針對攝護腺膿瘍的治療與結果：治療方式的比較
陳思翰1、吳俊賢1,2、吳振宇1,2、郭威廷1,2、林嘉祥1,2
1義大醫院泌尿科；2義守大學醫學系
Treatment and outcomes of prostatic abscess: comparison of treatment methods
Sih-Han Chen1, Chun-Hsien Wu1,2, Richard Chen-Yu Wu1,2, Wei-Ting Kuo1,2, Victor C. Lin1,2
Department of Urology, E-Da Hospital, Kaohsiung, Taiwan1
School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan2
Purpose: Prostatic abscess is a uncommon disease and it may result in severe clinical outcomes such as urethral fistula, sepsis and death if it is not treated properly. The aim of this study is to compare the outcomes between conservative treatment with antibiotic alone and minimally invasive methods either tranrectal ultrasound (TRUS) - guided aspiration or transurethral deroofing (TUD).
Materials and Methods: A retrospective study was performed in which prostatic abscess diagnosed between July 2005 and April 2020. Patients were divided into two groups; Group A treated by conservative treatment with antibiotic alone and Group B treated by minimally invasive methods either TRUS - guided aspiration or TUD. Descriptive statistics were evaluated using the Chi‐square test and t‐test was performed for continuous variables with P < 0.05 considered statistically significant.
Results: Nine patients had conservative treatment alone and 22 patients underwent minimally invasive methods. The mean age was 64.2 (range, 38-77 years )and 64.7 (range, 44-91 years ) years for Group A and B, respectively. Four patients (44.4% ) in Group A and 13 patients (59.1%) in Group B had diabetes mellitus (p=0.693). The Charlson comorbidity index was three points and four points for Groups A and B. The most common presentations were fever and dysuria for Groups A and B (77.8% versus 63.6% and 77.8% versus 86.4%, respectively). The most common infective organism in Group A were Escherichia coli (33.3%) and Psedomonas aeruginosa (33.3%) and in group B was Klebsiella pneumoniae (37.5%). Multiple prostatic abscess observed by abdominal computed tomography was detected in three patients (60%) and 14 patients (82.4%) in Groups A and B, respectively. The median hospital day was 14 (8-33) and 13 (4-25) days for Groups A and B, respectively. In Group A, four patient (44.4%) was complicated by septic shock, whereas in Group B, four patient (18.2%) was complicated by septic shock, two patients (9.1%) with recto-urethral fistula, three patients (13.6%) with epididymo-orchitis and one patients (4.5%) with urethral stricture. Two patient had recto-urethral fistula was diagnosed of prostatic tuberculosis. The spontaneous closure of the fistula was noted after a period of transurethral bladder catheterization. No recurrences for patients treated conservatively but three patient (13.6%) recurrences were noted in Group B.
Conclusions: Minimal invasive of prostatic abscess was likely to be performed on patients who had higher Charlson comorbidity index and history of diabetes mellitus for better disease control. The complication rate of minimal invasive method was low and could be resolved adequately.