Prostate abscess is a limited accumulation of pus in the prostate tissues, developing against the background of prostatitis or an infectious-purulent process of extragenital localization. It is manifested by a sharp throbbing pain in the perineum and rectum, intoxication, chills, fever, difficulty urinating and defecation. Diagnosis includes rectal finger examination of the prostate, TRUS, puncture of the abscess. During treatment, an abscess is opened through the perineum or rectum, antimicrobial and detoxification therapy is prescribed.
ICD-10
N41.2 Prostate abscess
Information
Prostate abscess gland can develop primarily (as an independent pathology) or secondarily (as an outcome of acute prostatitis). It is a serious infectious and inflammatory disease, which is characterized by purulent melting of the gland tissues with the formation of a closed abscess. With an unfavorable course, it can be complicated by a breakthrough of pus into the scrotum, perineum, urethra, pelvic tissue, on the anterior abdominal wall or into the abdominal cavity. The danger of untimely recognition of the disease lies in the likelihood of developing peritonitis or sepsis. Mortality in prostate abscess is recorded in 3-16% of cases.
Causes
The weakening of local and general immunity caused by hypothermia, venous stagnation in the pelvis, intercurrent diseases, smoking, violation of the regularity of sexual life predisposes to the development of the disease. The immediate cause of the purulent process is:
- Acute prostatitis. The formation of a prostate abscess occurs in 5% of patients with this pathology. This is facilitated by inadequate prostatitis therapy or careless performance of transurethral instrumental interventions.
- Surgical interventions. In some cases, prostate abscess complicates operations on the prostate gland and bladder (transurethral resection of the prostate, bladder tour, etc.).
- Stone formation. The cause of pathology may be obstruction of the excretory ducts of the gland by formed stones, which is often found in chronic prostatitis, prostate adenoma, urethritis, etc.
- Remote foci of infection. Secondary abscess occurs due to hematogenous transfer of infection from the foci of extragenital localization, for example, with hydradenitis, furunculosis, osteomyelitis, angina, chronic tonsillitis, etc. The etiological agents in this case are gram-positive microorganisms.
Prostate abscess symptoms
In the development of an abscess, infiltrative and purulent-destructive stages are distinguished. Clinical manifestations are most pronounced in the infiltrative stage. Pathology is characterized by symptoms of severe septic disease: severe intoxication, high fever of the hectic type with chills, sweating, tachycardia, sometimes impaired consciousness and delirium. Pain, as a rule, has a unilateral localization corresponding to the affected lobe of the prostate.
There is an irradiation of pain in the perineum and rectum; the nature of the pain is sharp, pulsating. Defecation and urination are difficult and extremely painful; sometimes acute retention of urine and stool develops, non-discharge of gases. In the second stage, due to the delineation of the purulent cavity, the condition improves: the pain subsides, the temperature decreases. However, this does not mean that the disease has passed – during this period, the formed abscess of the prostate gland can open into various organs and tissues with the development of complications.
Complications
A prostate abscess can break into the paraurethral tissue or the amniotic space with the development of phlegmon. When the abscess is opened, pyuria appears in the urethra, the urine becomes cloudy, with an admixture of pus, an unpleasant pungent odor. In the case of opening a prostate abscess, a rectal fistula is formed in the rectum, as evidenced by an admixture of mucus and pus in the feces. However, complete emptying of the purulent cavity does not occur with the breakthrough of the abscess, which means that a recurrence of prostate suppuration is possible. The most threatening complications of the disease are peritonitis and sepsis.
Diagnostics
In clinical urology, the diagnosis of prostate abscess is established on the basis of a combination of manifestations, laboratory and instrumental data, diagnostic operations (biopsy of prostate abscess). The following procedures are assigned:
- Finger rectal examination. In the process of palpatory examination of the prostate, a rounded protruding formation is determined, fluctuation is felt due to the liquid contents of the abscess; the prostate gland is enlarged, tense and extremely painful. In case of an abscess, the study is performed extremely carefully because of the danger of developing bacteriotoxic shock.
- Ultrasound of the prostate gland. Trans-rectal ultrasound reveals a hypoechogenic focus of a rounded or oval shape against the background of an enlarged and edematous prostate. Ultrasound helps not only to identify the abscess, but also to determine its size, localization, monitor the puncture of the abscess and the sampling of the contents to identify the pathogen.
- Laboratory tests. Typical signs of acute inflammation are detected in the blood: an increase in the number of leukocytes and the rate of precipitation of erythrocytes; in the general analysis of urine – leukocyturia, proteinuria. A bacteriological examination of urine or a smear from the urethra reveals pathogenic microflora.
If the development of fistulas is suspected, urethroscopy, cystoscopy, ultrasound of the bladder, anoscopy, and consultation with a proctologist are performed. The disease is differentiated with acute prostatitis, pyelonephritis, epididymitis.
Treatment
Upon confirmation of the diagnosis, emergency hospitalization in a urological hospital is indicated. Tactics in relation to the purulent process depends on its stage. In the infiltrative stage, antibiotic therapy with cephalosporins, fluoroquinolones, aminoglycosides is used; intravenous infusions of solutions for detoxification, immunostimulating therapy. In order to relieve acute pain syndrome, presacral and paraprostatic blockades are performed.
If, according to palpation and ultrasound, a formed abscess of the prostate gland is determined, its perineal or transrectal autopsy and drainage are performed. To prevent damage to the urethra, a metal buj is inserted into it, i.e. preliminary bujation of the urethra is performed. In most cases, preference is given to perineal access, which allows the abscess to be opened widely, while avoiding secondary infection and the formation of rectal-urethral fistulas. In the postoperative period, antimicrobial and detoxification therapy is prescribed.
Prognosis and prevention
Timely treatment of prostate abscess contributes to a favorable prognosis for life and preservation of reproductive function. The ability to work is lost only during the illness. An unrecognized abscess of this localization, as a rule, leads to generalization of infection and urosepsis.
Prevention of pathology is, first of all, prevention of acute prostatitis. It includes physical activity, exclusion of hypothermia, normalization of the rhythm of sexual life, treatment of chronic foci of infection and urological diseases. When the initial symptoms of the disease appear, an immediate consultation with a urologist is necessary.
Literature
- Oliveira P., Andrade J.A., Porto H.C., Filho J.E., Vinhaes A.F. Diagnosis and treatment of prostatic abscess // Int. Braz. J. Urol. — 2003; 29: 30-34. link
- Jang K., Lee D.H, Lee S.H., Chung B.H. Treatment of prostatic abscess: case collection and comparison of treatment methods // Korean J. Urol. — 2012; 53(12): 860-4. link
- Abdelmoteleb H., Rashed F., Hawary A. Management of prostate abscess in the absence of guidelines // Int. Braz. J. Urol. — 2017; 43(5): 835-840.
- Schneider H., Ludwig M., Hossain H.M., Diemer T., Weidner W. The 2001 Giessen Cohort Study on patients with prostatitis syndrome–an evaluation of inflammatory status and search for microorganisms 10 years after a first analysis // Andrologia. — 2003; 35: 258-62.
- Lee D.S., Choe H.S., Kim H.Y., Kim S.W., et al. Acute bacterial prostatitis and abscess formation // BMC. Urol. — 2016; 16: 38.