Prostate abscess: clinical manifestations and treatment methods

Prostate abscess is an acute inflammatory process of the prostate gland with a clearly limited accumulation of pus in the tissues. The disease is accompanied by acute pain and symptoms of general intoxication of the body.

This condition requires immediate treatment, as there is a high risk of complications, including breakthrough of purulent formation, sepsis, and peritonitis.

Complicated abscess leads to death in 5–10% of cases.

Prostate abscess is a local inflammation of the organ that can develop into a life-threatening condition.

Reasons for the development of pathology

Prostate abscess develops as an independent disease and as a complication of urological pathologies. Depending on the cause of its occurrence, it can be primary or secondary.

Primary abscess is rare. It is formed as a result of the spread of an infectious pathogen through the blood throughout the body.

This can happen with diseases such as chronic tonsillitis, frequent sore throats, and with weakened immunity. Septicopyemia develops, one of the forms of sepsis caused by staphylococcus or Pseudomonas aeruginosa.

A feature of the primary focus is that the gland itself is healthy, and in its tissues, in addition to the abscess, no pathological changes are found.

Primary abscess can occur against the background of other diseases in the complete absence of symptoms of prostatitis

More common is a secondary prostate abscess, the symptoms of which indicate complications of acute or chronic prostatitis. It is recorded in 5% of patients with this disease.

Reasons for development:

• incorrectly selected drug therapy;
• complication of instrumental interventions through the urethra (during endoscopic examination);
• complication after surgical treatment of genitourinary diseases;
• blockage of the prostate excretory ducts with stones;
• hypothermia.

Hypothermia, including general hypothermia, of the entire body can provoke the development of an abscess.

Clinical manifestations of an abscess

The formation of an abscess begins with the accumulation of purulent fluid in the lobules of the gland. Then the affected lobules merge into one large abscess with clear boundaries. The contents are enclosed in a capsule, nearby tissues are not damaged.

The development of the disease occurs in two stages. The first is infiltrative. At this stage, the clinical symptoms of prostate abscess are most pronounced.

Signs of general intoxication of the body:

• high temperature – up to 40° C and above, characterized by alternating rapid rises and falls;
• fever, chills;

A febrile state with sudden changes in temperature indicates the presence of a purulent focus in the body

• increased sweating;
• cardiopalmus;
• semi-conscious state, delusions, hallucinations.

Patients experience intense unilateral throbbing pain, which is localized in the lower abdomen and groin. They can radiate to the lower back and rectum.

Urination in the infiltrative stage is difficult and very painful, which leads to acute urinary retention; the act of defecation is disrupted.

The second stage is purulent-destructive. Tissue destruction occurs at the cellular level. The symptoms subside and an imaginary improvement occurs.

In the second stage of abscess formation, pus spreads through the prostate parenchyma and then into the surrounding tissues

This condition is dangerous, since due to the breakdown of tissues, the capsule breaks and pus spills into the surrounding tissues. It is not excreted by the lymphatic system, but contributes to the formation of new infectious foci.

Prostate abscess is dangerous due to the following complications:

1. Cellulitis is a diffuse purulent inflammation without clear boundaries, in which pus permeates the tissue.
2. Secondary septicopyemia ─ after opening the abscess, pus is spread by blood throughout the body, as a result of which ulcers can form in any internal organs.
3. Formation of fistulas in the bladder and rectum.
   A sign of these complications is pus in the urine and stool. The most severe complication of an abscess, which requires resuscitation measures, is generalized sepsis
4. Sepsis is an infectious blood poisoning.
5. Peritonitis is an inflammation of the peritoneum (a film covering the abdominal organs).

Diagnosis of the disease

Prostate abscess is diagnosed based on anamnesis, palpation, laboratory and instrumental research methods.

Palpation of the prostate allows you to clearly determine the location of the abscess. At the same time, the organ itself is enlarged and tense, the patient experiences acute pain.

In a general blood test (CBC), the number of leukocytes is significantly increased, which indicates an acute inflammatory process in the body. The ESR (erythrocyte sedimentation rate) indicator is also sharply increased.

A general blood test for prostate abscess is characterized by inflammatory changes - leukocytosis and accelerated ESR

A general urinalysis (UCA) is characterized by the content of leukocytes, proteins, and pus in the urine. A bacteriological examination of a smear of the urethral contents reveals pathogenic bacteria.

Transrectal ultrasound (US) identifies the lesion itself, determines its shape (oval or round), and its exact dimensions. Using ultrasound, the capsule is punctured and biomaterial is collected for research.

Important! Prostate abscess must be differentiated from acute prostatitis, pyelonephritis (infectious inflammation of the renal pelvis), inflammation of the testicular appendages.

Cystoscopy – examination of the inner surface of the bladder

If the presence of fistulas is suspected, the following instrumental diagnostics are additionally performed:

• urethroscopy ─ examination of the urethra;
• cystoscopy and ultrasound examination of the bladder;
• anoscopy ─ examination of the rectum.

Treatment of prostate abscess

Treatment of the disease depends on its stage and includes both conservative therapy and surgical methods of removing the abscess.

In the infiltration stage, when a capsule with pus has not yet formed, cephalosporin antibiotics or aminoglycosides are prescribed.

Conservative therapy is effective only in the first days of disease development

To relieve pain, a presacral blockade is performed (a break in impulses transmitted by the peripheral nervous system, which is achieved by administering anesthetics) and a paraprostatic blockade (an anesthetic is injected directly into the gland, next to the capsule).

To eliminate the symptoms of intoxication, detoxification therapy is carried out through intravenous infusions, which allows the waste products of bacteria to be removed and reduces the load on the kidneys.

If during diagnosis it is precisely established that the formation has a cavity filled with fluid, and it is delimited from healthy prostate tissue, only surgical treatment is indicated.

Insertion of a special metal tube into the urethra - bougie - is mandatory before surgical treatment of an abscess.

The procedure for opening or puncturing an abscess is carried out under local anesthesia, provided that the amount of pus does not exceed 5–8 ml. The urethra is bougienage first, so as not to cause mechanical damage to it during manipulation and to ensure the outflow of urine.

The puncture site is most often chosen in the perineal area. This gives the surgeon a larger field for manipulation, and the risk of possible complications is minimized. Less commonly, the puncture site is chosen through the rectum. The procedure is carried out under the control of an ultrasound sensor. After removing the pus, the inflammation site is washed. They continue to carry out detoxification and antibacterial therapy.

Complications after such surgery are extremely rare. The treatment prognosis is favorable; surgical treatment of the abscess does not pose any danger to the reproductive function of a man.

After opening the abscess, drainage of the cavity is mandatory.

If the contents of the capsule are more than 8 ml, a cavity incision is made under general anesthesia. After removing the pus, the resulting cavity is washed with clean rinsing water and a drain is inserted for 2–3 days. At the end of the procedure, an antibiotic is injected into the cavity.

In severe cases or when opened independently, a prostate abscess can lead to chronic pathological processes. As a result, men develop potency, sexual dysfunction, and infertility.

You will learn more about the diagnosis and treatment of prostate abscess from the video:

Source: http://bolezni.com/stati-o-boleznyah/prostatit/abscess-prostaty.html

Prostate abscess: causes, symptoms, treatment, prevention

A prostate abscess is a limited accumulation of purulent masses in the organ. The provoking factor in the development of pathology may be prostatitis or an infectious process outside the genital organs. The pathology is characterized by a sharp, pulsating pain that is localized in the intestines and perineum. To cope with the disease and prevent complications from occurring, you need to consult a doctor in a timely manner.

Causes

A primary abscess can be associated with tonsillitis or furunculosis, as well as with other purulent inflammations. Bacterial microorganisms and purulent masses are distributed throughout the body through the bloodstream and penetrate the prostate. This disorder is medically called septicopyemia.

Factors that provoke the disease include:

• presence of bad habits;
• weakening of the immune system;
• sedentary lifestyle;
• hypothermia of the pelvic organs.

The primary form of abscess is observed very rarely. Secondary pathologies are diagnosed much more often. In this case, organ damage occurs against the background of existing inflammation. The key factor is the presence of acute prostatitis.

In addition, the cause of the pathology may be improper therapy or surgery. In the absence of adequate treatment, stagnant processes develop, which leads to the appearance of swelling.

The lack of new blood flow to the organ provokes its inflammation. So, at first small abscesses form, but gradually they form one large abscess with clear boundaries.

Symptoms

The disease is accompanied by striking general and local manifestations. At the initial stage of its development, prostate abscess is accompanied by the following symptoms:

• throbbing pain that is localized in the lower abdomen and perineum;
• subfertile body temperature;
• discomfort when emptying the bowels and bladder;
• stool retention.

The listed manifestations are characteristic of the initial stage of the pathology. In such a situation, the inflamed lesion contains a dense infiltrate. Then, over the course of several days, purulent melting of the prostate is observed, resulting in the formation of an abscess. All this provokes an increase in local symptoms of prostate abscess, which is why general symptoms arise:

• increase in body temperature to 39-40 degrees;
• headache;
• weakness.

In some cases, an imaginary normalization of the condition occurs. A person’s temperature may drop, and the pain will decrease. Sometimes purulent impurities are observed in the stool. Such symptoms accompany the rupture of the abscess and the entry of its contents into the rectum. This process entails the formation of a fistula. As a result, the disease becomes chronic.

Diagnostics

To make a correct diagnosis, you need to conduct a detailed examination of the body. The doctor examines the patient and prescribes a number of procedures:

1. Blood analysis. With prostate abscess, leukocytosis is observed and the erythrocyte sedimentation rate increases.
2. Analysis of urine. With this diagnosis, proteinuria and leukocyturia are observed.
3. TRUSY. With the help of the procedure, it is possible to detect symptoms of swelling and enlargement of the prostate in size. The abscess is accompanied by the appearance of a round or oval hypoechoic focus.
4. Bacteriological analysis of urine or urethral smear. Using these tests, it is possible to detect microorganisms that caused the disease.
5. Ultrasound examination of the prostate. When it is carried out, it is possible to estimate the size of the formation and the area of ​​its location.
6. Puncture. The procedure is performed under ultrasound control.

If it is necessary to identify a fistula in the prostate, a consultation with a urologist is necessary, and the following procedures may also be necessary:

• urethroscopy;
• Ultrasound of the bladder;
• cystoscopy;
• anoscopy.

After collecting data from all studies, differential diagnosis is carried out for the presence of similar diseases (pyelonephritis, acute prostatitis, epididymitis). It is necessary to distinguish prostate abscess from other pathologies in order to prescribe the correct treatment.

Treatment

The choice of treatment for prostate abscess is determined by the severity of the disease. When small purulent formations appear, conservative treatment methods are sufficient. Here we are talking only about the use of medications. However, they are effective only in the initial stages of the disease. As the pathology progresses, surgical intervention is required.

Drug treatment

A common cause of an abscess is usually bacteria. Therefore, only antibiotics help to cope with the disease. The urologist must select a specific agent, taking into account the sensitivity of microorganisms to a specific substance. The individual characteristics of the body are of no small importance.

In addition to such medications, anti-inflammatory drugs and detoxification agents are prescribed. The same drugs are used after surgical treatment. They help speed up recovery processes.

Surgical intervention

If medium or large abscesses form, it will not be possible to do without surgical intervention. During the operation, the formation in the prostate is opened and the affected areas are cleaned.

Usually the manipulation is performed under general anesthesia. Access to the damaged area can be different - through the intestines or perineum. The specific option is chosen by specialists taking into account the characteristics of the body.

Prognosis and prevention

Timely treatment of prostate abscess provides a favorable prognosis and preservation of reproductive functions. Thanks to successful treatment, the patient can return to the usual rhythm of life that changed during the illness. The lack of timely diagnosis and treatment of the formation provokes the generalization of the infectious process and blood poisoning.

To avoid prostate abscess, the following recommendations must be followed:

• Maintain normal physical activity: this helps prevent congestion in the pelvic organs.
• Normalize sexual activity.
• Visit a urologist periodically.
• Avoid hypothermia.
• Treat infections promptly.

Prostate abscess is a serious pathology that can cause infection of the entire body. To prevent the development of complications, it is necessary to start therapy on time and strictly adhere to the doctor’s prescriptions.

© 2018 – 2019, MedProstatit.ru. All rights reserved.

Source: https://MedProstatit.ru/abscess-prostaty.html

Prostate abscess: causes, symptoms and treatment

• Urologist-andrologist 1st category Denis Georgievich
• 45293
• Update date: December 2019

Prostate abscess is one of its most serious diseases.

According to statistics, it develops in 5% of men who have problems with the prostate gland and do not pay enough attention to their health.

Timely examination and treatment will prevent the development of an abscess, and if one appears, avoid complications associated with it.

What is a prostate abscess?

A limited area of ​​prostate tissue that has undergone purulent melting under the influence of pathogenic microbes is called an abscess.

There may be several such areas, depending on the cause.

Like any infectious disease, an abscess localized in the prostate causes not only a dramatic picture of local symptoms, but also affects the general condition of the body.

The absorption of toxins resulting from tissue breakdown into the blood impedes the functioning of organs and systems. The prostate itself suffers the most, and disruption of its function negatively affects all indicators of men's health and the condition of the urinary tract.

The purulent process in the prostate is also fraught with the development of complications and long-term consequences, which will require more complex and lengthy treatment. Every man interested in maintaining his health and quality of life should be aware of all this.

Suppuration poisons the entire body

Causes

The formation of an acute abscess in the prostate gland has 2 sources of origin:

• diseases of the gland itself;
• foci of infection in other organs.

Prostate diseases

An abscess can develop against the background of various pathological conditions of the gland: acute and chronic advanced prostatitis, adenomas and cysts, stones with blockage of the excretory ducts, foci of tuberculosis, and cancer. It is often a complication of various instrumental procedures (catheterization, puncture, bougienage) and surgical interventions on the prostate. Such an abscess is called primary.

Infection in other organs

An abscess in the prostate gland can be metastatic in nature when the infectious agent enters the blood or lymph flow from other organs.

This happens with purulent tonsillitis, bacterial cholecystitis, boils, lung abscess, hidradenitis, sepsis. The infection can also spread from organs close to the prostate - the urethra, bladder.

Such an abscess, brought in from the outside, is called secondary.

An important role is played by the so-called risk factors that predispose to the development of a purulent process in the prostate.

A prostate abscess can also develop in a child against the background of congenital anomalies of the genitourinary organs or infectious diseases.

Infection can enter the prostate even from distant organs, for example, with sore throat

Symptoms of prostate abscess

The clinical picture of a purulent process in the prostate is always pronounced; it includes local and general manifestations. The first signs of the disease are:

• throbbing pain in the lower abdomen, in the perineum;
• painful urination and defecation;
• frequent urge to urinate;
• stool retention;
• increase in body temperature to subfebrile levels.

These symptoms develop in the first stage of the disease, when the focus of inflammation is a dense infiltrate. Over the course of several days, purulent melting of the gland tissue occurs, forming an abscess. This leads to an increase in local manifestations, and general symptoms are added:

• high body temperature (up to 39-40);
• general weakness;
• headache.

Sometimes there is an imaginary improvement in the condition: pain decreases, body temperature decreases, and an admixture of pus appears in the stool. This happens when an abscess breaks into the rectum, a fistula is formed, and a chronic purulent process remains in the gland.

Diagnostics

When establishing a diagnosis, all data is taken into account - from ascertaining the patient’s medical history and complaints to using precise additional methods. The examination begins with a rectal examination of the prostate.

A painful protruding formation is easily palpated through the wall of the rectum.

It can be dense to the touch in the infiltration stage or fluctuating (fluctuating) in the abscess stage, when a cavity with pus has formed.

Next, the patient is sent for an ultrasound examination. The most accurate visualization method is TRUS (transrectal ultrasound), when the device's sensor is inserted into the lumen of the rectum, that is, as close as possible to the prostate. The monitor of the device reveals an enlarged gland with the presence of a round cavity formation with liquid (pus).

In the infiltration stage, the lesion will look like an echo-positive (lighter colored) shadow. This picture can also occur with a prostate tumor; in these cases, MRI (magnetic resonance imaging) is performed for differential diagnosis; it accurately determines the size, shape of the lesion and the nature of its structure.

If necessary, instrumental methods are used: ureterocystoscopy (if a urethral fistula is suspected), rectoscopy (if a rectal fistula is suspected). Invasive methods are also used: diagnostic puncture of the prostate, diagnostic laparoscopy.

A clinical examination of blood and urine, a bacteriological examination of culture from the urethra, tests for sexually transmitted diseases, tuberculosis, and a blood immunogram are mandatory.

If an abscess is suspected, both the gland itself and neighboring organs and the body as a whole are examined

Treatment methods for prostate abscess

Depending on the stage of the abscess, its treatment can be carried out in two ways:

• conservative;
• combined.

Conservative treatment

If the abscess is in the infiltration stage and examination does not reveal a purulent cavity, complex treatment is prescribed, including broad-spectrum antibiotics (from the cephalosporin, fluoroquinolone group), uroantiseptics, painkillers and antihistamines. To remove toxins, glucose-salt and other detoxifying solutions are administered intravenously.

The pain during infiltration is quite intense; to eliminate it, blockades are performed: an anesthetic solution is injected into the sacral area on both sides or directly into the tissue around the prostate through a puncture in the perineum.

Combined treatment

In the presence of pus, drug treatment is combined with a surgical method, which is necessary and leading. Opening the purulent cavity is performed under anesthesia through the skin of the perineum or the wall of the rectum.

A drainage tube is inserted into the cavity to drain pus and wash the cavity.

Preference is given to minimally invasive interventions using a fiberoptic video probe, with small tissue incisions and the possibility of a thorough examination and cleansing of the purulent cavity.

There is an opinion that prostate abscess can be cured using traditional methods. This is a dangerous misconception that can lead to the development of serious complications. Traditional medicine can only be an addition to the main treatment; their use must be agreed with a doctor.

Possible complications

A prostate abscess, itself essentially a complication of various diseases, can lead to the development of more severe consequences, such as:

• breakthrough of pus into the pelvic cavity with the development of pelvic peritonitis;
• infection in the blood, development of sepsis;
• opening into the lumen of the urethra or rectum, the formation of a chronic fistula, which is not easy to cure;
• complete purulent melting of prostate tissue, requiring its complete removal.

To avoid such consequences, in case of any problem with the prostate, at the first, even minor symptoms, you must consult a doctor, undergo examination and, if necessary, treatment.

Complicated abscess may require surgical intervention

Prevention

Is it possible to prevent the development of purulent inflammation of the prostate gland? To really prevent this dangerous disease, compliance with preventive measures will help, which include:

1. Timely treatment of infectious and urological diseases.
2. Regular examination by a urologist.
3. Elimination of hypothermia.
4. Maintaining a high level of immunity, which includes good nutrition, hardening, and getting rid of bad habits.
5. Sufficient physical activity and sports.
6. Regulation of intimate life: both rare and too frequent sexual contacts lead to impaired blood circulation in the prostate.
7. Practicing safe sex to prevent genitourinary infections and sexually transmitted diseases.

You should always remember that the health of the prostate gland largely determines the functional abilities, general vitality and quality of life of a man.



Until August 10, the Institute of Urology together with the Ministry of Health is conducting the program “Russia without prostatitis .” Within which the drug Predstanol is available at a discounted price of 99 rubles. , to all residents of the city and region!

Source: https://ProstatitNo.ru/prostata/abstsess-prostaty/

Prostate abscess

A prostate abscess is a limited accumulation of pus in the tissues of the prostate, developing against the background of prostatitis or an infectious-purulent process of extragenital localization. It manifests itself as sharp throbbing pain in the perineum and rectum, intoxication, chills, fever, difficulty urinating and defecating. Diagnostics includes digital rectal examination of the prostate, TRUS, puncture of the abscess. During the treatment process, the abscess is opened through the perineum or rectum, and antimicrobial and detoxification therapy is prescribed.

N41.2 Prostate abscess

Prostate abscess can develop primarily (as an independent pathology) or secondary (as a result of acute prostatitis). It is a serious infectious and inflammatory disease, which is characterized by purulent melting of gland tissue with the formation of a closed abscess.

If the course is unfavorable, it may be complicated by the breakthrough of pus into the scrotum, perineum, urethra, pelvic tissue, onto the anterior abdominal wall or into the abdominal cavity. The danger of untimely recognition of the disease lies in the likelihood of developing peritonitis or sepsis.

Mortality with prostate abscess is recorded in 3-16% of cases.

Prostate abscess

The development of the disease is predisposed by weakening of local and general immunity caused by hypothermia, venous congestion in the pelvis, intercurrent diseases, smoking, and disruption of regular sexual activity. The immediate cause of the purulent process is:

• Acute prostatitis . The formation of a prostate abscess occurs in 5% of patients with this pathology. This is facilitated by inadequate treatment of prostatitis or careless implementation of transurethral instrumental interventions.
• Surgical interventions . In some cases, prostate abscess complicates operations on the prostate gland and bladder (transurethral resection of the prostate, TUR of the bladder, etc.).
• Stone formation . The cause of the pathology may be obstruction of the excretory ducts of the gland by the formed stones, which often occurs in chronic prostatitis, prostate adenoma, urethritis, etc.
• Distant foci of infection . A secondary abscess occurs as a result of hematogenous transfer of infection from foci of extragenital localization, for example, with hidradenitis, furunculosis, osteomyelitis, tonsillitis, chronic tonsillitis, etc. The etiological agents in this case are gram-positive microorganisms.

In the development of an abscess, infiltrative and purulent-destructive stages are distinguished. Clinical manifestations are most pronounced in the infiltrative stage.

The pathology is characterized by symptoms of a severe septic disease: severe intoxication, high fever of the hectic type with chills, sweating, tachycardia, sometimes impaired consciousness and delirium.

Pain, as a rule, has a unilateral localization, corresponding to the affected lobe of the prostate.

There is irradiation of pain into the perineum and rectum; the nature of the pain is sharp, throbbing. Defecation and urination are difficult and extremely painful; Sometimes acute retention of urine and stool and failure to pass gas develops.

In the second stage, due to delimitation of the purulent cavity, the condition improves: the pain subsides, the temperature drops.

However, this does not mean that the disease has passed - during this period, the formed prostate abscess can open into various organs and tissues with the development of complications.

A prostate abscess can break into the paraurethral tissue or peri-vesical space with the development of phlegmon. When an abscess is opened, pyuria appears in the urethra, the urine becomes cloudy, mixed with pus, and has an unpleasant, pungent odor.

If a prostate abscess is opened in the rectum, a rectal fistula is formed, as evidenced by the admixture of mucus and pus in the stool. However, complete emptying of the purulent cavity does not occur when the abscess breaks through, which means that relapse of prostate suppuration is possible.

The most serious complications of the disease are peritonitis and sepsis.

In clinical urology, the diagnosis of prostate abscess is established on the basis of a combination of manifestations, data from laboratory and instrumental studies, and diagnostic operations (biopsy of the prostate abscess). The following procedures are prescribed:

• Digital rectal examination . During palpation examination of the prostate, a round, protruding formation is determined, fluctuation is felt due to the liquid contents of the abscess; the prostate gland is enlarged, tense and extremely painful. In case of an abscess, the examination is performed with extreme caution due to the risk of developing bacteriotoxic shock.
• Ultrasound of the prostate gland . TRUS reveals a hypoechoic round or oval lesion against the background of an enlarged and edematous prostate. Ultrasound helps not only to identify an abscess, but also to determine its size, location, monitor the puncture of the abscess and the collection of contents to identify the pathogen.
• Laboratory research . Typical signs of acute inflammation are detected in the blood: an increase in the number of leukocytes and the rate of erythrocyte sedimentation; in the general urine analysis - leukocyturia, proteinuria. A bacteriological examination of urine or a smear from the urethra reveals pathogenic microflora.

If the development of fistulas is suspected, urethroscopy, cystoscopy, ultrasound of the bladder, anoscopy, and consultation with a proctologist are performed. The disease is differentiated from acute prostatitis, pyelonephritis, epididymitis.

If the diagnosis is confirmed, emergency hospitalization in a urological hospital is indicated. Tactics regarding the purulent process depend on its stage.

In the infiltrative stage, antibiotic therapy with cephalosporins, fluoroquinolones, and aminoglycosides is used; intravenous infusions of solutions for the purpose of detoxification, immunostimulating therapy.

If, according to palpation and ultrasound, a formed prostate abscess is determined, it is opened perineally or transrectally and drained. To prevent damage to the urethra, a metal bougie is inserted into it, i.e.

preliminary dilation of the urethra is performed. In most cases, preference is given to the perineal approach, which allows the abscess to be widely opened while avoiding secondary infection and the formation of rectal-urethral fistulas.

In the postoperative period, antimicrobial and detoxification therapy is prescribed.

Timely treatment of prostate abscess contributes to a favorable prognosis for life and preservation of reproductive function. The ability to work is lost only during the illness. An unrecognized abscess of this localization, as a rule, leads to generalization of infection and urosepsis.

Prevention of pathology is, first of all, prevention of acute prostatitis. It includes physical activity, avoiding hypothermia, normalizing the rhythm of sexual life, treating chronic foci of infection and urological diseases. When initial symptoms of the disease appear, immediate consultation with a urologist is necessary.

Source: https://www.KrasotaiMedicina.ru/diseases/zabolevanija_urology/prostatic-abscess

Prostate abscess: causes, symptoms and treatment in an article by urologist Lelyavin K. B.

Published January 17, 2019 Updated July 22, 2019

Prostate abscess is a life-threatening polyetiological purulent-necrotic inflammatory disease in which purulent melting of the glandular tissue of the prostate occurs with the subsequent formation of single or multiple purulent cavities. An abscess in the prostate gland requires urgent, immediate hospital treatment.

Prostatic abscess in most cases is a serious complication of acute or chronic lower urinary tract infection and occurs as a result of focal accumulation of pus in the prostate gland.

In the modern era of widespread use of antibacterial drugs, the incidence of prostate abscess has decreased significantly. Today, the prevalence of this pathology is about 0.5-2.5% of all prostate diseases and 0.2% of all urological diseases.[1]

The disease has become quite rare, especially in developed countries.

A significant decrease in the incidence of prostate abscess was influenced by a decrease in the incidence of gonococcal urethritis, since before the advent of modern antibiotic therapy, 75% of prostate abscesses were caused by gonococcus, and the mortality rate from the pathology ranged from 6 to 30%.[2] At the same time, despite the low prevalence of the disease, timely diagnosis and adequate treatment of prostate abscesses remain serious problems for urologists.

Since the advent of antibiotic therapy, the bacteriology of prostate abscesses has changed. Historically, the causative agents of prostate abscess were gonococcus, Staphylococcus aureus and Koch's bacillus. Currently, the most common causative agents of the disease are gram-negative bacteria such as Escherichia coli and staphylococcus.[3]

Predisposing factors for the onset of the disease:

• various instrumental manipulations on the urethra;
• use of indwelling urethral catheters;
• chronic renal failure (long-term hemodialysis);
• immunosuppression (HIV infection);
• organ transplantation.

Most prostatic abscesses develop as a result of or against the background of acute and chronic prostatitis, as well as after a prostate biopsy. Thus, according to the literature, prostate abscess complicates the course of acute prostatitis in approximately 5% of cases and is the result of the progression of acute parenchymal inflammation in the prostate gland.[8]

In recent years, there have been reports that prostate abscess is no longer considered a consequence of an untreated urinary tract infection.

In elderly patients, prostate abscess can complicate the course of benign prostatic hyperplasia. In younger men, a prostate abscess may be the initial manifestation of chronic conditions such as diabetes, HIV infection, and cirrhosis of the liver. Thus, more than 50% of men suffering from prostate abscess have diabetes mellitus.

Cases of hematogenous bacterial spread of infection from distant sites (for example, the digestive tract and respiratory tract) have been described in the specialized literature.[5]

If you notice similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

The most pronounced clinical manifestations of the disease are signs of a severe septic condition:

• increased body temperature (hectic in nature, i.e. in the form of debilitating fever) with chills;
• intoxication;
• increased sweating and palpitations;
• Possible impairment of consciousness.

From the urinary system organs the following may develop:

• frequent urination;
• dysuria (eg, pain and difficulty passing urine);
• sometimes acute urinary retention and hematuria (presence of blood in the urine).[4][5]

Patients are concerned about pain in the lumbar region and perineum. A distinctive feature is that the pain syndrome has a unilateral localization, which corresponds to the lobe of the prostate affected by the inflammatory process.

The nature of the pain syndrome is intense, sharp, with pulsation, usually spreading to the rectum. In some cases, there is a disturbance, including retention of urination and defecation, and sometimes it is difficult to pass gas.

The above clinical manifestations of the disease are characteristic of the infiltration stage. After the transition of the pathological process occurring in the prostate to the stage of purulent destruction or during the period of delimitation of the abscess, some “improvement” in the patient’s condition occurs:

• the intensity of the pain syndrome decreases;
• body temperature decreases.

However, such well-being is imaginary, since it is during this period that a formed abscess can break through into the tissue located around the urethra or the paravesical tissue space, which is located around the bladder, with the subsequent development of serious complications (for example, phlegmon).

After a spontaneous breakthrough of the abscess into the tissue located around the urethra (urethra) occurs, it is possible:

• the appearance of pus in the urine;
• change in the color and character of urine (it becomes cloudy, flakes appear);
• addition of an unpleasant pungent odor.

In some cases, the prostate abscess is opened into the lumen of the rectum with the subsequent formation of a rectal fistula. In this situation, patients note the appearance of mucus and pus in the stool.

It should be noted that after the abscess breaks through, the abscess cavity does not completely empty, so a relapse of the disease is possible in the future.

Prostate abscess due to immunodeficiency (HIV infection) has its own characteristic features. In this category of patients, symptoms of intoxication significantly predominate:

• weakness;
• muscle pain;
• prolonged increase in body temperature to subfebrile levels;
• joint pain.[4][5]

At the same time, local manifestations of prostatic abscess are less pronounced. Sometimes only with detailed questioning it is possible to identify a slight deterioration in urination and the appearance of nagging pain in the perineal area.

In HIV-infected patients, prostate abscess can occur against the background of septicopyemia (especially in heroin addicts).

The prostate gland has a fairly high natural resistance to exogenous and endogenous infection. Therefore, the inflammatory process occurs only when local immunity is suppressed or reduced and the virulence of microorganisms is very high.

In order to understand how infection of the prostate gland occurs, it is necessary to become familiar with the anatomy of the organ. It consists of two lobes, each of which includes 18-20 separate small lobes or lobules, which open into a single common independent duct.

With prostate abscess, infectious agents enter the gland tissue in three ways:

• through the outlet openings of the ducts located on the back of the urethra;
• by the lymphogenous route (with a long-term stay of the urinary catheter);
• hematogenously, i.e. through the blood (with bacteremia).

Inflammation in the prostate gland is accompanied by the release of a large number of leukocytes and microorganisms. Further, as a result of treatment or mobilization of the body’s own defenses, the focus of acute or chronic inflammation is demarcated.

Some authors suggest that prostate abscess is mainly a complication of bacterial prostatitis, acute or chronic, most often seen in men aged 50-60 years, but abscess can occur at any age.[6]

Currently, enterobacteria, especially Escherichia coli, are the main causative agents of acute bacterial prostatitis and prostate abscess. Less common are Klebsiella sp.

, Proteus mirabilis, Enterococcus faecalis and Pseudomonas aeruginosa.

[7] Recently, the literature has reported an increase in the number of cases of methicillin-resistant Staphylococcus aureus as the causative agent of prostate abscess.

PathogensMicroorganisms

BASIC	Escherichia coli Klebsiella spp Proteus mirabilis Enterococcus faecalis Enterococcus faecalis Pseudomonas aeruginosa
POSSIBLE(value not proven)	Staphylococcus (staphylococcus spp.) Streptococcus (streptococcus spp.) Corynebacterium (corynebacterium spp.) Chlamydia trachomatis (chlamydia trachomatis) Ureaplasma urealyticum (mycoplasma hominis)

 

Source: https://ProBolezny.ru/abscess-prostaty/