Prostatic abscess

Last revised by Yuranga Weerakkody on 27 Sep 2023

Prostatic abscesses are a rare complication of prostatitis

Prostatic abscesses have become relatively uncommon due to the increased use of antibiotic therapy in patients with prostatitis. It tends to affect diabetic and immunosuppressed patients. Most patients affected are around 50 to 60 years old 7.

Patients commonly present with dysuria, fever, suprapubic pain, and possibly urinary retention. Urinalysis reveals leukocytes. Clinically the condition may appear similar to acute bacterial prostatitis without abscess formation 8.

The organisms usually involved include:

  • Escherichia coli
  • Staphylococcus spp.
  • Gonococcus spp. (rare)

Transrectal sonography (TRUS) is considered a 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. There may be inhomogeneous echoes within these ill-defined areas 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
  • T1 C+ (Gd): tends to show peripheral contrast enhancement.
  • DWI
    • limited studies only 2
    • tends to show restriction of diffusion corresponding to hypoechoic lesions on ultrasound
  • ADC
    • limited studies only 2
    • mean ADC values within the abscesses have been reported to be very low

Percutaneous transperineal or transrectal drainage is often considered the first choice for therapy due to 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:

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Cases and figures

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  • Case 7
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  • Case 8: on TRUS
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  • Case 9
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  • Case 10: neonatal prostatic utricle abscess / cyst
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  • Case 11
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  • Case 12
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  • Case 13
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