This protocol covers a specific and more advanced presentation of prostate abscess: a cavity exceeding 1 cm in diameter on transrectal ultrasound with extraprostatic penetration confirmed on CT, in which prior ultrasound-guided aspiration and parenteral antibiotics have failed to achieve complete resolution.
The abscess cavity measures greater than 1 cm on transrectal ultrasound, and CT imaging demonstrates that the abscess has extended beyond the prostate capsule. Abscess size is a key determinant of treatment success: cavities below 1 cm may respond to conservative management, while larger collections — particularly those with extraprostatic spread — typically require more definitive intervention.
The prior intervention was transrectal or transperineal ultrasound-guided aspiration combined with broad-spectrum parenteral antibiotics. Escalation to this protocol is triggered when that approach did not result in complete resolution of the prostate abscess on subsequent ultrasound imaging.
When aspiration-based drainage has failed in this setting — particularly with evidence of extraprostatic involvement — an open surgical drainage procedure is the intervention to consider. The clinical goal is complete resolution of the abscess. The full details of the surgical approach and its indications are available in the structured protocol.
DOI: 10.1590/S1677-5538.IBJU.2016.0472