This protocol applies to prostate abscess where transrectal ultrasound demonstrates an abscess cavity greater than 1 cm in diameter, with CT scan confirming the abscess is localized to the prostate and without extraprostatic penetration.
Abscess cavity >1 cm in diameter on transrectal ultrasound; CT scan confirms localization to the prostate with no extraprostatic extension. Abscess size is a key decision point: conservative treatment is associated with success when cavities are <1 cm in diameter, while larger cavities are better addressed by active drainage.
Management involves ultrasound-guided aspiration of the abscess combined with broad-spectrum parenteral antibiotics. Minimally invasive drainage is the preferred standard approach — it can be performed under local anaesthesia and repeated if initial drainage is incomplete.
Complete resolution of the prostate abscess confirmed on follow-up ultrasound.
DOI: 10.1590/S1677-5538.IBJU.2016.0472
When managing prostatic abscess, size does matter; in one study, conservative treatment was successful if the abscess cavities were <1cm in diameter, while larger abscesses were better treated by single aspiration or continuous drainage.
Very rarely open surgical drainage might be required in patients with extraprostatic involvement.
Treatment consists of an array of measures including parenteral broad-spectrum antibiotic administration and abscess drainage.
There is a preference for minimally invasive procedures such as TRUS-guided aspiration or transperineal ultrasound guided aspiration.
These procedures are considered as the standard procedure for drainage of PA as they are easy to perform under local anaesthesia, have low morbidity and can be repeated in case of failure or incomplete drainage.
Success was defined as complete resolution of PA on subsequent US and complete resolution of PA after second TRUS guided aspiration respectively.
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