Ultrasound-guided needle aspiration in prostatic abscess

Objectives. To review the clinical presentation of prostatic abscess and to assess the usefulness of ultrasound-guided needle aspiration as a treatmen t option for this condition. Methods. Between October 1984 and November 1997, prostatic abscess was diag nosed in 31 patients. The average age was 60 years (range 29 to 79). Prosta te ultrasound was performed using either a hypogastric or transrectal appro ach. Initial therapy included ultrasound-guided needle aspiration in 24 (77 .4%), transurethral resection of prostate (TURP) in 5 (16.1%), or conservat ive management with antibiotic therapy. During follow-up, ultrasound examin ations and urine cultures were performed on an outpatient basis. Results. Past medical history most often included previous urinary infectio n (15 patients, 48%) and bladder outlet obstruction (13 patients, 42%). Six ty-one percent of patients presented with irritative voiding symptoms at th e time of diagnosis. Ultrasound-guided needle aspiration resolved 83.3% of cases; 2 patients needed a second procedure. Three patients required TURF f or drainage and 2 to remove an obstruction after abscess resolution. Conclusions. A high degree of suspicion is needed to diagnose prostatic abs cess clinically. Transrectal ultrasound is necessary for the differential d iagnosis. Transrectal ultrasound-guided needle aspiration is a technically simple and effective therapeutic procedure with no morbidity and, in case o f failure, may be repeated or a drainage TURF may be undertaken. (C) 1999, Elsevier Science Inc. All rights reserved.