapy. Such patients should undergo prostate ultrasonography Ultrasonography Imaging tests are often used to evaluate patients with renal and urologic disorders. Abdominal x-rays without radiopaque contrast agents may be done to check for positioning of ureteral stents... read more and possibly cystoscopy Cystoscopy Cystoscopy is insertion of a rigid or flexible fiberoptic instrument into the bladder. Indications include the following: Helping diagnose urologic disorders (eg, bladder tumors, calculi in... read more .
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 of Prostate Abscess
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).