Transrectal ultrasound-guided needle aspiration for prostatic abscesses: an alternative to transurethral drainage?

Prostatic abscesses traditionally are drained transurethrally. Problems of this method include the risk of anesthesia, dissemination of bacteria, incomplete drainage of multiloculated or peripheral abscesses, and retrograde ejaculation, which may not be acceptable for young patients. Prostatic abscesses can be drained under transectal ultrasound (TRUS) guidance. Multiple, peripheral, or multiloculated abscesses are visualized. No anesthesia would be required. Repeat procedures can be performed easily with minimal morbidity. The risks of dissemination and retrograde ejaculation is negligible.

A standard TRUS probe and a 21-gauge Chiba needle are inserted through the biopsy guide into the abscesses. Five patients underwent the procedure. Four patients had a mean follow-up of 18 months.

TRUS could visualize the abscess in all patients. Aspirate cultures corresponded to the urine culture except in one patient with sterile urine. Three had residual disease on repeat TRUS, but only two patients required repeat aspiration. All patients recovered and had no evidence of disease on follow-up. However, it was an average of 4 months before patients could be considered cured according to TRUS findings. Prostate volume decreased from a mean of 54 mL on diagnosis to 16 mL on follow-up. There was no hospital readmission or morbidity.

TRUS needle aspiration for prostatic abscess is a feasible alternative to transurethral drainage. Repeat procedures may be required, but all patients recovered. There is minimal morbidity associated with the procedure; however, the recovery period may be longer.