青少年之攝護腺膿瘍 - 病例報告

趙梓辰、楊緒棣

台北慈濟醫院  泌尿科

Prostate Abscess in an Adolescent: A Case Report and Review of Literature

Tze-Chen Chao, Stephen Shei-Dei Yang

Division of Urology, Taipei Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan

Introduction: Prostate abscess is an uncommon in adults and is even infrequently noted in pediatric population who were usually immunocompromised. Currently the recommended management of a large prostate abscess≧1cm is surgical drainage with adequate antibiotics. Herein, we present a case of large prostate abscess in an adolescent who was successfully treated only with antibiotics without surgical drainage.

Case presentation: A 14-year-old male adolescent presenting with fever and low back pain for one week was transferred to our hospital. Urine culture at previous hospital revealed Escherichia coli which was resistant to the fourth generation of cephalosporin and fluoroquinolone. He denied a history of recent trauma and other bladder and bowel symptoms. He had hypospadias repair at the age of 4 years and several times of urinary tract infections (UTI) in his preschool years. According to the patient’s father, he has developmental delay in language and cognition, repetitive and compulsive like behaviors such as squeezing water into his urethra through condoms almost every day.

Transabdominal sonography demonstrated a 5.4 × 5.9 cm heterogeneous septated mass over pelvic region which was confirmed by computed tomographic (CT) scan. Free uroflowmetry showed staccato pattern. He was treated with ertapenem for 2 weeks. Follow-up abdominal CT scan showed resolution of prostate abscess 14 days later. At 1-month follow-up, transabdominal ultrasound did not show any sign of prostate abscess and uroflow pattern was bell shape.

Discussion: This is the first case of a large prostate abscess in an adolescent who was successfully treated with antibiotics only. Prostate abscess usually affected people of middle age with an estimation of 0.2 – 0.5 % of men, but it could occur at any age. Common pathogens of prostate abscess are Escherichia coli and Klebsiella pneumonia, while atypical pathogens are often presented in severe immunocompromised patients. Risk factors of prostate abscess in adults include diabetes, chronic kidney disease, cirrhosis, liver abscess, HIV/AIDS, previous chemotherapy, organ transplant, and genitourinary instrumentations. Up to date, there were only three case reports of prostate abscess in children. Predisposing factors of the three cases were previous MRSA infection, and chronic granulomatous disease. The recent one case had no identifiable risk factor. The possible risk factors of the presented case were the behavior of squeezing water into his urethra through condoms for masturbation and history of UTI. The repetitive forceful influx of contaminated water into urethra may cause prostatic infection and the untreated prostatic infection led to the formation of abscess.

Currently there is no standard treatment for prostate abscess. In the previous case reports of patient with adolescent prostate abscess, all patient received drainage or transurethral unroofing of prostate abscess. The size of prostate abscess in the previous 3 cases were no more than 3 cm. Compared the size of the prostate abscess, our case revealed the largest size (up to 6 cm in the greatest dimension on abdominal CT scan), which had good response to antibiotics treatment only. It has been suggested that surgical treatment is optimal when patient had slow response to antibiotics. According to previous literature, antibiotics alone should only be used in stable patients with small prostate abscess less than 1 cm. However, our case demonstrated that antibiotics treatment alone first is also a curable way in adolescent patient with prostate abscess. Therefore, it is questionable that large prostate abscess should be treated better by aspiration or surgical drainage first. We believe that with adequate antibiotics prescription, adolescents with prostate abscess could be treated conservatively first.