Prostatic Abscess - Causes, Symptoms, Diagnosis, and Treatment

What Is a Prostatic Abscess?

An abscess is a pus that builds up in a particular area of the body. It can be present externally or on internal organs like the brain, prostate gland, spinal cord, and other genital organs. Normally, the skin acts as the first line of defense against bacteria and infections. However, when bacteria invade the skin, the body's immune system gets activated. As a result, the cells that work as a policeman of the body, the white blood cells, attack these pathogens, causing the death of the surrounding cells and tissues. A gap is filled with pus, bacteria, and dead tissues when the cells die. When the abscess grows, the pressure on the skin increases, causing inflammation of the surrounding organs and tissues. When this abscess occurs in the prostate gland, it is known as a prostatic abscess. It is one of the most common complications of acute bacterial prostatitis (bacterial inflammation of the prostate gland). If the abscess is left untreated for a long time, it causes severe complications in the urinary tract. People suffering from diabetes, end-stage renal disease, and liver cirrhosis are at the highest risk of developing a prostatic abscess.

What Are the Causes and Risk Factors of a Prostatic Abscess?

A prostate abscess is commonly seen after the inflammation of the prostate gland due to bacterial entry. The other factors that increase the risk of prostatic abscess are listed below:

1. Uncontrolled Diabetes - Diabetes is a condition in which blood sugar levels increase. People suffering from uncontrolled diabetes are likely to develop a prostate abscess because their immune system is not strong enough to prevent bacterial entry. As a result, the inflammation of the prostate gland and abscess is seen more in diabetics than non-diabetics.

2. End-Stage Renal Disease - It is a condition in which the kidneys stop working permanently. The patient needs to undergo a kidney transplant or remain on dialysis to survive. The prostate gland is located close to the urinary bladder. The bacteria can quickly enter the prostate gland through the urinary tract because the kidneys are nonfunctional. As a result, the risk of prostatitis and abscess increases.

3. Immunocompromised Disorders - People who are suffering from immunocompromised diseases like acquired immunodeficiency syndrome (AIDS) are more likely to develop a prostatic abscess. It is because the immune system has failed to function, and the body's internal organs are vulnerable to bacterial infection.

4. Self-Catheterization - A catheter is a tube inserted into the urinary bladder through the urethra to drain urine from the body. People who frequently do self-catheterization are at a higher risk of developing a prostate abscess. It is because the bacteria gain entry into the prostate gland through the catheter if not inserted properly.

5. Bladder Neck Dysfunction - The point where the bladder coincides with the urethra is known as the bladder neck. It comprises muscles that contract and relax rhythmically to facilitate the drainage of urine. However, the problem arises when the bladder neck does not function well or is blocked. The urine might flow back to the kidneys, increasing the risk of prostatic abscesses.

6. Prostatitis - The inflammation and infection of the prostate gland are known as prostatitis. The patient has pain in the genital area and difficulty in the passage of urine. When the urine does not exit the body, it flows back to the kidneys and becomes a potential source of bacterial infection. These bacteria enter the prostate gland and cause a prostate abscess.

What Are the Signs and Symptoms of a Prostate Abscess?

As the prostate abscess occurs due to a urinary tract infection, the signs and symptoms of both are similar. The patient presents with the following symptoms of a prostate abscess.

• Pain and burning sensation while urinating.

• Urinary incontinence or leakage of urine.

• Hematuria, or the presence of blood in the urine.

• The patient feels a strong urge to urinate.

• Inability to empty the bladder at once due to severe urinary retention.

• Fever.

• Pus-filled urethral discharge.

What Methods Are Used to Diagnose a Prostate Abscess?

A prostate abscess is diagnosed based on medical history, physical examination, laboratory tests, and imaging tests. The diagnostic methods have been described below:

1. Physical Examination - During the physical exam, the surgeon inserts a lubricated and gloved finger into the prostate gland via the rectum. If the patient experiences pain during the examination and presents with urethral discharge, he might be suffering from prostate disease.

2. Laboratory Tests - The following laboratory tests are usually recommended in the case of prostate abscess:

• Blood Tests - The doctor recommends the patient undergo a blood test to check the general health of the prostate gland and the presence of infections.

• Urine Culture - The patient collects urine in a container or a sterile bag provided by the hospital authorities. The urine sample is left for a few days in the lab to allow the bacteria and microorganisms to grow. If bacterial growth is rapid, a urinary tract infection or abscess can be suspected.

• Urinalysis - The urine sample given by the patient is sent to the laboratory for examination under a microscope. It helps to determine urine output and detect bacteria and white blood cells in the urine.

3. Imaging Tests - The following imaging tests are usually recommended:

• Transrectal Ultrasound - In this procedure, the patient is laid on a table, and a device known as a transducer is mainly used to obtain images of the rectum. The transducer is inserted into the rectum, and the sound waves are sent to the body. When these waves bounce back from the rectum, the images are obtained on the computer screen. The ultrasound is done to know the length and width of the prostate gland and the exact location of the abscess. The walls of the abscess can be seen on the ultrasound.

• Cystoscopy - It is one of the most effective methods used to diagnose the problems of the prostate gland and the urinary tract. A small tube-shaped device, which is known as a cystoscope, is inserted through the urethra. The cystoscope has a camera attached to it that helps to visualize the prostate gland.

• Computerized Tomography (CT) Scans - This procedure helps get three-dimensional (3D) images of the body's internal organs. These images help to check the spread of infection from the prostate gland to the other organs.

How Is a Prostate Abscess Managed?

The treatment depends upon the size of the abscess and the severity of the infection. Both surgical and nonsurgical options are available to manage a prostate abscess, but not all cases require surgery. The treatment options have been described below:

1. Antibiotics - Antibiotics remain the first choice when a prostate gland abscess must be managed. After the diagnostic tests have confirmed that the abscess is less than two centimeters, antibiotics are generally recommended. The following drugs are usually recommended to treat prostatic abscesses:

   • Levofloxacin.

   • Carbapenem.

   • Trimethoprim.

   • Tobramycin.

2. Surgery - Surgical intervention is required when the abscess is more than one centimeter. If the pus is removed, the abscess will automatically shrink. There are two ways to drain the abscess, mainly the transurethral and transperineal approaches. Both these methods are described below:

   • Transurethral Approach - In this method, the abscess is located on the ultrasound, and the doctor inserts an instrument into the prostate gland through the urethra. The abscess is then punctured and drained with the help of the instrument.

   • Transperineal Approach - A needle is inserted into the perineum (between the anus and the scrotum). Next, the contents of the abscess, the pus, are sucked up in the needle.

What Are the Complications of a Prostate Abscess?

An abscess forms in the prostate gland due to urinary tract infection or prostatitis. If the prostate abscess is left untreated for long, the following complications occur:

• Urosepsis - Urosepsis is a type of urinary tract infection that originates from the urinary tract. It is one of the most serious complications of a urinary tract infection. Sepsis is hazardous because it damages the healthy tissues of the body. Therefore, it is important to treat UTIs to get rid of urosepsis.

• Septic Shock - When the prostate abscess is left untreated for a long time, the bacteria enter the bloodstream and infect the other body organs. As a result, the patient might go into a state of shock (septic shock) as the blood pressure reduces drastically. Septic shock becomes a life-threatening condition if left untreated for a long time.

Conclusion:

A prostate abscess develops when the bacteria invade the prostate gland and form pus. An abscess can occur in any organ of the body. Normally, the body's immune system protects against bacteria, but the problem occurs when the patient is suffering from immunocompromised diseases. Other conditions that increase the risk of a prostate abscess include diabetes, prostatitis, and benign prostatic hypertrophy (prostate gland enlargement). The patient presents with dysuria (painful urination), hematuria, perineal pain, and urinary frequency. As these symptoms are similar to those seen in urinary tract infections, diagnostic tests are recommended to confirm the presence of an abscess. The patient must not worry about the treatment because small abscesses are usually treated with antibiotics. Surgical intervention is only required in case of large abscesses. However, consult the doctor to undergo the treatment at the earliest to avoid complications.