高雄市阮綜合醫院 外科部 泌尿科
Prostate abscess in a peritoneal dialysis patient
Ping-Ju Tsai1, Cheng-Chen Su1, Chung-Sung Shen1, Shih-Ya Hung1, Yi-Chun Liu2
1Division of Urology, and 2Division of Nephrology, Yuan’s General Hospital, Kaohsiung, Taiwan
Prostate abscess is an uncommon condition of infective urinary tract disease. Predisposing factors for prostate abscess included acute bacterial prostatitis, urethral catheterization, diabetic mellitus, chronic kidney disease, cirrhosis and immunocompromised patients. The prostate abscesses were attributed to gonococcus, Escherichia coli, Staphylococcus aureus, and Klebsiella pneumoniae. We can make the diagnosis with transrectal ultrasound and abdominal CT scan. Treatments of prostate abscess were attributed to parental broad-spectrum antibiotics administration and abscess drainage. The methods of drainage included transrectal aspiration and transurethral (TUR) incision of prostate.
We presented that a 60-year-old male has hypertension, diabetes mellitus, coronary artery disease, cerebrovascular accident with left hemiparesis, bilateral blow-knee amputation, and end stage renal disease with peritoneal dialysis. He called for help at emergency room due to fever, poor appetite, and vomiting. Abdominal CT scan revealed loculated fluid and air collection in the prostate and seminal vesicles. We performed TUR drainage and urethral Foley indwelling with 24 hours irrigation. Prostate abscess pus culture showed Escherichia coli. After 2 days, we removed the drainage Foley and he was discharged. Unfortunately, he recalled for help at emergency room due to cloudy peritoneal dialysis fluid and sepsis. Peritoneal fluid culture revealed Escherichia coli. We suspected prostate abscess related continuous ambulatory peritoneal dialysis (CAPD). After removal of peritoneal dialysis tube and antibiotics therapy, his conditions improved. At last, he was under stable conditions and received regular hemodialysis at outpatient department of nephrology.