林昌民、闕舜仁、白彝維、陳永泰、陳日昇、陳欣宏

基督復臨安息日會醫療財團法人臺安醫院 外科部 泌尿科

Chang-Min Lin, Leonard S. Chuech, Yi-Wei Pai,

Tung-Tai Chen, Jih-Sheng Chen, Shin-Hong Chen

Divisions of Urology, Department of Surgery, Taiwan Adventist Hospital, Taipei, Taiwan

 

We report a patient with prostatic abscess who was treated with staged surgery.

A 47-year-old man with a history of type 1 diabetes mellitus presented to the emergency department complaining of fever, chills and low back pain. His blood pressure, pulse rate, and temperature were 102/62 mmHg, 106 per minute, and 38.7°C. Abdominal examination found no distention or tenderness but mild tenderness over bilateral costovertebral angle. A digital rectal exam revealed a enlarged prostate with tenderness and fluctuation. Laboratory results were leukocytosis (white blood count was 23,430 cells/mm³)and pyuria (WBC>100 /HPF). C-reactive protein level was 23.64 mg/dL. On abdominal CT scan, the patient had an enlarged prostate accompanied by abscess over right lobe. After admission, intravenous cetazone was given. Blood and urine culture grew out Klebsiella pneumonia, and we switched the antibiotic to cefazolin and gentamicin. Percutaneous tube drainage for prostatic abscess was performed under the ultrasound guidance. After his fever subsided, he received transurethral resection of prostate later and the thick prostatic pus was removed completely. The patient recovered and discharged on a two-week course of ciprofloxacin with urology follow up. 

The prostate abscess is an uncommon disease with the incidence rate of 0.5%. The most common symptoms of the disease are dysuria, frequency, perineal pain, fever, chills, and low back pain. It mostly occurs in the 5th and 6th decades of life and the most common organism is Staphylococcus aureus. Patients with diabetes mellitus, renal insufficiency and immune suppression are particularly at risk. Urethral catheterization, lower urinary tract instrumentation and a prostate biopsy are among the possible predisposing factors. TRUS and other cross-sectional imaging methods (pelvic CT or MRI) might be useful in the diagnosis, treatment and monitoring of the response to treatment. Nowadays, minimally invasive treatment such as TRUS-guided needle aspiration or drainage via tube trans-perineally or transrectally under local anesthesia or sedation is preferred. TURP is indicated in those patients in whom ultrasound-guidance drainage is not successful or in patients with associated bladder outlet obstruction. We successfully treated our case without recurrence or fistula formation by stage surgery (drainage and then TURP). Further studies are therefore warranted to establish the optimal timing, methods and indications in patients with prostate abscess.