Prostatic abscesses can be a rare complication of prostatitis.
It has become relatively uncommon in clinical practice due to antibiotic therapy in those with prostatitis. It tends to affect diabetic and immunosuppressed patients. Most patients tend to present in the 5th to 6th decade 7.
Common presenting features are dysuria, fever, suprapubic pain +/- urinary retention. Urine examination usually reveals pus cells. Clincal presentation can sometimes be similar to acute bacterial prostatitis without abscess formation 8.
The prostate is a relatively uncommon gland for abscess formation.
The organisms usually involved include:
- Escherichia coli
- Staphylococcus spp.
- Gonococcus spp. (rare)
Transrectal sonography (TRUS) is considered very reliable imaging method to diagnose a prostatic abscess 1-2. It usually demonstrates ill-defined hypoechoic areas within an enlarged and/or distorted prostate gland. They may be inhomogenous echoes within 8-9.
- tends to show well defined areas of low attenuation 3
- the prostate gland can either be symmetrically or asymmetrically enlarged
MRI signal characteristics of an abscess include 2
- T1: hypointense
- T2: hyperintense
- C+ (Gd): tends to show peripheral contrast enhancement.
- limited studies only 2
- tends to show restriction of diffusion corresponding to hypoechoic lesions on ultrasound
- limited studies only 2
- mean ADC values within the abscesses have been reported to be very low
Treatment and prognosis
Percutaneous transperineal or transrectal drainage is often considered the first choice for therapy due of the lower risk of complication compared with surgery. A TRUS guided aspiration is also reported to be an effective and minimally invasive treatment modality.
Imaging differential considerations include:
- prostate tumours
- infections of the prostate
- benign prostatic hypertrophy
- cystic lesions of the prostate
- prostate cancer
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