Open Access

RESIDENT’S CORNER

Transurethral resection of prostatic abscess

Mark G. Biebel¹, Wesley R. Pate¹, Toby C. Chai¹

Boston University School of Medicine, Boston, Massachusetts, USA
AddresscorrespondencetoDr.MarkG.Biebel,BostonMedical Center, 725 Albany Street, Suite 3B, Boston, MA02118 USA

Canadian Journal of Urology 2021, 28(2), 10638-10642.

Abstract

Prostateabscess(PA)isanuncommonprostaticinfection, with risk factors including indwelling catheters, acute or chronic prostatitis, bladder outlet obstruction, voiding dysfunction, recent urologic instrumentation (especially transrectalprostatebiopsy),chronickidneydisease(CKD), diabetes mellitus (DM), human immunodefciency virus (HIV), intravenous drug use (IVDU), and hepatitis C. Treatment of PA consists of antibiotics and abscess drainage via transurethral resection (TUR) or image-guided transrectal or transperineal drainage. Numerous studies have demonstrated that TUR of PA has a higher success rate and shorter hospital length of stay when compared to image-guided drainage. Despite this, TUR of PA is a relatively uncommon surgery with few useful recommendations on how to best perform this procedure.
WedemonstratetheTURsurgicaltechniquefordrainage of a 6 cm loculated PA in a 44-year-old man with active IVDU and hepatitis C. The patient presented with progressive voiding symptoms, urinary retention, and leukocytosis. Given the size, loculated nature of the abscess, and its proximity to the prostatic urethra, we decided to proceed to the operating room for surgical drainageasopposedtoimage-guidedtransrectaldrainage. Herein we describe the transurethral technique. He clinically improved postoperatively and repeat imaging 4 days later showed decreased abscess size.
Transurethral drainage of a PA is a safe, efficient, and effective treatment option. Treatment approach should depend on abscess size, location, and presence of loculations.Combiningdifferentendourologictechniques and instruments may be necessary.

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