陳致豪、李高漢、劉建良、黃冠華

奇美醫學中心 外科部 泌尿科

Zhi-Hao Chen, Kau-Han Lee, Chien-Liang Liu, Steven Kuan-Hua Huang

Divisions of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan

 

Prostate abscess is a rare disease during clinical practice, but has high mortality rate between 1% and 16%. The main bacteria specimen is E. coli, consisted 70% of the cases. We presented a case of 44-year-old male with prostate abscess undergoing transurethral incision of prostate. Abscess culture showed an extremely rare bacteria, called Burkholderia pseudomallei.

 

This 44-year-old male without systemic disease had intermittent fever off and on for 1 week. He also had urine frequency and dysuria. Contact history showed tiny cutting injury by grass about one week ago. Therefore, he went to our emergency depetment for help. Septic shock was noted and empiric antibiotics with IV fluid hydration was prescribed. Abdominal CT showed Prostate abscess with involvement of bilateral seminal vesicles. Further blood culture showed Burkholderia pseudomallei. We choose conservative treatment with antibiotics use, because the patient refused operation at first. After two weeks of administration with minocycline + Ceftazidime, follow up transrectal prostate ultrasound still showed no improvement of prostate absecess. We then performed ransurethral incision of prostate and operative finding showed severe vacuolization of prostate with much abscess drained out. Pathology report showed acute necrotizing inflammation. After antibiotics use during admission, he had stable vital sign and discharged smoothly.

 

Prostate abscess should be treated with empiric antibiotics and adjusted due to microbiology result. Methods for drainage of abscess could be considered according to patient’s clinical condition and response to antibiotics treatment.