This protocol addresses prostate abscess where transrectal ultrasound reveals a cavity exceeding 1 cm in diameter and CT confirms extraprostatic penetration of the abscess — a presentation that warrants active intervention beyond conservative management alone.
Evidence indicates that conservative treatment is sufficient only when abscess cavities remain below 1 cm; larger cavities require single aspiration or continuous drainage. When the abscess has spread beyond the prostate capsule on CT, the clinical picture is more complex. In rare cases of extraprostatic involvement, including penetration through the levator ani, more definitive surgical drainage may need to be considered.
Management centres on image-guided drainage — either transrectal or transperineal — combined with broad-spectrum parenteral antibiotic therapy. These minimally invasive procedures are preferred for their low morbidity and the ability to repeat them if initial drainage is incomplete.
Goal: Complete resolution of 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.
This is in the form of transperineal incision and drainage in cases where the abscess has penetrated through the levator ani muscle.
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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