Extensive Prostatic Abscess in an Elderly Patient Requiring Multidisciplinary Drainage
Background. Prostatic abscess is rare and mainly affects immunocompromised individuals, classically presenting with both systemic and lower urinary tract symptoms. Our case is unique as the patient presented with an exceptionally long duration of symptoms prior to seeing a health-care provider, had...
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Wiley
2020-01-01
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| Series: | Case Reports in Urology |
| Online Access: | http://dx.doi.org/10.1155/2020/4398561 |
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| author | John Michael Nesemann Kathy Huen Jonathan Bergman |
| author_facet | John Michael Nesemann Kathy Huen Jonathan Bergman |
| author_sort | John Michael Nesemann |
| collection | DOAJ |
| description | Background. Prostatic abscess is rare and mainly affects immunocompromised individuals, classically presenting with both systemic and lower urinary tract symptoms. Our case is unique as the patient presented with an exceptionally long duration of symptoms prior to seeing a health-care provider, had no systemic symptoms, and was managed via a multidisciplinary approach. Case Presentation. We present a case of a 70-year-old man with type-two diabetes who endured two months of lower urinary tract symptoms and constipation without systemic symptoms prior to seeking medical attention. He had a positive urinalysis and culture and was initially thought to have a urinary tract infection; however, computed tomography scan revealed a large, complex, and multiloculated prostatic abscess. Multidisciplinary drainage of the abscess was performed by interventional radiology and urology. A postoperative Foley catheter was left in place, and the patient recovered without complications. Discussion. Prostatic abscess is uncommon and presents almost exclusively in patients with immunocompromising conditions such as diabetes. Prior to the advent of antibiotics, the major causes were gonorrheal and Staphylococcus aureus infections, but with the advent of antibiotics, microbial culprits have shifted to gram-negative organisms. Patients typically present with lower urinary tract symptoms, perineal or lower back pain, and systemic symptoms. Management often consists of intravenous antibiotics and surgical drainage either by transrectal ultrasound-guided needle aspiration, or transurethral deroofing of the prostate. Our case highlights the following: (a) the importance of a high index of suspicion for a prostatic abscess in an immunocompromised patient with persistent leukocytosis and perineal pain after treatment with antibiotics and (b) the potential for an early multidisciplinary approach to draining extensive, loculated prostatic abscesses. |
| format | Article |
| id | doaj-art-aea01ef53f12499891558d5c22ef7851 |
| institution | Kabale University |
| issn | 2090-696X 2090-6978 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Urology |
| spelling | doaj-art-aea01ef53f12499891558d5c22ef78512025-02-03T00:58:43ZengWileyCase Reports in Urology2090-696X2090-69782020-01-01202010.1155/2020/43985614398561Extensive Prostatic Abscess in an Elderly Patient Requiring Multidisciplinary DrainageJohn Michael Nesemann0Kathy Huen1Jonathan Bergman2University of California Los Angeles, David Geffen School of Medicine, Los Angeles, USADepartment of Urology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USAOlive-View UCLA Medical Center, Veterans Association Greater Los Angeles, David Geffen School of Medicine, Los Angeles, USABackground. Prostatic abscess is rare and mainly affects immunocompromised individuals, classically presenting with both systemic and lower urinary tract symptoms. Our case is unique as the patient presented with an exceptionally long duration of symptoms prior to seeing a health-care provider, had no systemic symptoms, and was managed via a multidisciplinary approach. Case Presentation. We present a case of a 70-year-old man with type-two diabetes who endured two months of lower urinary tract symptoms and constipation without systemic symptoms prior to seeking medical attention. He had a positive urinalysis and culture and was initially thought to have a urinary tract infection; however, computed tomography scan revealed a large, complex, and multiloculated prostatic abscess. Multidisciplinary drainage of the abscess was performed by interventional radiology and urology. A postoperative Foley catheter was left in place, and the patient recovered without complications. Discussion. Prostatic abscess is uncommon and presents almost exclusively in patients with immunocompromising conditions such as diabetes. Prior to the advent of antibiotics, the major causes were gonorrheal and Staphylococcus aureus infections, but with the advent of antibiotics, microbial culprits have shifted to gram-negative organisms. Patients typically present with lower urinary tract symptoms, perineal or lower back pain, and systemic symptoms. Management often consists of intravenous antibiotics and surgical drainage either by transrectal ultrasound-guided needle aspiration, or transurethral deroofing of the prostate. Our case highlights the following: (a) the importance of a high index of suspicion for a prostatic abscess in an immunocompromised patient with persistent leukocytosis and perineal pain after treatment with antibiotics and (b) the potential for an early multidisciplinary approach to draining extensive, loculated prostatic abscesses.http://dx.doi.org/10.1155/2020/4398561 |
| spellingShingle | John Michael Nesemann Kathy Huen Jonathan Bergman Extensive Prostatic Abscess in an Elderly Patient Requiring Multidisciplinary Drainage Case Reports in Urology |
| title | Extensive Prostatic Abscess in an Elderly Patient Requiring Multidisciplinary Drainage |
| title_full | Extensive Prostatic Abscess in an Elderly Patient Requiring Multidisciplinary Drainage |
| title_fullStr | Extensive Prostatic Abscess in an Elderly Patient Requiring Multidisciplinary Drainage |
| title_full_unstemmed | Extensive Prostatic Abscess in an Elderly Patient Requiring Multidisciplinary Drainage |
| title_short | Extensive Prostatic Abscess in an Elderly Patient Requiring Multidisciplinary Drainage |
| title_sort | extensive prostatic abscess in an elderly patient requiring multidisciplinary drainage |
| url | http://dx.doi.org/10.1155/2020/4398561 |
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