Management of large prostatic abscess associated with urethral stenosis and penile cancer recurrence

The purpose of this report was to analyze the management of a large prostatic abscess in a patient with urethral stenosis and recurrence of penile cancer, who had presented with acute urinary retention.

The clinical diagnosis was based on the end-fire transrectal ultrasound (TRUS) findings and later confirmed by CT. The patient had several surgical scars and radiation-induced effects in the lower abdomen, therefore the placement of a percutaneous sovrapubic catheter was considered hazardous. The placement of a transurethral catheter was impossible because of firm meatal stenosis due to previous penile partial amputation and growing tissue that suggested local recurrence of penile cancer.

Transurethral placement of a 8 Fr catheter was possible under radiologic/ultrasound control using a hydrophilic glidewire. The definitive treatment also included percutaneous transperineal drainage and placement of a 8 Fr pig-tail drain under TRUS. Subsequent surgical treatment of the penis showed low grade superficial squamous cell carcinoma. Management and follow-up of prostatic abscess is based on TRUS imaging. After 4 years of follow-up, abscess recurrence was observed and treated with a urethral catheter and antibiotics.

Urethral stenosis due to penile cancer is a predisposing factor in the development of prostatic abscesses. Placement of a bladder catheter and percutaneous drainage of the abscess are the mainstays of treatment. In malignant urethral stenosis, the conservative management of a prostatic abscess is safe and efficacious in a long-term follow-up. Transrectal US is a key instrument to guide intervention and to check results.