Clinical Management and Treatment Outcomes of Prostatic Abscess in a Tertiary Care Center

Abstract Background Prostatic abscess (PA) is an uncommon but serious urological emergency with a high mortality rate if not properly treated. It can lead to severe complications, including urosepsis and death. Diagnosing and treating PA remains challenging due to limited comparative studies on treatment modalities. Objective This study aims to characterize the clinical features and evaluate the treatment outcomes of prostatic abscesses treated at our center. Methods This retrospective study describes a case series of patients hospitalized with PA at our hospital from January 2017 to April 2020. Results Seventy-six cases of PA were confirmed using transrectal ultrasonography (TRUS), MRI, or CT scan. The mean age was 51.58 years (range 24 to 85). The most common predisposing factors were diabetes mellitus, urinary tract infections, and immunodeficiency. Presenting symptoms included lower urinary tract symptoms (67%), fever and chills (47%), and perineal pain (32%). Digital rectal examination revealed a severely tender prostate with areas of fluctuation in two-thirds of cases. Single abscess cavities were found in 36.84% of cases, while 63.16% had multiple cavities. Bacteria were isolated from urine, pus, and blood in 31.34%, 58.2%, and 19.6% of cases, respectively, with E. coli and Burkholderia pseudomallei being predominant pathogens. Mycobacterium tuberculosis was found in the pus of 4 out of 45 cases. Management included conservative treatment in 5 cases (6.58%) and surgical interventions in most cases: open cystostomy with abscess drainage (50%), TRUS-guided aspiration (15.79%), and transurethral resection deroofing (23.68%). Successful treatment was achieved in 93% of cases. Conclusion Prostatic abscess is a serious infection with high mortality. Early diagnosis, appropriate antibiotic therapy, and surgical intervention are crucial for successful treatment. Empirical antibiotic decisions should adhere to the guidelines of each medical facility.