title: Prostatic abscess: Objective assessment of the treatment approach in the absence of guidelines.
abstract: OBJECTIVE
  To assess the outcome of the drainage procedure used for treating a prostatic abscess, and to propose a treatment algorithm to reduce the morbidity and the need for re-treatment. Patients and methods We retrospectively reviewed patients who were admitted and received an interventional treatment for a prostatic abscess. All baseline relevant variables were reviewed. Details of the intervention, laboratory data, duration of hospital stay, follow-up data and re-admissions were recorded.
  
  
  RESULTS
  A prostatic abscess was diagnosed in 42 patients; 30 were treated by transurethral deroofing and 12 by transrectal needle aspiration. The median (range) size of the abscess was 4.5 (2-23) mL and 2.7 (1.5-7.1) mL in the deroofing and aspiration groups, respectively (P = 0.2). In half of the cases multiple abscesses were evident on imaging before the intervention. The median (range) hospital stay after deroofing and aspiration was 2 (1-11) and 1 (1-19) days, respectively (P = 0.04). Perioperative complications occurred only in the deroofing group, in which two patients developed septic shock requiring intensive care (Clavien 4) and one developed epididymo-orchitis (Clavien 2). There were two late complications in the deroofing group, in which one patient developed a urethral stricture that required endoscopic urethrotomy (Clavien 3a) and one developed a urethral diverticulum and urinary incontinence that required diverticulectomy and a bulbo-urethral sling procedure (Clavien 3b). A urethro-rectal fistula developed after aspiration in one patient. Re-treatment for the abscess was indicated in two (7%) patients in the deroofing group, which was treated by aspiration.
  
  
  CONCLUSIONS
  Transrectal needle aspiration for a prostatic abscess, when done for properly selected cases, could minimise the morbidity of the drainage procedure.
authors.affiliation: Mansoura Urology & Nephrology Center, Mansoura University, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Elshal
authors.affiliation: Mansoura Urology & Nephrology Center, Mansoura University, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdelhalim
authors.affiliation: Mansoura Urology & Nephrology Center, Mansoura University, Egypt.
authors.forename: Tamer S
authors.initials: TS
authors.lastname: Barakat
authors.affiliation: Mansoura Urology & Nephrology Center, Mansoura University, Egypt.
authors.forename: Atallah A
authors.initials: AA
authors.lastname: Shaaban
authors.affiliation: Mansoura Urology & Nephrology Center, Mansoura University, Egypt.
authors.forename: Adel
authors.initials: A
authors.lastname: Nabeeh
authors.affiliation: Mansoura Urology & Nephrology Center, Mansoura University, Egypt.
authors.forename: El-Housseiny
authors.initials: el-H
authors.lastname: Ibrahiem
keywords: Abscess; Aspiration; Deroofing; MIS, minimally invasive surgery; Prostate; Transrectal